Ask Your Doctor About BLENREP
February 19, 2021 2:33 PM   Subscribe

Can someone explain pharmaceutical advertising to me? Like, why?

I get several promoted tweets served to me every day for obnoxiously-named drugs (BLENREP, JYNARQUE, and Human Fibronectin Solution are all from today). As a consumer, I can't actually run out to the store and buy these. And if I were a doctor (which I'm not despite what Twitter apparently believes), presumably I'm making decisions based on factors other than seeing promoted tweets. Is there something going on related to, like, protection of trademarks or patents, or something? Or is the user story from the marketing team really: "Some person will see this ad for BLENREP, and ask a doctor for BLENREP, and then we will sell one more unit of BLENREP"? And does the direct advertising of drugs and treatments actually work? Of all the things I see advertised on social media feeds, this one puzzles me the most.
posted by majorsteel to Shopping (15 answers total) 2 users marked this as a favorite
Best answer: For starters, it's basically only legal in the US and New Zealand. Everywhere else in the world it is not legal to advertise prescription drugs directly to consumers.

does the direct advertising of drugs and treatments actually work?

Unfortunately it probably does. For example:
In this paper we use published information to analyze the economic value of Direct to Consumer Advertising (DTCA). The reviewed research finds that DTCA leads to increased demand for the advertised drug and that the effect of the drug tends to be class-wide rather than product specific.
We find that: DTCA impacts antidepressant use in a statistically and economically significant manner; that these effects are present in both television and magazine advertising exposure ... The overall size of the effect is a 6–10 percentage point increase in antidepressant use from being exposed to television advertising; the corresponding magazine effects are between 3 and 4 percentage points.
posted by jedicus at 2:52 PM on February 19, 2021 [9 favorites]

I occasionally get medical ads too; they’re clearly aimed at prescribers so assume Twitter somehow thinks I can prescribe something to someone.
posted by chesty_a_arthur at 2:55 PM on February 19, 2021 [1 favorite]

It's not so much a person will see an ad for a particular drug and think "oh I need this drug" but that they'll see an ad for a drug and think "OH MY GOD, CURSE THESE WRTECHED RESTLESS LEGS OF MINE" or "OH MY GOD, AM I PEEING MORE THAN I NEED TO" or "MAYBE THIS RASH I'VE BEEN IGNORING FOR TEN YEARS IS THE HEARTBREAK OF PSORIASIS." The advertising creates both the problem and the answer to the problem.

You see an ad that tells you it's not the 6 liters of cola you drink in a day that's keeping you from sleeping at night but in fact your damn restless legs, and you go to the doctor and tell her that you're pretty sure you have Restless Leg Syndrome. Your doctor, who was just taken to lunch last week by a drug rep from Boehringer Pharmaceuticals, says there are a few things you can try, you can get more exercise, cut down on your caffeine intake, or you can give Mirapex® a try. And oh what luck! You've heard of Mirapex! Let's try that.

Get Well $oon.
posted by phunniemee at 2:55 PM on February 19, 2021 [14 favorites]

Twitter also thinks that I'm a doctor! Constant ads for prescription drugs, medical conferences, how to recruit promising young McDreamies to my thriving practice. My Twitter ads don't even mention the heartbreak of psoriasis ... no idea what symptoms they're supposed to cure.

My favorite part of all ads is "Don't take BLENREP if you are allergic to BLENREP."
posted by cyndigo at 3:12 PM on February 19, 2021 [6 favorites]

“And if I were a doctor ... presumably I'm making decisions based on factors other than seeing promoted tweets”

That “presumably” is doing a lot of work there.
posted by kevinbelt at 3:19 PM on February 19, 2021 [10 favorites]

Best answer: OK, to understand how drug ads in the US work, you need to understand that there are three different kinds of drug ad:

(1) 'Product claim' ads: these work like regular ads. They tell you about a condition and a drug, and try to convince you that if you have a condition then you should use that drug. So, for example, "if you have erectile dysfunction, you may benefit from Viagra."

(2) "Reminder" ads: these can mention the name of a drug, but not what it is used for. So, for example, "this dude races the Viagra car sure seems cool" and then a Viagra logo and that dude telling you to ask your doctor about Viagra. The stated purpose of these ads is to "remind" consumers that the drug exists, so that they can remember to get refills when their prescription runs out. But they function as a form of brand marketing, to get the name of a given drug into consumers' and prescribers' heads so that they will favor it over competitors. Kinda like a car commercial that just shows a car speeding around some gorgeous scenery and then shows you the company logo.

