Under the Influence with Terry O'Reilly - Weight Loss Drug Ads: Good or Bad?

Episode Date: October 5, 2024

Companies are spending big bucks advertising weight-loss drugs like Ozempic and Rybelsus. This week, we’re dropping an episode of Brian Goldman’s White Coat, Black Art podcast into our feed.We thought you might find the topic interesting. In Canada, "reminder ads" can only give the medication's name, but they can’t tell you what the drug is for. They just tell people to ask their doctor for more information. I join Dr. Goldman in this episode to talk about those ads.Are those ads good – or are they bad? Hosted on Acast. See acast.com/privacy for more information.

Hi, it's Terry O'Reilly. As you may know, we've been producing a lot of bonus episodes while under the influences on hiatus. They're called the Beatleology Interviews, where I talk to people who knew the Beatles, work with them, love them, and the authors who write about them. Well, the Beatleology Interviews have become a hit, so we are spinning it out to be a standalone podcast series. You've already heard conversations with people like actors Mark Hamill, Malcolm McDowell, and Beatles confidant Astrid Kershaw. But coming up, I talk to May Pang, who dated John Lennon in the mid-70s. I talk to double fantasy guitarist Earl Slick, Apple Records creative director John Kosh. I'll be talking to Jan Hayworth,

who designed the Sgt. Pepper album cover. Very cool. And I'll talk to singer Dion, who is one of only five people still alive who were on the Sgt. Pepper cover. And two of those people were Beatles. The stories they tell are amazing. So thank you for making this series such a success. And please do me a favor, follow the Beatleology interviews on your podcast app. You don't even have to be a huge Beatles fan, you just have to love storytelling. Subscribe now and don't miss a single beat. This week, we're dropping an episode of my friend Brian Goldman's White Coat Black Art podcast into our feed because we thought you might find the topic interesting.

Companies are spending big bucks advertising weight loss drugs like Ozempic and Rebelsis. But here in Canada, reminder ads can only give the medication's name. They can't tell you what the drug is for. They just tell you to ask your doctor for more information. I joined Dr. Goldman in his episode to talk about those ads. Are they good or are they bad? Back in 1981,

Liz Mensch applied for a job in marketing at Boots Pharmaceuticals in the U.S. At her job interview, the 23-year-old was surprised when the company president said the drug company's customers are the doctors who prescribe the pills. She told the president that the actual customer should be the patients who take the pills. Mensch got the job, and in 1983, Boots aired the first TV prescription drug commercial in America, a TV spot for a pain

reliever called Rufin. Just 48 hours later, the U.S. government made the company take it down. Still, it was only a matter of time until pharma put consumers under the influence. Terry, what are you doing? This isn't under the influence. It's White Coat Black Art. And I'm Dr. Brian Goldman. Right. Sorry, Brian.

And that's Terry O'Reilly, host of the CBC's Under the Influence, and our very special guest. He's standing by because he knows commercials like I Know Medicine. This week, we're talking about a particular kind of prescription drug commercial that is ubiquitous on Canadian TV, commercial radio, and podcasts. Commercials like this one. Order up for Damien. Hey, how did your doctor's appointment go, by the way? Did you ask about Rebelsis? Actually, I'm seeing my doctor later today. Did you say Rebelsis? My dad's been talking about Rebelsis.

Rebelsis? Really? Yeah, he says it's a pill that... That's right. Did you know it's also covered by most private insurance plans? Well, I'll definitely be asking my doctor. We can't air the entire ad because we haven't licensed it, but you probably know how the rest of it goes. They want you to ask your doctor if Rebelsis is right for you. Now, I can tell you that Rebelsis is a pill that contains semaglutide, the same ingredient found in Ozempic and Wegovy, that the medication can help you lose weight and lower your A1C, and the side effects.

All the things that American drug commercials mention in sometimes nauseating detail. In Canada, pharmaceutical companies can only run what they call reminder ads. You know, there's this medication you can take, but we can't tell you what disease it's for. Or they can run so-called help-seeking ads where they name a disease and tell you there's a drug treatment but can't name the drug. I wonder what these ads actually accomplish. Which is why we've brought in a real expert.

Hi, I'm Terry O'Reilly. I'm the host of Under the Influence on CBC Radio. And I am, I guess you would call me a career ad man. Been in the business for about 40 years. Wow, that's as long as I've been in the business of emergency medicine. And we kind of started the same year, I think, on CBC. Yeah, it's almost like we're doppelgangers. Yeah. Terry O'Reilly, welcome to White Coat Black Art.

