If you watch network prime-time news programs at all, you can’t help but be impressed by the number of direct-to-consumer (DTC) ads that dominate the commercials. It seems the demographics of the viewers of these programs are older folks, ideal targets for all manner of medication-focused commercials. The conditions that dominate the DTC ad space are inflammatory disorders—Crohn’s disease, rheumatoid arthritis, psoriasis, psoriatic arthritis, and eczema. The ads tout remarkable results and urge viewers to ask their doctors if certain drugs are “right” for them.
Explore This IssueACEP Now: Vol 38 – No 07 – July 2019
Of course, the goal is to get physicians to “write” prescriptions. Most physicians think of themselves as being immune from such pressures. But, apparently, the pharmaceutical companies have reason to think otherwise—which is why these ads are prevalent. In the United States, DTC advertising expenditures were about $6.13 billion in 2017.
DTC ads are banned everywhere except in the United States and New Zealand—and there are processes under way in New Zealand to ban them again. The New Zealand Medical Association has opposed the law allowing DTC ads since 2006. The American Medical Association has opposed DTC advertising only since 2015.
The focus of most DTC advertising centers on the psychosocial aspects of the various targeted diseases. Ads for psoriasis depict embarrassment when a patient’s involved skin is exposed to the public on the beach. Ads for monoclonal antibodies against Crohn’s disease depict the unexpected and socially inconvenient urge to go to the bathroom. Generally, the focus is curing the pathology in order to deal with the embarrassment and limitations these conditions impose on patients and not just the clinical symptoms.
Meet the “Mabs”
Let’s take a look at anti-inflammatory monoclonal antibodies, which many of us now casually refer to as “mabs.” In the past, steroids were used to suppress inflammation, but they had widespread effects that were often problematic. Over time, scientists were able to develop anti-inflammatory drugs that had more dominant effects on certain organs or tissues. The analogy to steroids is important in that, although they target certain organs, mabs still can have some systemic effects, just like steroids.
As of 2017 there were 73 mabs approved by the US Food and Drug Administration (FDA). Ten new ones were approved in 2017, up from one in 2010 and three in 2013. Since then, a total of 33 new mabs have been approved in the United States. Of the 73, 34 are for cancer, 26 are for immune disorders, four are for infections, three are for cardiovascular disease, and six are for other problems. It is anticipated that worldwide sales of mabs will approach $125 billion by 2020.
The names of the specific mabs and their relatives are infamously unpronounceable, but there is a method to the apparent madness of how they are named. The original source of the mab is established by the letters before “mab.” Specifically: