The danger of marketing prescription drugs online

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If pharmaceutical companies are allowed to send abbreviated pitches, they'll emphasize the benefits of their medications and send consumers elsewhere to find out the risks.

By David Lazarus

Source: Los Angeles Times

November 18, 2009

Google, Yahoo and the pharmaceutical industry are pushing to change how prescription drugs are hawked online. That's not a bad thing necessarily.

The danger is that all the happy, sunny marketing pitches could end up front and center on the Web and on Twitter, while all the nasty, scary side effects are relegated to cyber-ghettos that consumers never see.

"There's no question that the pharmaceutical industry would love to send out abbreviated versions of ads that leave out the scary stuff," said Sidney Wolfe, director of health research for the advocacy group Public Citizen. "But if you talk only about the benefits of a drug and send people somewhere else for the risks, you'll get a real distorted view of what these drugs do."

The Food and Drug Administration started tackling this thorny issue last week when it invited leading Web companies and pharmaceutical interests to testify about what they'd like to see in a brave new world of digital drug ads.

As it is now, a Google search for, say, "high blood pressure" returns more than 40 million listings. But at the top, over a shaded background, are links to websites such as ManageBloodPressure .com and BloodPressureChol esterolRx.com.

These are sponsored results, although who paid Google to put them there is unclear. Nor is it clear that each link will take you to a website for a prescription drug.

Current FDA rules require both the benefits and risks of a drug to be included in any print ad or commercial. But what about online, where a sponsored search result or corporate tweet may have only a handful of words?

"The drug companies make a legitimate point in saying that the Internet is different from print and TV," said Steven Findlay, senior health policy analyst at Consumers Union. "The burden is on the FDA to think this whole thing through very carefully."

We're still months away from a possible new rule for online drug ads. But most interested parties agree that some sort of change is coming down the pike.

"We need more transparency," said David Zinman, vice president of display advertising for Yahoo Inc. "You can't just take the same rules from print and TV and put them online.

"The goal," he said, "isn't just to help advertisers. It's also to help consumers."

The stakes are high. Ever since the FDA ruled in 1997 that drug makers could pitch their prescription wares directly to consumers, the pharmaceutical industry has spent billions of dollars annually persuading people to ask their doctors about all manner of high-priced, name-brand remedies.

Print ads for prescription drugs typically include pages of fine print spelling out potential hazards. TV and radio commercials usually end with rushed recitations of all the bad stuff.

It's trickier online. A company-sponsored search result, a corporate tweet or a postage-stamp-size display ad lacks the room for all that information.

So drug makers skirt the problem by advertising a condition or a symptom, and not revealing the name of the related pill until a Web user clicks on the link. The fine print doesn't have to be unleashed until the name of the drug actually appears.

Eric Obenzinger, a Google Inc. spokesman, said new rules are needed that would allow drug makers to communicate more clearly through searches and tweets.

"There's about 4 billion searches per year for health conditions," Obenzinger said. "It's important that people get good information."

That's the thing. One lesson newspapers and other media companies have learned is that Internet users seldom click online ads.

So let's say the FDA allows drugs to be pitched online without all the risks being immediately spelled out. Let's say the agency allows online ads, search results and tweets to include a link to all that dark and depressing stuff.

Would anyone go there?

My hunch is no, which would probably be just fine with the pharmaceutical industry, but would be a significant setback for ensuring that consumers are well-informed about a drug before they start pestering their doctors for a taste.

My hunch is that people will receive a tweet from, say, Sepracor Inc. letting them know -- in 140 characters or less -- that Lunesta will help them get a good night's sleep.

They won't click the link that reveals using Lunesta could cause "aggressiveness, agitation, hallucinations and confusion," or that the risk of suicide among depressed people may increase, or that allergic reactions "such as swelling of the tongue and throat" may be fatal.

Jeffrey Francer, assistant general counsel for Pharmaceutical Research and Manufacturers of America, an industry group, said he believes people will click on that link, and will have instant access to "lots and lots of information about benefits and risks."

"What we're trying to do is think creatively about how healthcare companies can lead people to comprehensive information," Francer said. "We're trying to get people to FDA-regulated information."

That's another thing. If drug companies start blitzing consumers with online ads, sponsored search results and marketing tweets, how will federal officials keep up with the tsunami of salesmanship?

Clearly we're going to need an entirely new FDA division dedicated solely to surfing the Web and policing all that digital content -- and that won't be cheap.

It's still early enough in the game that most of these issues hopefully will be tackled before the FDA comes to any conclusions. And it's constructive that all concerned seem to be trying to come up with workable solutions.

For example, Google's Obenzinger showed me the company's idea for presenting both benefits and risks of drugs in sponsored search results.

They've done a pretty good job, although I can't help but notice that the benefits are in dark print while the risks are in lighter gray print.

It will be up to federal officials to strike the right balance between digital commerce and keeping people safe. All too often, commerce tends to come out on top.

That's shouldn't be the case this time. Not with potentially millions of lives at stake.

David Lazarus' column runs Wednesdays and Sundays. Send your tips or feedback to david.lazarus@latimes.com.