Some of the earliest advertisements in history came from what was later to become pharmaceuticals. Indeed, our story starts in the 18th Century.
Patent Medicines of the Eighteenth Century
It was the ads for patent medicines, known as Nostrum Remedium, that drove circulation of many newspapers. They were among the first categories of the advertising industry. Emerging from as early as the 1700s, patent medicine products (nostrum remedium) were sold at high prices, and made from inexpensive ingredients. They used basic branding to stand out and often contained royal endorsement to protect the brand from copycats.
False product claims were rife. There was no regulation. Drug companies and many individuals could concoct outlandish recipes, patent them and market them however they wished with impunity. These were widely printed in the US and the UK in the 1800s. Scientific method – observation and thorough testing of hypotheses for an evidence-base – was yet to be established.
Looking back at early examples is hilarious. Patent medicines were often patently absurd. Things like weight-loss bath salts, cigarettes for asthma, and ointments that promised to offer “a certain and sure cure” for a range of completely unrelated maladies and disorders.
Here are a few examples:
Australia was by no means exempt from all this. A book about Colonial Australia reveals 500 print ads including one for pills that promised to enrich the blood, restore strength, straighten the spine and tone the nerves. At the time, both cannabis cigarettes and opium were available for sale in Sydney and Melbourne.
On the other side of the world, China with a long history of Traditional Chinese medicine (TCM), had (and continues) to use fat extracted from a water snake as a topical treatment. The water snake oil was rich in omega-3s and is an effective anti-inflammatory used for arthritis and bursitis. It was used by many of the Chinese indentured labourers in the United States who were building the transcontinental railroad. Hence, snake oil was introduced to other Americans. One of those Americans was Clark Stanley.
Stanley was an opportunistic entrepreneur who saw the potential to profit from snake oil. He developed a false story about learning a recipe from Hopi medicine men that used rattlesnakes and began advertising his wares.
At the 1893 World Expo in Chicago, Stanley gave a shocking product demonstration that involved killing and boiling a live snake to skim off its oil. The theatrics proved effective. Sales soared. Research much later revealed that Stanley’s rattlesnake oil was very low in the therapeutic properties compared to the Chinese version and that the products themselves did not actually contain rattlesnake oil in the first place. They what they actually contained was beef fat, red pepper and turpentine. Consumers had been double-diddled! Stanley is also responsible for the derogatory term ‘snake oil salesman’ which is now synonymous with ‘charlatan’.
Come 1905 and American journalist Samuel Hopkins Adams had had enough. He investigated the wild west of Nostrum Remedium products and published 11 muckraking articles about the patent medicine fraud in the respected Collier’s Weekly magazine. It was an exposé that, along with attention from other journalists, led to action by Congress.
In the United States, the Pure Food and Drug Act came into law in 1906. For the first time, product manufacturers were forbidden by law from “the manufacture, sale, or transportation of adulterated or misbranded or poisonous or deleterious foods, drugs or medicines, and liquors.” The law mandated drug purity levels and some products needed to list ingredients on the packaging.
However, advertising and promotion of the products were left out of the legislation, so product claims continued to be unregulated.
In the USA, the Federal Food, Drug, and Cosmetic Act in 1938 gave the Food and Drug Administration (FDA) the authority to regulate drugs. Drug companies needed the approval of a product’s safety before they could provide it.
Through the 1960s in the United States, there were a number of changes and new cases that curtailed pharmaceutical advertising. They included: providing proof of effectiveness as well as safety, not making false and misleading product claims, listing risks and benefits in a fair and balanced way, including all facts relevant to the advertised use, and including a summary of risks. The conflation of changes to the Pure Food and Drug Act since 1906 meant that advertising direct to consumers (DTC) was no longer viable. But this all changed again in the 1980s with political and cultural changes.
Direct to Consumer (DTC) Drug Advertising Today
During the Reagan era of the 1980s in the US, and through the 1990s, drug companies were heavily running print, radio and television drug commercials to consumer audiences.
As at 2006, through online advertising and other forms of DTC marketing, one study found that pharma spends around 40% of promotional budgets on DTC. A 2011 study found that online DTC advertising earned a 5 to 1 return on investment, better than traditional methods like print and TV.
The promotion of prescription drugs to consumers was made possible by the rise of consumer-oriented medicine following the social movements for patients’ and consumers’ rights. However, whether this has been a constructive or destructive aspect of the American healthcare system is very much open to debate. Food and Drug Administration (FDA) is responsible for regulating DTC advertising for prescription medications. The Federal Trade Commission (FTC) is responsible for oversight on over-the-counter medications.
Canada’s Drug Ads
Canada does not allow advertising direct to consumers. However, of the ads to doctors studied in Canadian medical journals, one study found that about one third contained misleading information.
An earlier Canadian study of the radio advertising of over-the-counter (non-prescription) medicine found that one third failed to comply with regulatory requirements.
Drug Advertising in Australia
In Australia, advertising pharmaceutical drugs directly to consumers is banned. The Therapeutic Goods Advertising Code mandates how and where non-prescription and complementary medicines are allowed to be advertised and the allowable claims that can be made. The Code is upheld by government, industry, and consumers to ensure compliance.
Advertisements for therapeutic goods directed to consumers may also need to be formally approved by Consumer Healthcare Products (CHP) Australia or Complementary Medicines Australia (CMA) if they are to be shown in media such as TV or public billboards.
The Code of Conduct for the Australian Pharmaceutical Manufacturers Association governs the standards for marketing drugs to health professionals. With all of these separate codes and there is a tight web of compliance oversight.
For prescription medicines, a reader-friendly leaflet called the Consumer Medicines Information (CMI) is provided. The leaflet is the result of collaboration between industry, consumers, and health professionals to provide accurate, easy to understand information.
Having said that, just because drug companies can’t advertise specific drug brands direct to consumers, doesn’t mean they are not ubiquitous in the public consciousness. Pharmaceutical companies have other effective methods for promotion without naming product brands. For example, drug companies focus on educating consumers about chronic conditions and specific symptoms as benefiting from medical intervention. One example of this is the alleged Female Sexual Dysfunction.
Some consumers believe it is their right to have information. Others, including many doctors, believe it is irresponsible for a consumer to believe an advertised product is right for them, such as one alleviating mild anxiety, when a lifestyle change might be as effective and be without harmful side effects. It is noted by NPS medicine wise that it is unfortunate that “common problems experienced at different life stages” are often communicated as a disease requiring treatment.
New Approaches to Pharmaceutical Marketing
As of 2008, only two countries allow DTC advertising of pharmaceuticals: the USA and New Zealand.
Many new medical marketing strategies have emerged in recent years. In the USA, these include online display advertising, social media, research, patient associations, key opinion leaders (influencer marketing), patient influencers, and mobile advertising.
More commonly, pharmaceutical marketing is targeted to prescribers. It involves visits by sales representatives, free samples, and continuing medical education (e.g. seminars, workshops, retreats), journals ads, and hospital marketing.
In Australia, patient testimonials are prohibited, as is the use of patient influencers.
According to an industry veteran, in Australia, it is good ole print which is the “most effective tool of most pharmaceutical marketers in terms of ROI.” This is not to say that pharma doesn’t understand the power of search or social, it does use this very carefully in a constrained fashion, but they are outside the scope of what’s most legally permissible due to Australia’s the heavy compliance requirements.