How advertisement killed half a million Americans

Author: Sofija Podvisocka

Turning on the TV in any American household almost certainly foretells the appearance of a drug commercial on the screen. America’s liberal direct-to-consumer-advertising (DCTA) policies help directly encourage consumers to ask their healthcare providers for certain medications. This allows Big Pharma companies to push promotional agendas under the guise of informing the public. Many of these advertisements are mostly harmless, such as commercials for over-the-counter allergy medications. However, the increased emphasis on marketing pharmaceuticals is also one of the major causes behind the half a million Americans succumbing to opioid overdose.

While DTCA is only fully legal in the United States and New Zealand, there have been recent proposals to loosen DTCA regulations in Europe as well.

While DTCA has certain merits, such as creating a platform to educate individuals on certain options for medication through commericals, it also has certain drawbacks. For one, it furthers the power imbalance between pharmaceutical companies and physicians. It holds the ability to sway a public one way or another through direct marketing tactics


Even more distressing is its history of false advertising, such as Purdue Pharma’s OxyContin campaign in the 1990s. This campaign actively asserted that the medication was non-habit forming and that pain was a vital sign to be treated directly. When Purdue Pharma introduced OxyContin in 1996, it advertised the drug as a safe alternative to other opioids due to its unique period release of the compound, which ultimately proved to be untrue. As seen on the ad here, no direct risk of dependence is mentioned except in the very fine print, where it reads that this should be treated with the “degree of caution appropriate to the use of a drug with abuse potential”– a particularly optimistic view of the reality. These companies routinely supplemented their advertisements with aggressive sales initiatives directly targeting healthcare providers; they often incentivized physicians to push painkillers with promise of financial return.

On one hand, the increased availability of information improved public health literacy– the ability for individuals to make their own, informed choices about treatment. However, it also relied on the lack of formal experience of these individuals in order to sway their decisions. By targeting both consumers and physicians, organizations like Purdue Pharma increased revenues from OxyContin up to $3 billion a year within 15 years. The general combination of medicine and marketing led to a rise in the abuse of certain medications, opioids and benzodiazepines being at the forefront.

In contrast to the explicit advertising of products like OxyContin in the United States, data on the potential overprescription and abuse of pharmacuetical opioids in Europe is limited. The harsh regulations on opioid prescriptions largely curb the abuse potential. Most of the non-prescription opioids subject to abuse in the EU are instead directly imported from hubs of production in Afghanistan and Pakistan; heroin takes the lead as the drug of choice for 82% of opioid users. On the other hand, prescription opioids have a higher overdose rate in the United States than does heroin. This statistic may be skewed by the inclusion of fentanyl as a separate substance; fentanyl overdose is largely linked to its covert inclusion in a variety of other substances, so the rate of use and the rate of overdose may not be fully correllated.

Prior to the DTCA ban, however, European pharmaceutical companies also often advertised their medications. Notoriously, the German company Bayer’s commercialized and promoted heroin products for both adults and children. It seems almost comical now to see heroin sold as a sweetened syrup. Most of these advertisements come from a much earlier era, the majority stemming from the early 20th century. Perhaps they were enough to ingrain the use of the habitual analgesics into European society, the repercussions of which are still prevalent today.

Unfortunately, even with the EU ban on DTCA, opioid overdose deaths have risen. The amount of prescription opioid users has nearly doubled in the Netherlands from 2008 to 2017, although the reasons for this increase are still largely speculative. One of the theories is the increased prevalence of pain as a vital sign to be treated directly– echoing the similar beginning of the opioid crisis in the United States. Of course, the issue of overcompensation also arises as physicians wary of overprescribing opioids instead underprescribe them to patients with chronic pain who need these medications to increase their quality of living.

As the EU holds conversations about DTCA regulations and considers any potential loosening or tightening of the restrictions, it is important to note that it is not only the prevalence of pharmaceutical marketing that lent the United States to such a vulnerable position. It is a culmination of a lack of affordable healthcare, the propagation of information lacking credulity, and a world in which ‘pain’ is a vital sign to be treated by itself through analgesics rather than a symptom of underlying issues. More than ever, the public must be critical of the information they consume among the onslaught of phone notifications, TV commercials, and social media posts. A continued regulation of the involvement of Big Pharma in consumer decision-making stands necessary. However, it is equally necessary to treat the financial incentives of these companies and their capitalization on healthcare as we should be treating pain– not as a vital sign, but as a symptom.

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