(3) 'Help-seeking' ads: these ads describe a health condition and implore you to seek help, but do not actually mention a drug. So, for example, "just because you're over 40 doesn't mean you can't have the sexy sex." The stated purpose of these ads is to inform consumers that they may have treatable conditions. But, again, the unstated goal is to get you to get your doctor to prescribe you a specific drug.

The distinctions between these kinds of ads is important because they are subject to different kinds of regulations (see the FDA link above). (1) are more heavily regulated than (2) or (3). Why? The FDA assumes that 'product claim' ads are the ones doing the persuading, while 'reminder' and 'help seeking' ads are pretty harmless. So they tightly regulate the product claim ads but give much wider leeway to the others. Canada follows suit, banning 'product claim' ads but allowing the others, again under the assumption that they are harmless.

But marketing firms are smart, and in the real world the three types of ad are used as part of a comprehensive marketing strategy. If you see any one Viagra reminder ad it may seem pointless (why do I care that this dude drives a Viagra car?). But if you see a bunch of Viagra reminder ads, in combination with some help-seeking ads about ED, then your subconscious will put 2 and 2 together and tell your doctor to give you an Rx for Viagra.

Does it work? Yes. It works on consumers and prescribers. Just like seeing a bunch of billboards with "Drink Pepsi" on them will make you more likely to choose Pepsi when you are at the 7-11, seeing a bunch of "NASCAR dude drives a Viagra car" and "over 40 has sexy sex" will make you more likely to ask your doctor about Viagra - and make your doctor more likely to prescribe it. These ads work by establishing brand recognition so that, when a patient or a doctor is deciding what to do, there is a small subconscious nudge in the direction of Viagra. It may not seem like much, but on the margins of a billion-dollar industry it can mean millions of dollars.

IAARWSTS (I am a researcher who studies this stuff)
posted by googly at 3:36 PM on February 19, 2021 [44 favorites]

Given that pharmaceutical companies spend over $50 billion a year on marketing and advertising, about as much as they spend on R&D, I have to assume they think it is worth it. At least as important as actually creating new drugs.
posted by JackFlash at 3:41 PM on February 19, 2021

Brand awareness is also a real thing. Even if I don't have $condition, it gets it into my head that $condition ought to be treatable (a la "you can still have sexy sex!") and gives me a thing to suggest - not just that I could take the drug, but my sister who's been having a weird rash might want to try it -- and now you've got a rec not just from the TV but from your sister, even though I didn't mean it that way.
posted by Lady Li at 3:49 PM on February 19, 2021 [2 favorites]

And "well, it might help, do you want to try ____" gets a more positive reaction if you have heard of ____ before, in a benign context that you have kind of positive associations with. Even if you don't remember the context.
posted by Lady Li at 3:54 PM on February 19, 2021 [1 favorite]

Response by poster: Wow, thank you all. Awesome explanations googly and jedicus. (Also lol at "sexy sex"). I mean, I get it fundamentally - I studied historical advertising from the 1890s-1900s way back in my skool daze (the birth of the "let's create a problem that only our ['electric'] product can solve" revolution) - but the pharma ads just seem to be a different beast. It's telling that they are banned everywhere else; it just all seems so weird to me.

And, as if on cue, Twitter is informing me of an exciting new CABG bilateral ITA procedure to tailor target vessel choices to optimize long-term survival in coronary bypass patients. Not pharma, I know, but The Algorithm definitely seems to think I'm a doctor. Does... does that make me a doctor??!!
posted by majorsteel at 4:21 PM on February 19, 2021 [4 favorites]

I'm a bit frustrated with some of the anti-patient sentiment here.
The advertising creates both the problem and the answer to the problem.

You see an ad that tells you it's not the 6 liters of cola you drink in a day that's keeping you from sleeping at night but in fact your damn restless legs, and you go to the doctor and tell her that you're pretty sure you have Restless Leg Syndrome...
Real, smart people who are engaged with consensus reality have restless leg syndrome, which is a real medical condition with real diagnostic criteria and real, scientifically proven treatments. Some of those people find out about those treatments from ads and then go talk to their doctor. They're not crazy or stupid. They're excited to get useful information about their lives.

To be clear: FUCK PHARMACEUTICAL COMPANIES. Fuck living in a world where patients are hearing "Ask your doctor about RLS treatment" from a for-profit company and not a nonprofit. But don't throw the patients under the bus.