Well, great to be here. Thanks for having me. I've seen and heard this Rebelsis ad probably 50 or 60 times, and when that was in heavy rotation, it drove me crazy. It's obviously a dorky ad, but I'm going to ask you as an ad man, please dissect it. What do you think of it? It's painful. I'll start with that. The acting is so stiff. Clearly, they're using non-union actors. All the people in that ad are slightly overweight, I would say. And so that's an important casting call right there for that ad. You'll notice that when they went to say what Rebelsis does, there was a loud sound of a coffee grinder obscuring whatever they said because that ad is trying to exist within the Canadian pharmaceutical advertising regulations, which stipulate that you can't tell the audience in the commercial what the prescribed drug does. You can only talk about brand name, price, which they never do, and quantity. That's

all you can say in Canada in a pharmaceutical ad. So they're trying to get people to remember the brand name by saying it about a thousand times in that commercial. And then hopefully with all the other online chit-chat about this and in the press, they're hoping people will connect the dots and then go ask their doctor about it. So, you know, I gather the generic term for this kind of an ad is a reminder ad. You're the ad man. What is a reminder ad supposed to do? Well, it's supposed to plant the brand name in your mind. Think about Ozempic, for example, they used that jingle from 1974 from that hit song by the group Pilot, which was called Magic. So they have co-opted that jingle, changed the word. So instead of it's magic, it's Ozempic. So remember that a jingle is one of the best ways, even though it's fallen out of favor in my industry by and large, a jingle is the best way to get somebody to remember something.

Since you mentioned Ozempic, let's play this ad for the product that we heard incessantly during the Summer Olympics. Have a listen. I just asked. And of course the O-O-O, I guess, is for Ozempic. It kind of nods to the jingle, the song that you were talking about, but it's its own jingle. I guess it's its own creative. Everybody's talking about Ozempic because it's in the news. There's all kinds of earned media.

It's talked about on talk shows. Rebelsis doesn't have that advantage, does it? No, because I think Ozempic had a first move advantage. It's really become the Kleenex of rapid weight loss drugs, hasn't it? It's kind of the Viagra of the category. So I think all the other drugs that are coming after it are going to have to do a lot of ketchup to try and get the same brand name awareness. No doubt about it.

You know, I'm going back to that kind of mediocre execution of these ads. In part, you've said, you know, they're hamstrung by what they can and they cannot say. But is that a poor excuse for lack of creativity, in your opinion? Absolutely. I've always said that creativity loves constraint, meaning that when you're constrained in some fashion, whether it be by regulation or budget or time, not enough time to do it well, that it fuels creativity because it forces you to go down an unconventional route, you know, give up all the conventional thinking to figure something out. And the constraints of that, you can lead and usually do lead to great creativity. Have you ever worked on a pharmaceutical commercial in Canada or an ad campaign?

I have. Not very many. Over the 40 years, I have to say pharmaceuticals weren't that active on mainstream media for most of my career. I think that the gates really opened maybe about 10 years ago where they really started to be active. I did some of the early Viagra work, which was interesting. So there's an advertising agency in Canada called Taxi Advertising. And when Viagra hit the market, it had the same stipulations and regulations. You couldn't say what it did. So they did what I think is some of maybe the best pharmaceutical advertising ever done. So the first ad, if people remember, all it showed was this average guy walking out of his home in the morning and whistling and singing to this song about good morning, good morning. And he's skipping all the way to work. You know, he's smiling. At the end of this, of the commercial,

the elevator closes and he kind of gives us a the end of the commercial, the elevator closes, and he kind of gives us a wink and a raised eyebrow, and the elevator closes, and all you see is the Viagra logo. I remember the song. It was so well done. Good morning. Is that Debbie Reynolds? Exactly.

I think it is, but it was such a funny commercial. I mean, you didn't know what it was for, but then you knew what it was for. But they just skirted the regulation so beautifully. In other words, they went right to the line with it, but didn't cross the line. Then subsequent campaigns, Brian, that Taxi did. There's one where there's two golfers. Guys look like they're in their 60s or 70s golfing. And one of them says, what'd you do last night?

