Are drugs promoted on TV ads better than others? No, study finds. Sometimes they're worse.

They often start with someone in late-middle-age, gray-haired but active, taking a brisk hike, biking or looking out to sea.

There's a passing reference to some dreaded disease the person would be suffering but for the great drug they're taking. Tucked in the advertisement is a long list of potential, often horrible, side effects, delivered so rapid-fire, they sound almost comical. 

Pharmaceutical companies spend more than $6 billion a year on these direct-to-consumer ads meant to encourage people to ask their doctor about a particular medication.

"Consumer advertising has shown to help patients by raising disease awareness, removing stigma from certain conditions, promoting adherence to medicine and encouraging important conversations between patients and their doctors," said Sarah Ryan, public affairs representative for PhRMA, a trade group representing companies in the U.S. pharmaceutical industry. 

But a recent study finds the drugs promoted in these ads are not any better – and are sometimes worse – than others on the market. They often aren't intended as first-line therapies, deliver little value to patients or have more side effects than other equally effective treatments.

"You can't assume that drugs work or are really safe, just because they are advertised," warned Dr. Steven Woloshin, a co-author on the study and co-director of the Center for Medicine and Media at The Dartmouth Institute. "And if something seems too good to be true, it probably isn't."

What the study showed about drug ads 

Drug companies sponsored more than 660,000 television commercials in 2016.

Among the most-advertised drugs between September 2015 and August 2021, 32% addressed immune problems, 16% digestion and metabolism and nearly 14% neurologic conditions, according to the study.

Researchers from Harvard Medical School and Dartmouth compared those drugs against ratings set by independent agencies for added benefit, safety and strength of supporting evidence compared to other medicines for the same condition. They found only 27% of the ads were for drugs rated as having "high therapeutic value."

Advertised drugs aren't necessarily worse than other medications but they're usually not better, either, said Neeraj Patel, who helped lead the work and is now a medical student at Yale University.

"It's the drugs that are of marginal, if any benefit that are being strongly advertised because that's where the edge is," said Dr. Joseph Ross, a professor of medicine and of public health at Yale, who was not involved in the new study, but has conducted similar research. 

The problem is not a new one, Patel said. The painkiller Vioxx was heavily advertised before it was taken off the market for doubling the risk of heart attack and stroke. Opioids, too, were once heavily advertised on TV. 

"It's safe to say there can be a lot of adverse effects of these ads, as opposed to just a lack of benefit," Patel said.

Ryan criticized the study as flawed for relying on European groups' standards of effectiveness "that rarely reflect the values of American patients." Also, different people find different value from medications, so such one-size-fits all assessments "fall far short of capturing a medicine’s true value," she said via email.

Is there a good side to drug ads?    

Pharmaceutical companies say the ads help inform the public about their options.

Woloshin agrees. Ads for anti-depressants that blanketed the airwaves back in the late 1990s may have helped destigmatize depression. But Ross said many of the people who took the medications, called SSRIs, would have found more relief from cognitive behavioral therapy or working with a therapist instead of taking a drug. 

Dr. Richard Kravitz, a professor at the UC Davis School of Medicine, said informational ads could be useful if they focused on underused drugs of high value. "If a drug is overused or of relatively little value or where the benefits and harms are really closely balanced, then advertising is likely to have net harm," he said.

The Food and Drug Administration could devise regulations to encourage truly useful drug advertising and discourage harmful ads, but it would be tricky to avoid First Amendment issues and culture wars, Kravitz said. 

There's no question the ads work.

When patients see drug ads, they're more likely to ask about that specific drug, Ross said, and when they ask about it, they're more likely to get it.

At their best, direct-to-consumer ads could be triggers for an in-depth conversation with a physician, Kravitz said. But in reality, harried doctors who have six patients waiting probably won't be able to take the time for such discussions and will just give the patient the drug they request.

Convincing the patient that the drug they saw advertised isn't their best option "sops up a lot of time that could otherwise be better directed," Kravitz said.

What countries allow direct-to-consumer ads?   

The United States and New Zealand are the only two countries in the world that allow such direct-to-consumer advertisements. 

In 1999, the FDA issued guidance allowing companies to mention only a drug's most serious side effects in an ad. Instead of needing a print ad to fit a full list of side effects, drug companies could now put those ads on TV.

Rather than act as a deterrent, the "crazy" list of side effects in TV ads just becomes white noise, Woloshin said. "They kind of filter it out, so it really undermines the whole purpose," he said. 

Woloshin also questions the "awareness campaigns" promoted by some ads. Because they don't list a specific drug, they are completely unregulated, Woloshin said. "They're really under the radar."  

Before a new class of Alzheimer's disease drugs was approved last year, he said, drugmakers Biogen and Esai were running ads raising people's fear about the disease and offering a screening test that might or might not be accurate. 

Other drug ads "create" medical problems that are then solved by the advertised medication, Kravitz said.

Overactive bladder drugs that reduce the number of bathroom visits from say nine to seven in a day don't make "really a huge difference," he said, while they can lead to dry mouth and constipation.

Insurance companies play a gate-keeper role, sometimes preventing people from accessing the drugs they see advertised that might not be warranted.

But the insurance system is poorly designed to provide optimal care, said Ross, also a member of the Center for Outcomes Research and Evaluation at the Yale-New Haven Hospital.

"The insurance companies are bad at differentiating which care is the care patients need and which care is the care patients don't need,' he said. "They just put up roadblocks regardless."

What should consumers do?

Data provided by Ryan, of PhRMA, shows that drug companies spend far more on research and development than on marketing and promotion, over $90 billion in 2016. Drug marketing supports that research, and R&D grew far more, far faster than spending on direct-to-consumer ads.

Patel, the medical student who led the new study, said he doesn't think ads are "a very strong way to educate people about prescription drugs."

As part of the research, Patel had to watch hundreds of direct-to-consumer ads. He is concerned that seeing so many will influence his prescribing when he eventually treats patients. "I want to make sure I'm not thinking, 'This drug is advertising because it's this breakthrough medication,' but because the company finds it a good candidate for advertising," he said.

So, what should people do to protect themselves from a direct-to-consumer ad?

"You should ignore it," Ross said. "They're trying to sell you something you may not necessarily need. That's the sad part around this."

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.