Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z. I also produce and host this podcast series, Health Literacy Out Loud.

As many of us in the United States know, there a lot of ads for medication on TV these days. I’m probably not the only one who finds these ads both annoying and befuddling.

I was curious to learn more, so I reconnected with Diana Zuckerman, who had recently written a newsletter article about TV ads for medication.

We talked about a lot of information, and it was fascinating what she knew. I thought you’d be interested in this topic, too. I am so glad Diana agreed to talk with us on Health Literacy Out Loud.

Diana Zuckerman is President of the National Center for Health Research, which is a nonprofit think tank that conducts and analyzes research on a wide range of healthcare and health policy issues.

Diana and her team use research to inform policies and programs that affect the health of adults and children.

Among her many accomplishments, Diana has testified about the safety and efficacy of medical and consumer products before the US Congress, federal agencies, state legislative committees, and the Canadian Parliament.

I first met Diana years ago when we were both working on a project about treatment options for breast cancer. Soon thereafter, Diana agreed to be a guest on Health Literacy Out Loud talking about mammograms.

I’m so glad you came back, Diana. Welcome to Health Literacy Out Loud.

Dr. Diana Zuckerman: It’s great to have a chance to talk to you again.

Helen Osborne: When I get dressed in the morning, I turn on those news shows and it seems like there’s an incessant number of ads for medications. I never used to notice it. There seem to be more and more. What in the world do you think is going on?

Dr. Diana Zuckerman: It seems as if perhaps what we think of as free TV is actually being funded by all of these ads.

You’re right, there’s more than ever before. I think part of it is that a lot of these ads used to be in magazines and there aren’t so many magazines anymore. Some of them used to be in newspapers, and there are not so many in newspapers anymore. So you’re seeing them on TV and you’re seeing them online.

Helen Osborne: How does this all work? It seems to be the same ad over and over again many times. Sometimes they’re for really serious conditions like side effects from cancer medication. Sometimes they’re for more common scenarios that affect a lot of people, like diabetes.

What’s the profit motive in there? It sounds like it benefits the pharmaceutical company and maybe the TV show.

Dr. Diana Zuckerman: You’re absolutely right. First of all, the pharmaceutical company wouldn’t be paying all this money for these ads if they didn’t work.

You might be wondering, “Why are people getting information about cancer treatments on TV? Shouldn’t they be getting that from their doctor?”

But in fact, the way it works is that patients or future patients see these on TV and then they go to their doctor and say, “I just saw this ad for this new diabetes drug. Shouldn’t I try it?” or, “This new cancer drug, why haven’t you prescribed it?”

People are going to their doctors, and sometimes doctors do find this terribly annoying because sometimes patients are asking about treatments that are completely inappropriate for them. The doctors wish that the patient would just listen to them and not bring up these issues.       

But a lot of times, patients feel empowered because they’re getting information from TV. They think of that as objective information from knowledgeable sources instead of realizing somebody is trying to sell them something that may or may not be even remotely safe or effective for them. It might be safe and effective for somebody, but not for them.

Helen Osborne: Do you think that that overrides what a person is hearing from their doctor? This is an ongoing relationship. They have a serious illness. Do you think that these ads that you see for 30 seconds on TV could override that patient relationship there?

Dr. Diana Zuckerman: It certainly weakens the relationship with the doctors. I know doctors feel like it weakens their authority. Let’s face it, doctors would like to be “the” authority and they would like to be the one to tell a patient, “This is what you need.”

It’s possible, of course, that some doctors may not be as knowledgeable as you’d want them to be. Maybe they don’t know about all the new treatments. That’s possible.

But more likely, the ads are really aimed at convincing patients that they should be getting these new medications, and that doesn’t always mean that that’s a good idea. The doctors probably would know about these treatments if they really were appropriate for their patients.

Helen Osborne: Are these ads just for prescription medications, or are they for other things, too?

Dr. Diana Zuckerman: There are different kinds of ads, and there are different times of day and different channels, I think, where you’re more likely to see them.

In primetime, you’re more likely to see the ads for brand-name medications. These are often very expensive medications.

