Drug advertisements that scare

It’s a yearly tradition at the Lown Institute to spend the week of Halloween highlighting some of the most frightening pharmaceutical advertisements of the year. Despite larger health threats consuming the nation this year, pharma did not let up on their fear-mongering ads. Check out a few of the scariest below– if you dare!

You’re still at risk…

This ad for Vascepa, Amarin’s omega-3 fish oil medication, uses eerie music and images of heart scans and worried doctors to let viewers know that they may be at risk of heart attack and stroke. The use of video clips from a first person point of view, as if the viewer is currently in the hospital having a heart attack, is especially noticable.

Vascepa is the first FDA-approved fish oil medication for prevention of cardiovascular events. While many omega-3 fish oil supplements are available as supplements, none of them have shown to reduce heart attack or stroke for patients before. So what’s different about Vascepa? According to Amarin, the drug is a more pure and concentrated form of omega-3 than any other supplement.

The results of the REDUCE-IT trial showed a 5% absolute risk reduction of heart attack and stroke for people taking Vascepa compared to placebo. All patients in the trial were at risk of cardiovascular events and were already taking a statin. Vascepa also showed a very small impact on cardiovascular death (0.9% absolute risk reduction). Yet researchers noticed something fishy– rather than use an inert placebo, the trial used mineral oil as a placebo (mineral oil was also used as a placebo in Vascepa’s later trial EVAPORATE). Because the control group may have experienced worse heart outcomes due to the mineral oil placebo, it’s hard to know how much of the trial results are due to positive effects of the drug or negative effects of the placebo.

More recently, Amarin lost a patent lawsuit, opening the door for other companies to manufacture generic versions of Vascepa. With competition on the way, it’s no wonder Amarin is telling views to “call their doctor about Vascepa today.”

Heart damage may have already started

This ad for Farxiga, a drug used to treat type 2 diabetes, uses the theme of alarms to tell viewers, ironically, that there won’t be a loud alarm warning them about heart damage — it may have already started! The theme also creates urgency for the viewer, telling them that time is running out to prevent damage to their heart. People with type 2 diabetes are at elevated risk of heart failure which, the ad warns viewers, could put them in the hospital.

The solution is Farxiga, which the ad claims helps prevent hospitalization from heart failure for people with type 2 diabetes. Notice that the ad does not mention reductions in death or cardiovascular events. That’s because the trial on which the FDA approval was based only found significant differences in hospitalization for heart failure, not major adverse cardiovascular events or cardiovascular death. A more recent trial found improved cardiovascular outcomes specifically for patients who already had heart failure and reduced ejection fraction.

What the ad doesn’t mention, however, were some of the concerning side effects of the drug, including dehydration, serious urinary tract infections, genital yeast infections, and, in rare cases, a flesh-eating disease called Fournier’s Gangrene. Now that’s scary.

Are some scary ads justified?

During the Covid-19 pandemic, clinicians have been worried about secondary effects of the virus due to people not seeking access to care for serious health issues. In fact, a recent study estimates that about one-third of the excess deaths that occurred during the pandemic were not due directly to Covid-19, but to secondary factors such as not seeking emergency care, exacerbation of chronic diseases, and psychological distress.

The ad above was sponsored by several medical associations as well as drug companies Pfizer and Bristol-Myers Squibb. Contacting your doctor about acute medical issues is important during the pandemic, but why focus on deep-vein thrombosis and pulmonary embolism specifically? The answer may be that Pfizer and Bristol-Myers Squibb have had an “alliance” since 2007 for the purpose of developing and commercializing apixaban, an oral anticoagulant that treats blood clots. They have also collaborated on studies of atrial fibrillation screening, which explains why they created another advertisement urging people not to wait to see their doctor about afib symptoms.

No one should be waiting to contact their doctor about concerning symptoms, especially if they have underlying chronic conditions. But even for advertisements with a positive message, we still have to follow the money, and see where it goes.