And he says, well, get a load of this. Oh, can you believe that? Hey, that's nothing. It's morning. And then there's a blue Viagra pill covers his mouth. So you can't hear what he's saying, but then you realize at the end of the spot that he's talking about how much sexual activity he had last night. Again, showing that even within the limitations and restrictions of pharmaceutical advertising, there's still lots of room for creativity, which you rarely see in the category. You know, I'm assuming it costs a lot of money to make ads like that one and buy ad time. So you're not talking to the ad execs who are doing those campaigns, but you have insider knowledge. Why

are pharmaceutical companies spending that kind of money on ads like that and buying airtime? Because the upside is so huge. I was reading that Ozempic spent in 2023, I think they spent $120 million on media time in the US alone. I mean, that's big. Very few big brands spend that kind of money. So the upside is unbelievable. They figure, you know, they've done the math that by spending $120 million that the return will be in multiples of that. You're listening to White Coat Black Art. This week, a look at the value and purpose of those prescription drug ads that encourage you to ask your doctor. In 2023, US pharmaceutical companies spent $2.87. on advertising for the top 10 brands alone, up from $2.5 billion the year prior.

That's according to Vivix, a U.S. company that provides information to drug company clients. We don't have comparable figures for Canada, but the money spent here on ads is in the tens of millions. And the Association of Canadian Advertisers says pharmaceuticals are driving ad spending growth. As Terry said, pharma would not spend the money on ads if they didn't expect a return on investment. One expert I've known for years is Barbara Mintzis. She's one of Canada's leading authorities on the impact of direct-to-consumer prescription drug ads on patients and their doctors. She's a professor at the University of Sydney in Australia,

where we reached her. Barbara Mintzis, welcome to White Coat Black Art. Thank you. We've heard from Terry O'Reilly about Canada's restrictive rules for advertising prescription drugs. So what's the deal? Remind us why we have reminder ads. Well, we have reminder ads because actually it's against the law in Canada to advertise prescription medicines to the public. And these reminder ads have been allowed since actually late 2000, really through a loophole in the law. So it was a reinterpretation of a clause in the Food and Drugs Act that says

that prescription drugs can be advertised to the public, but only name, price, and quantity can be mentioned. That was brought in just to allow pharmacists to post comparative prices. It had nothing to do with really these kinds of ask your doctor ads that we're seeing now. Wow. That is so interesting that a kind of a legal quirk or regulatory quirk has allowed these ads to proliferate. And I think it's also I mean, you have to also look at what was happening at the time. government and every other government like ours that had a law against prescription drug advertising was under huge industry pressure to change our laws to make the situation much more like the United States. So in the late 1990s, the U.S. had really opened up television advertising of prescription drugs. And so the Canadian government, actually what happened was that

Health Canada brought in a new administrative policy. In essence, they found a way to partially give in to industry pressure without needing to change the legislation, without needing to go to parliament to consult with the provinces. What is the redeeming social value behind reminding the public to ask their doctor, for instance, whether Ozempic is right for them? There is no redeeming social value. So interestingly, in the United States, these ads for Ozempic and Ribelsis would be completely illegal. We always think about Canada as, you know, kind of having stronger regulations than the U.S. when it comes for this,

the unfettered free market. In this case, because these are drugs that have what is called a black box warning on their prescribing information, which warns about a serious risk to health. In this case, the warning is about a risk of thyroid cancer. In the U.S., reminder ads are not allowed to either doctors or to the public for drugs with black box warnings. So that's because of an understanding that what is the benefit to health really of an ad that reminds you of a brand name? Well, at least in the United States, the drug ads tell you exactly what the pharmaceutical product does. They also give that litany of side effects, often at breakneck speed.

Rebelsis isn't for people with type 1 diabetes. Don't take Rebelsis if you or your family ever had medullary thyroid cancer or have multiple endocrine neoplasia syndrome type 2 or if allergic to it. Stop rubellsis and get medical help right away. If you get a lump or swelling in your neck, severe stomach pain. Yeah. And of course, there was that medullary thyroid cancer that you mentioned. Right. Yeah. You know, jokes aside and people, you know, stand up comics make a lot of and talk show hosts make a lot of jokes about those kinds of commercials. But how would you compare the social value of that kind of ad to what we have here in Canada? Well, I would say that neither of them really have social value except for the company that's running them.

Like that's, if you're thinking of, okay, what is the value? The value is in increasing sales. Now, the reason, of course, that they've got all those side effects on the U.S. ads is that the U.S. FDA requires this. What do we know from research about the impact of pharmaceutical ads? What can you point to? So there's now a whole body of research because this kind of advertising prescription drugs to the public has been around for about a quarter of a century, a little bit more. So what we know is that when a person comes into their doctor's office to ask for an advertised drug after having seen an ad, they're very likely to leave with a prescription for that product. And that doctors also have reported feeling under pressure from patients to prescribe drugs that they've seen advertised. There's survey data from the U.S. about that. I carried out a study in family doctor's offices in, actually it was in Vancouver and Sacramento, in which we surveyed patients in the waiting room about what they wanted from the

appointment. And then we also had the doctors fill out a short questionnaire after the consultation. And what we found is that doctors were very likely to prescribe the drug that the person had asked for, but they were also much more likely to say that they would not have prescribed or they would have been less likely to prescribe the drug to another similar patient. What concerns do you have with people requesting a drug that they really only know by name recognition? The concerns would be that they may not even have the condition the drug is actually approved and tested and found to be beneficial to treat. So if you have something like the rhabelsis or the ozempic ads, you're looking at pictures of people who are just a

little overweight. And essentially, the drug is approved for use in type 2 diabetes, not for weight control. That's one thing. The other thing is that if they're taking a drug that really isn't going to help them because they don't have the condition that it's aimed to treat, or they have very mild symptoms where that might be better treated without a drug, they're just as likely to suffer side effects as somebody who would benefit from the drug, but they're not getting any benefit. They're only at risk for harm. These are also very new drugs usually, and we don't have the long-term data to know what the effect really will be in the long term. And then the other side is really

costs and sustainability of healthcare services. People are paying more money for these drugs than they might be paying for another alternative. If we're covering them through our healthcare service, then we also are spending money on things where we're not getting good sort of health return on our investments. Can you at least make a partial case that getting people to ask their doctor may be of some value to some patients because it makes them aware of something they might have been completely unaware of before? I think it's hard to make that case, I have to say, for these Rebelsis and Zempic ads. Now, that case was made a lot, for instance, for Viagra, that people were aware of it.

I mean, I don't think the reminder ads are really going to do anything other than branding. So what changes in prescription drug advertising would you like to see in Canada? So I would like to see the loophole that Health Canada opened up through their administrative policy in the year 2000 closed again.

There really is no rationale from any public health perspective to allow reminder advertising in Canada. And it's especially of concern because this is a kind of advertising that the U.S. controls more than other ads and doesn't allow for drugs for serious risks. So that's one thing. The other would be to really ensure that when U.S. media is targeting a Canadian audience, that they are not running advertising that is illegal in Canada. This is something that other countries have in place that we certainly could have in place in Canada. What's your advice to consumers who are going to continue to watch these reminder ads for the foreseeable future? My advice would be a strong grain of salt.

There was a quite well-known British pharmacologist, Andrew Herxheimer, who had a quip about pharmaceutical advertising that it's the truth, the half-truth, and nothing like the truth. They're giving you the idea that this drug is a magical solution. Reality is a little different. When it comes to reminder ads, there's another sobering reality that's more than a little different. While we debate the pros and cons of reminder ads in Canada, Canadians can watch those detailed drug ads coming from the U.S. pretty much every day. I can recite a commercial for Wegovy in my sleep. So let's bring back Terry O'Reilly

to grade those U.S. offerings. We have a couple of U.S. ads that I just want you to quickly comment on. Here's one for a product called Skyrizzy, which is a biologic that's used to treat psoriasis. It's also used for people who have colitis, inflammatory bowel disease. Have a listen. With Skyrizzy, three out of four people achieve 90% clear skin at four months. Of those, nearly nine out of 10 sustained it through one year. And Skyrizzy is four doses a year after two starter doses. Skyrizzy may increase your risk of infections Dr. Dose is. Skyrizy may increase your risk of infections and lower your ability to fight them.

What do you think of that? Well, you heard the fair balance issue there where they had the side effects about the same length of time as they talked about the benefits. And interesting, they're singing the benefits of that drug. Nothing is everything. Yeah. You know, you can show your skin because you don't have psoriasis because you're using the benefits of that drug. Nothing is everything. Yeah. Yeah. You know, you can show your skin because you don't have psoriasis because you're using this product. Exactly right. But interesting choice to sing the benefit in a very kind of upbeat pop kind of way.