Helen Osborne: I was wondering about that.

Dr. Diana Zuckerman: They certainly are prescription medications almost always, whereas on some cable channels and not during primetime, and particularly I think late at night, but sometimes early in the morning or in the middle of the night, you’ll see ads for products that are actually called dietary supplements.

Helen Osborne: What would a dietary supplement be?

Dr. Diana Zuckerman: It might be a treatment for your memory that’s not a prescription drug. It’s something you can buy at any health food store. You can buy it at any pharmacy, your local pharmacy. You can probably buy it in your local supermarket.

Whether they’re vitamins or minerals or specialized what are called dietary supplements that might consist of just one vitamin or one mineral, not a multivitamin, you’ll be told, “This will help your hair grow thicker,” “This will clear up your complexion,” “This will help your memory,” or, “This will help with your arthritis.”

Helen Osborne: I’ve seen ads on all of those things, Diana. I bet our listeners in the United States have, too. Do drug ads on TV happen elsewhere?

Dr. Diana Zuckerman: Certainly not for prescription drugs. I don’t actually know about ads for dietary supplements in other countries. I don’t know if that’s allowed or not.

It’s what’s called direct-to-consumer advertising. Instead of being advertised in medical journals or at conferences with physicians, the people who will prescribe the drugs, they’re called direct-to-consumer because the company is going past the doctor, past the person who prescribes it and is going directly to you, me or anybody that we know and saying, “This is a great product, and we want to tell you about it.”

They sometimes do it in a way that it almost looks like a newscast. Sometimes it’s hard to tell.

I’ve seen that in newspapers and on TV where you would think that this was a news program interviewing a doctor or a patient who’s saying, “I took this product and now whatever the problem was has disappeared.”

There are a lot of dietary supplements like that. Some of them I haven’t mentioned, but of course things to build your muscles, things for erectile dysfunction, things for perhaps so-called women’s health issues.

Helen Osborne: And men’s health issues. I see those a lot.

Dr. Diana Zuckerman: Yes, and men’s health issues. These are products that the way they are advertised, you would actually think they might be prescription drugs.

They might even say to you, “This is approved by the FDA,” or something like that. If they say that, that’s not true. They might use language that sounds like “approved by the FDA,” but really what they’re saying is, “The FDA has no problem with this product.” But that’s only because the FDA does not regulate dietary supplements.

Helen Osborne: I know from all your work, Diana, you do a lot about the studies and what are legitimate and all of that. I’ve seen some of these ads. They say, “It’s a small study.” It might have been done on just a handful of people and showed something in some journal I’ve never even heard of.

I want to ask you two big pots of questions. One has to do with any rules or regs about doing this stuff. The other one is about health literacy and the communication side of this one. These ads certainly are well done and engaging.

Why don’t we talk about rules and regs first. Are these ads legit? Do companies do this? Do they get in trouble for it? What’s the scoop?

Dr. Diana Zuckerman: If you’re talking about prescription drugs, the rule for advertising prescription drugs is that a company cannot say anything that the FDA thinks is not accurate.

For example, a company can say, “This medication is for prostate health,” but they can’t necessarily say, “This is an effective treatment for prostate cancer.”

But I think for a lot of listeners, they don’t really know the difference between something that is for prostate health, whatever that means, versus prostate cancer. Why would you care about your prostate’s health if you are not worried about cancer? You can’t say things that the FDA would disagree with.

The FDA has what’s called a label for every prescription drug. That label used to be one or two pages of minuscule writing that nobody can read.

Helen Osborne: Yes, I’ve seen those.

Dr. Diana Zuckerman: Sometimes they’re 40 or 50 pages now.

Helen Osborne: Oh my goodness.

Dr. Diana Zuckerman: They are available online, but of course no TV ad is going to include all that information. What companies do is they emphasize any good news they can tell you. “This is FDA approved for the treatment of asthma,” or diabetes or cancer, whatever it is.

Then they have to, by law, give you some warnings. But they generally can’t give you all the warnings because it would take too long, so the FDA has to agree which are the warnings that they have to mention. Should it be the most common warnings like headaches, or should it be the rare but most serious warnings like “This could kill you”?

