Online Drug Promotion: A Prescription for Deception

In our technological age, online access to health information is vital. A July 2010 survey revealed that three-fourths of U.S. adults searched the Web for health information, with 62 percent of them having done so within the previous month.[1] The pharmaceutical industry now markets its most lucrative drugs to Internet users, spending more than $1 billion on online drug marketing in 2011.[2]

Unfortunately, the regulations overseeing such marketing have not kept pace with current trends: The Food and Drug Administration (FDA) has lagged behind in setting clear rules for what is permissible.[3] This regulatory vacuum has predictably led to a litany of questionable marketing practices that continue to go unchecked.

Sponsored links and ‘vanity URLs’

One frequently used marketing tool is the so-called “vanity URL.” The vanity URL is found within the shaded box labeled “sponsored links” that appears at the top of a page of search results on a search engine such as Google, Yahoo or Bing. Unlike other ads within this shaded box, the vanity URL omits any mention of an advertised product, purporting to be an educational site informing readers about a particular disease.

For example, entering “high blood pressure” into a search engine yields a “sponsored links” box promoting sites such as www.understand-high-blood-pressure.com or www.managingmybloodpressure.com. These links immediately redirect the user to the official promotional site for a product treating the disease, in this case nebivolol (BYSTOLIC) and olmesartan (BENICAR), respectively. As of 2009, unbranded vanity URLs such as these had replaced branded ads as the sponsored links most commonly used by the pharmaceutical industry.[4]

Google generally prohibits the use of vanity URLs because of their deceptive nature, but the site makes an exception for the pharmaceutical industry,[5] possibly due to the lucrative sums the drug industry pays for this privilege. The FDA, meanwhile, has yet to take a position on vanity URLs, instead stating that it is working on the issue as part of its broader guidelines, still pending, on online pharmaceutical promotion.[6]

‘Help-seeking’ ads

Not all drug industry-sponsored links are misleading; some link to sites that do, in fact, seem to contain only generic, disease-specific information. However, these so-called “help-seeking” websites (for instance, www.arthritis.com) operated by drug companies are equally deceptive and are exempt from FDA regulations, as long as they do not recommend any specific drug to treat the disease in question.[7]

Although the drug industry argues that help-seeking advertisements are an innocuous way to raise public awareness of diseases, the companies benefit from these advertisements in at least two ways. The most straightforward is the fact that the websites usually contain direct links (under a “Treatment Options” tab, for example) to the sponsoring company’s brand-name drug for the condition. The websites also are often subtly designed with characteristics, such as color schemes and fonts, to resemble the company’s drug promotional websites. In some cases, the information is presented in such a way as to refer to the companies’ drugs in all but name only, prompting FDA warnings on a number of occasions.[8]

The ads also serve to convince otherwise healthy people that they might have the disease in question and that the medication linked from the help-seeking website is the right treatment for their (potentially nonexistent) disease. As health journalist Martha Rosenberg said: “When the medication is ready, the disease (and patients) will appear.”[9] This is especially successful for conditions in which the symptoms are vague and subjective.

One prime example is the help-seeking website www.isitlowt.com. “Low T” is a relatively new “condition” that refers to lower-than-normal testosterone levels in older men. Low testosterone levels are a normal result of aging, and though certain men may have especially low levels, the medical community is unsure of what constitutes “normal” levels or whether low levels of testosterone could even cause a patient’s symptoms.[10]

The sponsor of this help-seeking website, Abbott Laboratories, manufactures a medication called testosterone gel (ANDROGEL), which is indicated to boost testosterone levels in the nebulous category of men with “low” testosterone. Visitors to the website are urged to take a “low T” quiz to find out whether they have the disease, featuring questions about familiar “symptoms,” such as: “Are you sad and/or grumpy?” or “Are you falling asleep after dinner?” Once users are persuaded that they have the condition, they are invited to learn more about treatment options by visiting the promotional website for ANDROGEL.

What You Can Do

Here are some tips to bypass deceptive advertising and obtain truly unbiased, noncommercial health information.

If you use a search engine, such as Google, to find information on a particular disease, avoid all sponsored links in the shaded box at the top of the results page.

For all websites that seem to provide health information, scroll down to the bottom of the home page to find out whether a drug company is the site’s sponsor. If so, it is likely a help-seeking ad, and you should instead seek out unbiased sources.

Look for URLs that end in .gov. Government websites are reliable sources of health information. One particularly good source containing detailed information on every major disease is the National Institutes of Health’s “Diseases and Conditions” website, which features concise summaries of the causes, symptoms and treatment for hundreds of conditions. You can access the website at www.ncbi.nlm.nih.gov/pubmedhealth/s/diseases_and_conditions.

References

[1] “Cyberchondriacs” on the Rise? Harris interactive poll (page 2, table 1). http://www.harrisinteractive.com/vault/HI-Harris-Poll-Cyberchondriacs-2010-08-04.pdf. Accessed June 19, 2013.

[2] Bosch T. FDA Releases Draft Guidelines on Social Media and the Pharmaceutical Industry. Slate. Jan 3, 2012. http://www.slate.com/blogs/future_tense/2012/01/03/big_pharma_and_social_media_fda_releases_draft_guidelines.html. Accessed on November 2, 2012.

[3] Personal communication (phone conversation) with Jean-Ah Kang of the FDA’s Office of Prescription Drug Promotion, November 2, 2012. The FDA is currently working on this and many other questions raised in the November 2009 public hearing on online drug promotion, but no firm date on when final guidances will be issued was given. Also, Ibid.

[4] FDA Warning Letters Caused Dramatic Decline in Sponsored Link Exposures, According to comScore. comScore (2009 Oct 1). http://www.comscore.com/Press_Events/Press_Releases/2009/10/FDA_Warning_Letters_Caused_Dramatic_Decline_in_Sponsored_Link_Exposures. Accessed June 19, 2013.

[5] Display URL: What's the policy? Google advertising policies. http://support.google.com/adwordspolicy/bin/answer.py?hl=en&answer=175906. Accessed November 1, 2012.

[6] Personal communication (phone conversation) with Jean-Ah Kang of the FDA’s Office of Prescription Drug Promotion, November 2, 2012. The FDA is currently working on this and many other questions raised in the November 2009 public hearing on online drug promotion, but no firm date on when final guidances will be issued was given.

[7] Basics of Drug Ads. Help-seeking advertisements. FDA. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising/ucm072077.htm#help_seeking. Accessed November 5, 2012.

[8] Regulatory Alert: Unbranded Promotions Targeted by FDA Enforcement Actions. May 5, 2010. Digitas Health (Analyst: Dale Cooke). http://www.digitashealth.com/pdf/regulatory_alert_unbranded_enforcement_digitas_health.pdf. Accessed November 5, 2012.

[9] Rosenberg M. Eight Invented Diseases Big Pharma Is Banking on. Alternet. April 15, 2010. http://www.alternet.org/story/146471/8_invented_diseases_big_pharma_is_banking_on. Accessed November 1, 2012.

[10] Deardorff J. The reality of low T. Chicago Tribune. March 01, 2012. http://articles.chicagotribune.com/2012-03-01/health/sc-health-0229-sex-low-t-20120229_1_low-testosterone-testosterone-replacement-lab-results. Accessed June 19, 2013.