In other words: OP, part of why these ads work is that yes, there are a lot of people who didn't know their problem had a name, or didn't know that it was treatable, or didn't know that there were options beyond previous shitty treatment they'd abandoned due to unbearable side effects, until they saw that ad. There are a lot of people in the world who don't have medical research skills, have pretty lazy doctors, and end up getting their info from drug ads because this country doesn't have a better channel for public health information.
posted by nebulawindphone at 5:06 PM on February 19, 2021 [10 favorites]

Pharma companies whose drugs are the only (or at least the first patented and approved) treatment for a condition get multiplied returns on all three of these types of ads (two if you are in Canada or outside US).

Viagra when it launched was the only drug treatment really for ED. So if you went to your doctor to talk about more "sexy sex", Viagra was sure to be an option. They didn't even need to do the first type of advertising.

The same holds for other conditions where you are the only player. Think Gardasil = HPV vaccine.

This is one of many reasons that the pharma companies are very deft players in extending/expanding/challenging patents. As long as you are the only drug treatment option (even if it is spurious - search for what Lyrica did around Fibromyalgia), any coverage of a medical condition becomes a marketing channel.
posted by mephisjo at 7:05 PM on February 19, 2021

So you know, it's not just social media. Prescription drug ads air quite frequently on TV too, depending on the program. Turn on the 6:30pm national news on any network channel, and you will see.

I don't know anything about promoted tweet algorithms, but maybe you've been put in the same bucket as people who watch national news broadcasts.
posted by wondermouse at 7:11 PM on February 19, 2021

Related to what nebulawindphone and soundguy99 said...I have no love or respect for pharmaceutical companies, but my experience with healthcare in the US is that if you go in with a mindset of "the doctor will take the time to figure out what is wrong with me and know what I need and give me that"...well, you'll be left for seven hours after an accident without so much as a Tylenol waiting for the plastic surgeon on call to turn up, because it never occurred to you that you could and should _ask_ for pain relief.

For less urgent concerns, as well, I've had a _lot_ better results going in saying, "I'm worried about X, can we test for that?" rather than just describing symptoms and hoping if something's wrong the doctor will have the time and attention to pick up on it. I've actually considered (after the pandemic) talking to my doctor (I'm fortunate enough now to have access to a doctor, and one who listens, but I know the HMO pressures her to be as brief as possible) about some of the new migraine medications I've seen advertised. If it weren't for seeing the ads, I'd probably just assume that I'd tried what existed and it didn't work, so, shrug. My doctor wasn't my doctor when I last tried any migraine medication, so she'd never know what I had or hadn't tried.

This system sucks, but I feel like the pharmaceutical ads to consumers are more of a symptom than a cause. The pharmaceutical push towards directly influencing _doctors_ is more worrisome.
posted by LadyOscar at 8:21 PM on February 19, 2021 [2 favorites]

Way before direct to consumer ads were allowed there were drug detailers who visited doctor's offices regularly to give them "details" about whatever product they were selling. That worked well on the doctor end to encourage prescribing their particular drug. In the past decade there has been a lot of criticism about kickbacks thinly disguised as a "speaker's honorarium" or junket trips to vacation locations for half-day meetings followed by two days of golf. There has been strong pushback at least at academic institutions and a lot of new rules: reform was needed. (I have been to Cancun [NOT with Ted Cruz], Brussels, Toronto, Vail, Breckenridge, San Diego, New Orleans, Miami, Tampa, NYC, etc. for meetings on the pharma company's dime). They also spend a lot of money on print advertising in medical magazines typically read by physicians. Then there are the "unrestricted educational grants" handed out to non-profits to educate consumers on a particular health issue. Not that I think these grants are all bad, since small non-profits are some of the hardest working organizations around and often operate on out-of-pocket donations of the impassioned founders. But they do exist, and where there is potential good there is also potential diversion.

Pharma has always had a large promotional budget, it's the direct to consumer that's new. Docs I know, largely academic, tend to hate it, especially for particular drugs, considering it an intrusion on their professional judgement, but considering how often the ads run I have to assume there is enough payback for them to continue.

Tweets cost the company next to nothing, and it's not surprising that the enterprising PhRMA groups are messaging someone they think is a doc. It's like phishing - if one in a thousand responds to a low cost lure it's worth it.
posted by citygirl at 8:24 AM on February 20, 2021

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