Is DTC drug advertising in itself a drug?

A recent study from the University of North Carolina indicates that drug companies that spend more on marketing spend less on innovative research. The conclusion is the usual one: drug marketing is an awful thing.

Now, I'd be inclined to think that drug companies without active pipelines, and who have hit roadblocks in drug development, would end up spending more on marketing to get the most out of their existing drugs. It may be a little of both, of course, but the image of a parasitic marketing function sucking the lifeblood out of pharma companies is a persistent one.

But what if drug advertising, in and of itself, has a useful clinical outcome? A well-publicized article from Nature, late last year, indicated that trials of pain medications, as well as antidepressants and antipsychotics, are increasingly having problems proving efficacy, because the placebos seem to be getting more and more effective. Its harder and harder to show that a drug works better than the placebo.

But only the United States. Which is, aside from New Zealand, the only country that permits direct-to-consumer advertising of drugs. The effect is seen nowhere else in the world, but is consistent in the US.  Nut graf:

Based on patients’ ratings of their pain, the effect of trialled drugs in relieving symptoms stayed the same over the 23-year period — but placebo responses rose. In 1996, patients in clinical trials reported that drugs relieved their pain by 27% more than did a placebo. But by 2013, that gap had slipped to just 9%. The phenomenon is driven by 35 US trials; among trials in Europe, Asia and elsewhere, there was no significant change in placebo responses.

I don't know if anyone has done a clinical study where they compared a drug regimen against a drug regimen + advertising. Perhaps at some point, a high-quality ad campaign, complete with whispering voice listing an insane number of bizarre possible side effects, might be a recognized part of treatment. "Take this drug, but first, watch this ad".

As to whether campaigns for Placebicin or Nogudatol might themselves create effective drugs, well, marketers are standing by, ready to serve.

Marketing can be more powerful than people think.