Prescription drug lawsuit ads can pose public health risks

We've all seen them - 30-second television ads from attorneys, targeting those who've had a negative side effect after using a pharmaceutical product: "If you or a loved one suffered serious medical complications … you may be entitled to financial compensation."

Drug-injury advertisements are a way for law firms to obtain clients, but they're seen by a much broader audience - including those for whom the medications have positive, even life-saving, effects. And when the potential dangers of these drugs are highlighted in flashy TV commercials, people who should be continuing on the medication can be scared into stopping treatment.

"These ads influence drug utilization in a way that can harm public health," said Sylvia Hristakeva, assistant professor of marketing and management communications in the Charles H. Dyson School of Applied Economics and Management, in the Cornell SC Johnson College of Business. "They are not harmless. We need to take their content and reach more seriously."

Hristakeva is the author of "Bad-drug Ads or Killer Ads: The Effects of Drug Injury Advertising on Public Health," which published Oct. 28 in Management Science.

For her research, Hristakeva focused on anticoagulants, known for reducing the risk of blood clots and stroke, the fifth-leading cause of death in the U.S. The first drug of this type, Warfarin, was introduced in 1953; three others, known as non-vitamin K oral anticoagulants, or NOACs (sold under brand names including Pradaxa, Xarelto and Eliquis), were introduced between 2010 and 2012 and have been the target of drug-injury lawsuits.

Using Medicare data from 2015 to 2019 and advertising data from the litigation tracking firm X Ante, Hristakeva examined how exposure to drug injury ads affects prescription behavior and hospitalizations.

While drug injury ads don't explicitly urge viewers to alter their medications, Hristakeva found, they do lead to changes in treatment decisions. Specifically, she found that a $0.19 increase per capita in ad spending translates to a predicted decrease in NOAC prescription fills of 2.6%. The effect is comparable in size, but opposite in direction, to the well-documented influence of direct-to-consumer pharmaceutical ads promoting drug benefits.

Regarding hospitalizations, Hristakeva estimated that the same $0.19 per capita increase in ad spending (in counties with a significant portion of residents over age 65) leads to a 5.76% increase in hospitalizations for anticoagulant-related diagnoses. That translates to an additional 3,400 inpatient hospital visits per year.

At an average of $20,000 per visit (a figure based on previous research), that's $68 million in added hospitalization costs for stroke patients. "This is a conservative estimate," Hristakeva said, "It only reflects inpatient care. It does not account for longer-term costs like follow-up treatment, disability or lost income."

So what can be done? In recent years, Texas and Tennessee have taken steps to improve transparency in legal advertising, requiring clearer disclaimers and warnings to help viewers understand the nature of the ads.

"The laws require ads to clearly state that these are legal solicitations and not government alerts, and to include warnings advising patients not to stop medications without talking to a doctor," Hristakeva said.

Federal regulators have also taken notice. "We already have regulations that prohibit deceptive advertising," she said, "and the FTC has recently recognized the issue by sending warning letters to law firms."

Hristakeva emphasized that the influence of these ads extends beyond their legal purpose.

"They're not just reaching people who were harmed by a drug," she said. "They also influence the decisions of patients who weren't, and that has real implications for public health."

Beyond regulation, Hristakeva sees a role for public health initiatives. "Helping patients and doctors navigate these messages with accurate, evidence-based information could help reduce the unintended consequences," she said.

Support for this research came from the National Science Foundation and from the Morrison Center for Marketing and Data Analytics at the University of California, Los Angeles.