Why are Big Pharma, hospitals spending billions on needless hype?

They’ve not only provided abundant fodder for comedians. The flood of advertisements  for costly drugs and medical devices is raising concern among health care experts, the New York Times reports. Experts fear that the $14 billion in annual ad spending by Big Pharma and medical device makers only “increases prices and encourages patients to seek out more expensive and, often, inappropriate treatment.”

The United States and New Zealand are the only two nations in the world that allow consumer advertising for drugs. Big Pharma, medical device makers, and hospitals not only are spending greatly more in actual dollars but also in percentage terms, the Times says:  Big Pharma’s ad spend is up 46 percent over the last four year; it’s up by 38 percent for hospitals, medical centers, and clinics, and medical and dental insurers.

Further, the products getting the biggest touts often are the most expensive, and many of these are targeted not at mass audiences but patients in niches needing therapies for their conditions. Some of the medications, for example, would cost patients with conditions like diabetes, rheumatoid arthritis, or cardiac conditions, from several hundred to several thousand dollars each month. Doctors, if they prescribed these meds, would be offering Cadillac-cost meds to treat ailments for which cheap, generic drugs already are proven and available at vastly lower prices.

Touting a costly fix for toe nail fungus

The Times also points out that advertisers are spending big on seemingly odd choices, such as promoting a drug that: combats toenail fungus, a regimen that can take weeks and has a complete cure rate of less than 20 percent. Another example: a drug that fights constipation among users of opioid painkillers. This drug costs several hundred dollars per month, when physicians often resolve this constipation with dietary change, exercise, and drugs available over the counter.

Meantime, hospitals, clinics, and medical centers also are jumping into advertising, big time. The Times notes that a recent episode of the CBS news magazine “60 Minutes” included advertising for four expensive drugs and two hospitals, Memorial Sloan Kettering Cancer Center and NYU Langone Medical Center. The Times Magazine, on that same weekend, featured glossy full-page promotions for hospitals in New York, Denver and Boston. Those who track ad spending say that hospital advertising has risen 40 percent, to $2.3 billion, from 2011 to 2014. Among the major spenders are NYU Langone ($22 million annually) and the City of Hope, a cancer hospital near Los Angeles ($20 million).

Getting around the FDA

Where’s the once rigorous oversight of health care advertising? The paper says the federal Food and Drug Administration’s rules for medical advertising have sought to ensure that patients got “accurate, balanced information. Current regulations mandate that manufacturers advertise their drugs only for the disease for which they received federal approval, and that they list all potential side effects and risks,” a practice much derided by stand-up comedians. They successfully have mocked the speedy recitations of side effects for products that might treat a hangnail but cause a heart attack instead.

Marketers have gotten “clever,” the Times notes, in getting around regulators by featuring “emotional patients telling their success stories,” or by creating “help-seeking ads,” in which “a specific drug isn’t named (so that its side effects don’t have to be mentioned) but just enough information is provided about the condition, including a website for advice, to guide you to the branded medicine.”

Although Big Pharma might suggest that advertising is an exercise of its corporate First Amendment privileges, and that it provides more and better information for consumers to make health care choices, published research disagrees, the Times said. It pointed to a recent study that criticized cancer centers for pitching themselves by tugging at the public’s heart strings, with the expert authors concluding: “Clinical advertisements by cancer centers frequently promote cancer therapy with emotional appeals that evoke hope and fear while rarely providing information about risks, benefits, costs, or insurance availability. Further work is needed to understand how these advertisements influence patient understanding and expectations of benefit from cancer treatments.”

The American Medical Association has proposed a ban on medical advertising targeted at consumers. Although skeptics say such a move might run aground of constitutional free speech arguments, I wonder how long the big, unchecked ad spending will go on before the public pushes back due to inevitable harms that result from these excesses. Regulators certainly should question whether Big Pharma also unfairly is sticking patients with the costs of massive spends on advertising and marketing, adding to the already sky-high costs of drugs. It’s a fair question to ask — whether patients could get a $14 billion discount on existing prices if all these companies and hospitals cut out their hype?