drugadvertisingacritique

Drug Advertising - A Critique

Bone Loss Drug Ads: Half-Truth in Advertising

The print ad for Actonel, a drug to “help fight fracture,” features a fiftyish white woman next to the headline: “How many women over 50 will break a bone due to osteoporosis? A)1 in 2000, B) 1 in 200, C) 1 in 20, D) 1 in 2 Answer: D) 1 in 2.”

The source for the “1 in 2 correct answer,” listed after the quiz, is the 2004 Report of the Surgeon General on Bone Health and Osteoporosis. Here is how the Report actually put it: “Four out of every 10 white women age 50 or older in the United States will experience a hip, spine, or wrist fracture sometime during the remainder of their lives.” (Only white women were studied for fracture risk.)

The ad implies that the 1 in 2 fracture odds start at age 50. It does not explain this is the lifetime risk of having any fracture for women who live to be 90. But it is hip fracture that is the most serious consequence of osteoporosis, and osteoporosis-related hip fractures before the age of 70 are rare. In fact, a 70-year-old white woman with a total hip score of -2* has only a 5% risk of having a hip fracture in the next ten years. And an 80 year-old woman with bone density at her hip that is average for her age has a 9.7% risk of a hip fracture in the next decade.

But these statistics, which come from the excellent Web site of bone physiologist Susan Ott, MD, aren’t scary enough to appear in an ad for a bone drug. Dr. Ott acknowledges that bisphosphonates, the drug class to which Actonel, Fosamax, and Boniva belong, are widely prescribed to women under 65, but says she is reluctant to give them to women this young.

Dr. Ott, associate professor of medicine at University of Washington, would rather restrict bisphosphonates to those under 65 with severe osteoporosis—that is, a history of non-traumatic fracture—and those who take prednisone. She advises her patients to stop taking bisphosphonates after five years because of “long-term safety issues. Dr. Ott’s Web site is http://courses.washington.edu/bonephys

*Test result indicates bone loss, but not osteoporosis, which is -2.5 standard deviations below the young adult mean.

Gardasil Vaccine Ads Aimed at Teens

The first thing you notice about the Gardasil TV ads, featuring teen-age girls engage in various athletic activities, is that there is no mention of the fact that the Gardasil vaccine is for the prevention of a sexually transmitted disease.

One version of these ads, which features mothers and daughters, was found to be cleverly manipulative by a New York Times reporter, Claire Dederer. The ad shows cool, self-reliant girls involved in cool, self-reliant physical activities with the repeat message: I want to be one less woman who will battle cancer.

“The mothers appear about halfway through [the ad] and they’ve got the bad news,” writes Dederer. “In loving tones they break it to their daughters: ‘Gardasil may not fully protect everyone,’ they say. Tenderly they list the side effects. This is an ingenious ploy: the cool girls want to be ‘one less’; the moms are the ones putting on the brakes. Having mothers voice the downside of Gardasil reinforces the message that if you get this vaccination, you’re the rebellious, independent thinker: ‘forget the side effects. Forget Mom. I’m getting vaccinated.’”