That varies, but the thing that’s sneakiest is that very often the FDA will allow a company to not give the warnings if they say something like, “For more information about the risks of this product, see the advertisement in this month’s Ladies’ Home Journal.”

Helen Osborne: Oh my goodness, Diana. They’re not even saying it. Wow.

Dr. Diana Zuckerman: Right. In some cases, they may say one or two things and then say, “For more information, see People magazine,” or whatever it is.

Of course, the vast majority of people watching TV are not going to see it in that magazine. They’re not going to ever see that information, but for whatever reason the FDA has determined that that’s sufficient.

I, of course, don’t think it’s sufficient because there are a lot of warnings sometimes about, “Don’t take this if you’re taking a diabetes medication,” or, “Don’t take this if you have high blood pressure.” There are all kinds of warnings that are relevant to millions of people and they may not know. They may not ever hear it.

Helen Osborne: I’m laughing because the warning I hear over and over again is, “Don’t take whatever the name of the medication is if you’re allergic to it.” I think someone might have figured that out.

Thank you for that FDA, that approval. It sounds like if companies get dinged, maybe they take the ad off and do another one or something. I don’t know. I’m sure there’s a whole big part of it that I’m sure you know so well.

Let’s get onto the part about health communication and health literacy. That’s what all our listeners care about. That’s why I want to interview you on this topic.

This is just another way of communicating health information. These ads, for the most part, I think are done really well. They look like they have big budgets. What are you thinking about from a communication perspective?

I do want to tell you what keeps buzzing in my brain. There’s a medication I see over and over again and they are singing and dancing and getting their hair done, but the pictures and sound have nothing to do with taking an expensive medication for a serious problem.

Tell us more from a communication perspective about these, please.

Dr. Diana Zuckerman: I think you’ve hit it exactly right. There’s a communication from the feeling you get from watching these ads that’s very different from the words that they may be saying, or what the drug or the dietary supplement is really intended to do.

You see these people looking really happy, and yet they’re talking about an antidepressant or they’re talking about a cancer treatment or whatever. But the feeling you get watching it, which the companies have bought and paid for, is a feeling like, “Oh, now I feel hopeful. I feel like this is going to help me.”

You can have a voiceover on an ad saying all the terrible side effects that this particular drug might have, and at the same time, as you say, people are dancing, they’re playing with their children or grandchildren or they’re dancing with their friends.

It used to be they were dancing through a field of flowers. You don’t see too much of that anymore. But whatever it is, the communicating message is, “This will make you feel better.”

It’s very powerful and these companies know how to do it. They’re very good at communicating that message, and that message of hope and happiness really completely overwhelms any warnings they’re giving you about the risks of this medication.

Helen Osborne: I want to talk a little bit about communicating those risks. I just landed on something. It was a citizens’ petition from a few years ago. I don’t know if anything has happened more since. I’ll have a link to this on the Health Literacy Out Loud website for your web page.

This is a petition for the FDA to issue a rule banning the use of background music during the presentation of the risks in direct-to-consumer drug advertising. I highlighted many parts of this petition, but here’s one I’ll read to you, and listeners can hear.

They talk about, “The use of background music is a distraction from the presentation of risks because the music they choose is incongruent with the message presented, and it bombards the viewer with excess stimuli making it difficult for them to retain the information. This leads viewers to comprehend the benefits better than the risks and results in an unfair, highly positive view of an advertised prescription drug.”

Do you agree with that?

Dr. Diana Zuckerman: Absolutely. Of course, it’s not just the music, but music is powerful. Yes, it really does change your feelings and your mood.

If it’s maybe even a song that you love, maybe it’s a familiar oldies or something, you might be so distracted by the words to the song that you’re absolutely not getting those warnings at all. You’re not noticing them. Even if you hear them, you don’t remember them. What you remember is the song that’s going on in your head.

Helen Osborne: Then the information that they’re writing that we might really need to know about side effects is in teensy print. You really can’t read it.

Once I had the first conversation with you about this a week or two ago, I started to just read it, not listen to the music, and it’s a totally different experience.