You know, the basic age range for Ozempic, the target audience from what I've been reading is 50 to 55. That's the sweet spot. That commercial makes me feel like it's probably people in their 20s because of the sound of that pop tune. Yeah. Or teens even, late teens. Are there any US commercials that you like? No. None? I mean, in the pharmaceutical, I haven't seen any great pharmaceutical advertising for years and years, honestly. How important is it to use humor to grab the audience in a pharmaceutical ad? Well, I'm a big fan of humor overall because I think it's the great shock absorber of life.

And I think every advertisement is an intrusion. And the great marketing people always remember that. So in order to make that the most welcome intrusion, humor is a great way to do that. Some categories don't lend themselves to humor, but I think humor makes it memorable, makes it sticky. And especially because advertising needs repetition. Repetition is at the heart of a media bias. You need people to see an ad. The rule of thumb is you need people to see the ad 10 to 12 times before they'll actually consider taking action on it. And if you're going to have that kind of high repetition, if you have humor, smart humor, it has a longer shelf life.

As you've said, there are certain conditions that don't lend themselves to humor, at least so far. There are commercials for cancer chemotherapy pills. No, and I think that humor would be inappropriate in that situation. Another interesting aspect of all of this, Brian, that I've always wondered about is the names of these drugs are impossible to remember, hence them trying to use a jingle. But I mean, what pharmaceutical companies choose as names is always bewildering to me because you're always in marketing looking for this the simplest catchiest name now i understand the reason they choose these wonky names is because they can trademark them but still they're just a lot of them i can't even

pronounce unless i i hear it 90 times yeah it's anti-marketing to do that so it's an interesting category uh glitch that they have to deal with. Parker of what they're trying to do. Here's one of them, and it's called Trilogy. And this is a medication that's used by people with chronic obstructive pulmonary disease. And they use an old familiar song that, of course, many of us have heard before. Let's play a little bit of that one. Birds flying high, you know how I feel. Breeze drifting on by, you know how I feel. If you've been taking COPD sitting down, it's time to make a stand. Start a new day with Trilogy. No once daily COPD medicine has the power to treat COPD in as many ways as Trilogy.

With three medicines and one inhaler, Trilogy helps people... There's a vibe. They're trying to create a vibe there, aren't they? Yeah. By a great song, A Brand New Day. And I get the Trilogy thing because they said it was three medicines. But you don't hear that that often to my ear, Brian,

of hearing drug names that have some kind of connection strategically. Like Flonase to me made sense because it's about your nasal passages and being able to have some airflow going on. I mean, Flow Nays made sense to me. Not Ozempic? I don't know what Ozempic means.

Rebelsis sounds like rebel. I don't know if that's part of their thinking. Be rebellious about your life. Like, you know, disrupt your life by losing weight. I'm not sure if that's the thinking. Skyrizi, again, same thing. Yeah. What does that mean again, same thing. Yeah. What does that mean?

Oh, Tesla. Crickets. Rimbaud. Crickets. Last question. Here's your chance to tell the people who make pharmaceutical ads how to make them better. What would you do differently? Well, I think there's lots of room for creativity.

I think you could do a lot of storytelling in pharmaceutical ads. I just think that there's no excuse for bad work ever. Stipulations, regulations are no excuse because creativity loves constraint. Terry O'Reilly, those are wise words. Thank you so much for speaking with us. My pleasure, Brian. Some say we're at a fork in the road. We can permit tell-all ads like they have in the U.S.,

or we can ban reminder ads, as Barbara Mintz has suggested, a position endorsed by the Canadian Medical Association. And if we stopped asking our doctors, I'm pretty sure they would not mind one bit. That's our show this week. If you'd like to comment, our email address is whitecoat at cbc.ca. Before we go, just a note about the ads. We got the Novo Nordisk Ozempic ad, the Rebelsis American ad,

Pfizer's Viagra and AbbVie's Skyrese ads from YouTube. The Canadian Rebelsis ad came from the Daily's podcast. And GlaxoSmithKline's Trilogy ad came from iSpot TV. White Coat Black Art was produced this week by senior producer Colleen Ross with help from Jennifer Warren, Stephanie Dubois, and Samir Chhabra. Our digital producer is Ruby Buiza. That's medicine from my side of the gurney. I'm Brian Goldman. See you next week. There you are, alone in your car, waiting at a red light. Suddenly, there she is, pressed against your window, holding a homemade cardboard sign. Can you really tell what it says about her?

Don't let homelessness assumptions get in the way of homelessness solutions. Go to CanadaCanDoIt.ca. Help the Canadian Alliance to End Homelessness.