Kathleen Slattery-Moschkau

(WOMENSENEWS)–A slender woman in a flowing purple gown promotes a prescription stomach drug.

A second woman laughs at a party with ease, freed from a social anxiety disorder by her new medication. A third slumbers while a golden butterfly floats overhead, suggesting the rest and relaxation that can come with the help of a popular sleep aid.

Direct-to-consumer drug ads, illustrated with images such as these, are pitching pharmaceutical products to women and are flooding television, radio, newspapers and magazines.

"With their reassuring settings and soft background music, most drug ads have a female focus," says Barbara Brenner, executive director of the San Francisco-based Breast Cancer Action. "They target women either because they’re for women’s health products or because many women serve as primary caregivers and make health care decisions for their families."

Brenner’s group is among a consortium of 39 health and women’s organizations that have petitioned Congress to limit direct-to-consumer drug advertising, a $4.8 billion-a-year business that has seen a 15-fold spending increase in the past decade. According to critics, these commercials may pose a hazard to women’s health.

Fearing that direct-to-consumer ads may harm the doctor-patient relationship, pressure physicians to prescribe certain drugs and lead to the inappropriate use of medications, the group–backed by 200 physicians–is urging Congress to either ban these ads or subject them to a 3 percent tax and the inclusion of consumer warnings that indicate whether these drugs have been tested on fewer than 3,000 people.

Other authorities are also calling for change. In June, the Chicago-based American Medical Association recommended that drug companies delay direct-to-consumer ads for new products until their safety and efficacy are established. In August, Minnesota Governor Tim Pawlenty called for a moratorium on the ads. In September, the Washington-based Institute of Medicine recommended that a special symbol such as a black triangle be used to label new drugs or drug combinations for the first two years, during which there should be restrictions on advertising.

Restrictions Lifted in 1997

In 1997, the U.S. Food and Drug Administration lifted limitations on direct-to-consumer advertising. Previously, commercials for prescription-only drugs had to include nearly all warning label information–a requirement that made these ads prohibitively long to run on radio or television. New regulations allowed advertisers to name the product and disease and, instead of providing complete information on side effects, simply give major risks and additional sources of information such as Web sites.

Within months, drug commercials inundated radio and television. Many–such as ads for breast cancer treatments–came to dominate women’s programming.

Prescription drug spending is now the fastest-growing sector of health care, and 5 percent of consumers (8.5 million Americans per year) receive prescriptions for drugs they learn about through ads, according to the U.S. Government Accountability Office.

Every dollar spent on drug ads generates four dollars in additional sales, according to the Kaiser Family Foundation, based in Menlo Park, Calif. Kaiser researchers note that from 1994 to 2004, the total number of drug prescriptions jumped 68 percent; average prescription prices spiked from $29 to $64; and annual prescriptions per capita nearly doubled, from seven to 12.

In 2001, the U.S. Department of Health and Human Services ruled the FDA could not issue letters to halt misleading ads until the letters were reviewed for "legal sufficiency and consistency with agency policy."

A year later, in 2002, a congressional study found that many pharmaceutical companies disseminate misleading information about drugs even after they have been cited for violations.

‘Not Under Careful Review’

"Direct-to-consumer drug ads are not under careful review by the FDA or any other agency," says Deborah Socolar, co-director of the Health Reform Program at the Boston University School of Public Health. "And since many of them promote drugs that are new, they encourage people to use medications about which relatively little is known."

Case in point: Vioxx, a painkiller that hit the market in 1999 with commercials narrated by a female voice saying, "Perhaps my biggest victory is being able to plan my day around my life instead of my pain." In 2004, Vioxx, saw the largest prescription drug recall in history after researchers discovered it doubled the risk of stroke and heart attack, the No. 1 killer of U.S. women.

In defense of drug ads, proponents point to a 2004 University of Pittsburgh study that found these ads do not affect which medications patients receive, but whether they get treatment at all.

"Direct-to-consumer advertising can be a powerful tool in educating millions of people," says Paul Antony, chief medical officer of the Washington-based industry group Pharmaceutical Research and Manufacturers of America. "Because of such advertising, large numbers of Americans are prompted to discuss illnesses with their doctors for the first time, become more involved in their own health care decisions and take their prescribed medicines."

Cindy Pearson, president of the Washington-based National Women’s Health Network, disagrees. "The feminist health movement of the 1970s was about getting information into women’s hands via package inserts and health texts such as ‘Our Bodies, Ourselves,’" she says. "But now, drug and advertising agencies are feeding that language back to us with sales pitches masquerading as truth."

Promoting the ‘Impossible’

As an example, Pearson cites an ad for Celebrex, an arthritis drug made by the New York-based Pfizer and promoted with images of women practicing tai chi, movement that Pearson says would be "impossible" for most of the drug’s users.

That company, along with other drug makers whose products are mentioned in this article–such as the Whitehouse Station, N.J.-based Merck (maker of Fosamax)–all declined to be interviewed for this piece.

"Ultimately, we hope the U.S. will get in sync with the rest of the world on this," says Pearson, noting that direct-to-consumer drug ads are banned in every county except the U.S. and New Zealand.

Maryann Napoli, associate director of the New York-based Center for Medical Consumers, says many drug ads aimed at women minimize risks, exaggerate benefits and feature inappropriate images. She points to Fosamax, a drug for osteoporosis or bone thinning, which is four times more common in women than in men. "This drug’s ads say it can lower the risk of hip fracture," she says. "But while its graphics show young healthy women, studies show it only has this effect in much older women."

Napoli also criticizes advertising for drugs such as Lipitor, made by Pfizer. "Many drugs for high cholesterol show women in the graphics," she says. "But women were underrepresented in these drugs’ clinical trials."

"To drive sales in the important female demographic, drug companies identify which issues women are most concerned or insecure about," says Kathleen Slattery-Moschkau, writer and director of the 2006 documentary "Money Talks: Profits Before Patient Safety."

"These ads feature sexy, smiling women walking by the lake, rolling around with their children, or out on hot dates. They convince us that we too can be ‘this’ happy, ‘this’ sexy and ‘this’ beautiful if only we take this pill."

Molly M. Ginty is a freelance writer based in New York City.

Women’s eNews welcomes your comments. E-mail us at [email protected].

For more information:

Our Bodies, Ourselves, "Direct to Consumer Advertising":

"Marketing Mother’s Little Helper"

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