Do you have mesothelioma? Probably not, since it makes up less than .3% of all cancer diagnoses. But you’ve probably been asked if you have it, or any number of other conditions, if you’re a regular watcher of television.

It’s become a normal part of the American TV diet. You’ll see car commercials, you’ll see movie trailers, you’ll see pharmaceutical ads. Each ad is almost indistinguishable from the last, featuring a canned opening with an actor followed by a long list of possible side effects and deadly prescription combinations set to an elderly couple walking along the beach. The format is so widely known that it gets parodied ad nauseum. It’s all so familiar.

But it wasn’t familiar to the millions of British viewers who tuned into Sunday night’s dramatic interview between Oprah, Prince Harry and Meghan Markle. Viewers from across the pond were surprised at the amount and presentation of American pharmaceutical ads, and a number of viral tweets compiled by Ayesha Siddiqi drew further attention to them.

“i’m watching the meghan interview recording and yet again i can’t understand why american tv ads are like “ask your doctor for…” or “tell your doctor…” wrote user silverskyy. “Why the fuck would you be the one to tell a doctor what medicine to give you????? Maybe i’m too european to get it but wtf.”

“HELP why are all american ads about medicines??” wrote user SIMPRINT.

In the United Kingdom, advertising prescription drugs directly to patients is illegal — only promoting drugs directly to practitioners and prescribers is allowed. As a result, you won’t see any ads asking if you or a loved one is living with mesothelioma on your next trip to London. So while a British doctor may end up prescribing the same medicine as an American doctor, it won't be because you asked them to prescribe it, as many American medicine adverts encourage viewers to do.

The adverts and reactions from British viewers brought increased scrutiny and attention to American pharmaceutical ads — but how did these ads become such a staple of American television while they’re absent in the UK? According to the National Institute of Health, the FDA expanded its regulation of direct-to-consumer pharmaceutical ads significantly in 1997.

“Proponents [of these ads] claim that good direct-to-consumer advertising educates and empowers patients in their relationship with their healthcare providers. Furthermore, they assert that direct-to-consumer advertising provides an opportunity for patients to talk to providers about under-diagnosed and under-treated medical conditions that may lead to improved health outcomes,” says the National Institute of Health’s article on the history of pharmaceutical ads. “Opponents of the practice argue that there is an inherent conflict of interest for pharmaceutical companies in advertising products directly to patients and that the decision to advertise is not based on concern for the public health but rather investment return.”

British viewers on Twitter seemed to align themselves with opponents of the practice. “These medical adverts and the side effects though,” wrote TeaPartyBeauty. “American healthcare truly is a business.”

That brings up another question: why does listing a medicine’s side effects take up the majority of each commercial?

When the FDA expanded its direct-to-consumer pharmaceutical ad regulations, it created specific guidelines each ad must follow in order to air on television. As a part of these guidelines, each ad must list every side effect of the drug, including all contraindications (dangerous combinations of medications), warnings, major precautions (such as warning pregnant patients not to use the drug) and “the 3-5 most common non-serious adverse reactions most likely to affect the patient’s quality of life or compliance with drug therapy.” Hence, the long side effect lists. Each ad must also contain some combination of a toll-free telephone number, a referral to a print advertisement, a referral to a healthcare provider, or an internet web page address.

“American ads make me feel like I’m in some post apocalyptic-world,” wrote user IngaRochelle.

With the overwhelming number of negative reactions from first-time medical ad viewers, one has to wonder why pharmaceutical companies advertise their medications at all if the majority of their ad will be taken up by a long list of frightening possible side effects. The simple answer is that the ads work. 

Over time, viewers become numb to them and they become just another advertisement interrupting their show. In 2017, a study at the University of Pennsylvania found a strong correlation between drug advertisements and usage of said drug. We estimate that a 10% increase in advertising exposure increased the number of prescriptions purchased by about 5%,” said Wharton health care management professor Abby Alpert. “About 70% of this effect is driven by increased new initiation, and the other 30% is due to increased drug adherence among existing patients.” 

Five percent may seem like a small number, but it’s substantial enough to make pharmaceutical ads a cottage industry. But with the National Health Service in the United Kingdom under frequent attack by those who wish to take the healthcare service into the private sector, it may not be too long before British TV viewers are watching couples walk along a hilltop set to a laundry list of deadly drug side effects.

About the Data:

Thinknum tracks companies using the information they post online, jobs, social and web traffic, product sales, and app ratings, and creates data sets that measure factors like hiring, revenue, and foot traffic. Data sets may not be fully comprehensive (they only account for what is available on the web), but they can be used to gauge performance factors like staffing and sales.

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