We care about health literacy. You talked about the fact that the images don’t match the text, the risks are in teeny tiny font and they have music overlaying the whole thing. You and I, you even better than me, know they probably don’t even mention cost on there, and it might be a little fuzzy around research. That’s a lot of bad news.

Help us be a little hopeful. All of us care about communicating more clearly, we care about our own health and we care about the health of others. What can we be doing with this onslaught of health advertising?

Dr. Diana Zuckerman: One thing you can do is if you think that an ad is misleading or inaccurate, you can complain about it. That might seem too much trouble or it might seem, “What’s the point?” But the truth is a lot of times the FDA finds out about bad ads just that way. They find out by people complaining.

Helen Osborne: You want us to complain to the FDA?

Dr. Diana Zuckerman: Yes. If they’re about a dietary supplement, you should complain to the Federal Trade Commission because they’re the ones that regulate those ads, as well as food ads.

Some years ago, people complained that an ad said that Kentucky Fried Chicken was healthier than a Big Mac. These are two products that may be delicious, but are not healthy, either of them. Certainly Kentucky Fried Chicken isn’t healthier than a Big Mac, although in this particular case, the company said, “We are 5 calories less.”

In that case, the Federal Trade Commission said, “This is a misleading ad,” and they gave money back to people who said, “I watched this ad, I bought this food and I now realize I was misled.”

It is a different process for food and for dietary supplements. You can actually get your money back. Whereas if there is a misleading ad for a prescription drug, with luck, the FDA will require the company to take it off the air. But usually by the time that happens, the company has already had their ad campaign.

Helen Osborne: Thank you. We will have links to the FDA and the Federal Trade Commission there. But you’re right, that takes a lot of effort.

What about on an everyday basis? Can we do anything to deal with this with our loved ones, the patients, the public we talk about? Anything we can do? Should we just let them know about all you’ve shared about all the misleading advertising out there? Is there any other step we can take?

Dr. Diana Zuckerman: One of the things you can do is there are several websites that make it very easy to find out what the actual warnings are about a prescription drug. What are called “contraindications.” That’s the warning information about, “Don’t take this if you have this disease,” or you’re taking these other medications, or whatever.

One of those is www.Drugs.com. That’s a pretty easy website to remember. There are several others like that where they have accurate information based on FDA labels that will tell you what the risks are. You can even ask for the section on risks, because these labels can be very long.

Very often, it’s helpful to just go online and put the name of the drug and put “risks.” Very often, you can get that information. It takes about three seconds to do if you know how to spell the name of the drug. I think you’ll find very surprising information that you’ll never get from an ad, and it’s very easy.

I know a lot of people who, as we get older, are taking more medication and suddenly they’re having these weird complications. They don’t know what’s going on. They can go and see, “This new medication I started taking, one of the known side effects is hallucinating,” or dizziness, or whatever it is that the doctor didn’t warn them about.

But it’s online, it’s easy to find and then you can go to your doctor and say, “I’ve started having these weird problems and I see that it might be a side effect of this new medication. What should I do?”

Helen Osborne: Thank you. I had an experience just like that this week. I was on this little new med and I said, “What’s going on with me?” I typed that in, I saw it’s a common side effect, I followed up with the doctor and it’s all taken care of.

Diana, I want to thank you, thank you, thank you for raising our awareness and letting us know that we’re not making this up. There are more of these ads and they’re on all kinds of products that affect our lives.

There are government ways to kind of put some limits around this, but they’re not working all that well in the real time, maybe in hindsight, and the communication strategies are great.

I thank you so much. I just keep learning from you, Diana. You are great. Thank you for being a guest on Health Literacy Out Loud.

Dr. Diana Zuckerman: Thanks so much for inviting me.

Helen Osborne: As we just heard from Diana Zuckerman, it’s important to notice about ads for medication, too, those that might be very well done and on TV. It’s important to be aware of those, what they’re doing, how they’re helpful and often how they are not. That’s part of health literacy.

For help clearly communicating your health message, please look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. Get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

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Until next time, I’m Helen Osborne.

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