Today’s letter is short + sweet because I am reporting live from Berlin and just finished a veeeeeeeery strong negroni and pappardelle ragù. I ordered this in preparation for the expected (negative) response to a (positive) letter on direct-to-consumer pharma marketing. The German colleague who tipped me off to the good Italian food in town looked at me like I should be deported when I disclosed my drug ad hot take.
Before we dive in, I need y’all to know my best friend (PKH) and acupuncturist’s husband produced a really cool show: Dinner Party. It sold out, or I would’ve urged you to buy tickets. All I can say is it was unlike anything I’ve seen, and you should stay tuned in case it makes it back to the stage.
After a rough few weeks of negative PR, Trump signed an executive order for HHS/RFK Jr. to crackdown on direct-to-consumer pharma advertising and sent hate mail to tons of companies. RFK Jr. pledged to ban pharmaceutical ads in his campaign trail—a position that unites the Left/Right/Extremist on the spectrum. The earnest public health types think they’re manipulative, Europeans think we’re insane for advertising prescription drugs (see above), and others think wanting to live is cringe. Since 1997, the FDA has allowed drug ads that represent both the benefits and drawbacks from the promotional drug (my admin public health law professor would be so proud that I remembered this). The Trump administration does not have legal standing to ban pharma ads, because current interpretations of the First Amendment protect freedom of speech for pharmaceutical firms (among other corporations), but they can regulate these ads. Regulating US pharmaceutical ads isn’t new; it’s why people laugh at the 1.5x speed side-effect voice-over to soothing visuals. So, while Trump’s order did not ban drug ads, it empowered the FDA to send warning letters to hundreds of companies (e.g., Novartis, Eli Lilly, and Hims and Hers…tbh I’d probably write to that last one, too) and release this clunky copy-riddled video. (Seriously, who wrote this? Let me help you!) It also proposed broader oversight (big ups 2 big gov!) of social media marketing, despite not having the headcount to enforce the expanded remit. I wrote about this before, but TV viewership is at an all-time low. Sharing information is about finding people where they are, and they are scrolling social media and pressing play on their favorite podcasts. Where’s the Vyvanse x Spotify lo-fi beats study playlist?
It is important for my sanity to accept that RFK Jr. and his team think they’re doing what’s best—even when they’re missing the mark or promoting “natural” remedies that are snake oil (at best) or do more harm than good (at worst). We tell ourselves stories in order to live, as Joan Didion says in The White Album. It makes sense to want to ban DTC pharma ads if you’re operating from a belief that pharma ads are inherently evil. But I disagree with that premise. Here’s why:
DTC drug ads raise awareness + reduce information asymmetry
This is my top reason because health literacy is my passion (hence…Of Note… The Worried Well).
Searching, “Crohn’s disease” after watching a Skyrizi ad instead of subscribing to the chronically online adage “hot girls have stomach problems” is a public health gain. Pharma marketing both gets people to visit their doctor and seek treatment for (sometimes underdiagnosed) conditions and democratizes healthcare intel. Seeing your doctor because an ad resonated with you is the first step for many who could benefit from a diagnosis and discussing treatment options with their doctor. Other times, we learn some treatments aren’t right for us.
After watching a TikTok on migraines that talked about potential stroke risk, I asked my doctor about switching from a combination birth control pill to a progesterone-only pill. I had my first migraine with ocular aura in 2020, and a couple more through 2024. In that time, I’d gotten regular check-ups with my primary care provider/gynecologist, dermatologist, and ophthalmologist—all of whom knew my medical history and current prescriptions yet missed my risk factors. My doctors caught the risk implications before I even finished my question and swiftly changed my prescription. Just like us, our doctors are subject to human error. Pharma marketing can be another tool in the toolbox to improving health outcomes.
It’s an options game
Given we have more treatment options for some disease areas in the US than other countries, decisions about the most appropriate treatment are best left to the patient and their doctor to balance trade-offs and individual needs.
Banning drug ads may also risk monopoly by prioritizing bigger and more entrenched pharmaceutical companies who can capture market share without DTC prescription drug ads. This is because branded DTC drug ads don’t only increase name drug prescriptions, they have positive spillover effects on generics for the branded drug.
Some drugs are so good for population health gains that broader access has direct social value. Statins are the classic example of a highly effective and affordable drug with many low-cost generic options that benefit from branded ads. With statins, Alpert, Lakdawalla, and Sood (2023) found the “benefits of advertising exceed the costs for this class of drugs” and “advertising bans could be harmful to consumers.”
Pharmaceutical companies do their due diligence
The redditor pushing colloidal silver is not bound to stringent regulation. By design, DTC prescription drug ads present science-backed information. The FDA lays out what pharma companies can and cannot say in their drug ads, and pharmaceutical companies work with agencies they trust to deliver ads within these guardrails. Further, now that insurance companies, tech health start-ups, and compounding pharmacies have entered the Prescription Drug Marketing Chat, I admit that there’s room to uphold these new players to the same standards. Too many of you are on peptides of questionable origin for my liking.
Prescription medicines are not cigarettes
People who want to ban pharmaceutical marketing often point to early days of cigarette ads as an analogue for banning prescription drug ads. However, those ads promoted dangerous products (i.e., cigarettes) whereas pharmaceutical drugs support health gains.
That’s all from me for now! I open up the floor/comments/emails/DMs for your thoughts. Thank you for sticking with me, I hope we can find nuance to complex public health issues.
xxsem