I fly a lot and while I like to work on planes when I am not depositing sleep-induced drool on my seatmates, I also like to read trashy magazines. It’s my opportunity to engage in this guilty pleasure when no one is paying attention. My go-to threesome of magazines is pretty much always the same: People, Rolling Stone, Sports Illustrated. Everyone once in a while I moonlight with an Esquire or New Yorker or Time, but SI, Rolling Stone and People are the ones I routinely read to ensure maximum brain cell destruction and to make sure I cover all my favorite obsessions: baseball, music, and George Clooney.
Last week I grabbed People and Rolling Stone (had already read SI) on my way to the plane and halfway through People, the June 22nd one with Melissa McCarthy on the cover, I had a revelation. No, it wasn’t Kardashian-related, thank goodness. Rather, it was that an astonishingly high percentage of the pages I had so far turned featured ads for prescription drugs on them. So many of these ads were there that I actually tore my eyes away from pictures of the Rock and noticed them, despite my highly developed skill for screening them out. In fact, a total of 21 full pages–19% of the entire magazine– had ads for 9 different drugs, if you include the two ads for non-prescription products printed alongside their direct-to-consumer pharma friends. The drugs featured covered everything from breast and lung cancer to hepatitis, acne and psoriasis. There was something for everybody: birth control pills and pills to control hot flashes. Even I can do this math: I paid $5 for the magazine and $1 of that went to pay for pharma ads. Jeez, I want a 20% refund.
So then I conducted the second arm of my experiment, looking at Rolling Stone (the June 18th one with Orange is the New Black on the cover) to count the pharma ads and see how much more money I had wasted. Guess what? Exactly 1 such ad, this one for Xantac, a non-prescription heartburn drug which was presumably targeted to the readers who are spending most of their income buying crap food at rock concerts, or something like that. The interesting contrast was this: Rolling Stone actually had 6 separate ads (8% of pages) for chewing tobacco, cigarettes, cigars and vaping products, so essentially the precursor products to needing pharmaceuticals if one is hell-bent on getting lung cancer. People has no tobacco ads, which is a blessed relief.
Now, I am not naïve and I understand how ad sales work: ads are targeted based on readership and you can check out the two magazine’s own reported reader demographics immediately below. I know that advertisers are scouring the opportunity set for people who they believe are more likely to buy their product. But I have to wonder: do People readers want, need, buy pharmaceutical products at such a greater rate than Rolling Stone readers that this insanely out-of-balance ratio is warranted?
My first assumption was that this is an age thing; that the readership of People must be much older than the readership of Rolling Stone, and thus the need for more drugs for various miserable conditions that tend to come with aging. But that turned out to be a spurious assumption, as the actual median age of readers of each of the two is not that different: 38 for People and 35 for Rolling Stone. And furthermore, several of the ads in People were for acne products, so some kids must be sneaking around with People tucked into their backpacks, having stolen them from mom.
My second assumption was this might have something to do with the likely state of insurance held by readers. Of course there is no way to really test that assumption, but a couple of proxies: employment and income. People with higher income and jobs are more likely to have insurance (unless they are at the very low end and have Medicaid). But again, the demographics didn’t really answer this question too well. More Rolling Stone readers are employed (72% vs. 66%) and they also have more readers with salaries greater than $100K, though the median household income of the People group is higher at $72K vs. $65K. So insurance status isn’t like the answer.
Perhaps it’s having kids in the house that make you want to take more drugs? Yet the numbers are pretty close for households with at least 1 child: 42% at People vs. 46% at Rolling Stone. And most of the advertised drugs really aren’t meant for escapism, unless you are trying to escape from cancer, or hepatitis.
It would be easy to explain the People/Rolling Stone variance away by sheer volume of readers: Pharma companies are undoubtedly savvy enough to target large distribution publications vs. smaller ones to get more bang for their buck. And maybe that explains it, given that People has about 10x the readership. But I don’t think that’s really it.
What I think is that this is all about People having a high female demographic and it’s women who make the vast majority healthcare purchasing decisions. It’s also women who take far more prescription drugs than men.
In 2014 a major CDC report found that about 26 Billion prescriptions are written per year and that 75% of physician office visits involve drug therapy in one form or another. The percentage of the population taking at least one prescription drug during the past 30 days increased from 39.1% in 1988–1994 to 47.3% in 2009–2012. During the same period, the percentage taking three or more prescription drugs rose from 11.8% to 20.6%, and the percentage taking five or more drugs more than doubled from 4.0% to 10.1%. Remember, this includes everyone including infants.
In the CDC’s special report on pharmaceutical use in 2013, 58% of women were found to be taking prescription medications vs. 42% of men. Women were taking an average of 5 prescription drugs each (!) to 3.7 prescriptions for men. Wow, those seem like such high numbers to me, and we are not alone. In the UK about 50% of women take prescription drugs while 40% of men do and twice as many women as men use anti-depressants, perhaps because men don’t take enough of them.
The number of pharmaceuticals used by women has led to soaring levels of prescription drug abuse by women as well. The Centers for Disease Control study shows that the number of women dying from too many prescription drugs rose 400 percent between 1999 and 2010 to over 18 women per day. More men than women die of prescription drug abuse each year, but those numbers are getting close to equalizing. Furthermore, women tend to have more adverse side effects to many drugs than do men due to formulations being designed primarily for male physiology. While this is beginning to change as the problem is recognized, it makes me think that we should be a little more circumspect in wildly advertising medications to anyone, but particularly women, as if the drugs were nail polish colors or clothing. In fact, the People Magazine had 6 full pages of ads for cosmetics and clothing (1/3 that of drugs), something that most women use even more frequently than medication, or one would hope.
I don’t know for certain whether the proliferation of pharma advertising has driven drug use up, but I have a suspicion and I bet you can guess what it is. I know research exists proving both sides of the story. But fundamentally, isn’t that the point of drug advertising: to get more patients asking for and using the product? If it doesn’t work, I can’t imagine pharmaceutical companies would keep paying for it. Not only have they kept paying for it, but the amount of money they are paying keeps going up. Drugmakers spent $4.5 billion marketing prescription drugs in 2014, up from $3.5 billion in 2012, according to a recent article in the Washington Post. Notably, the U.S. and New Zealand are the only two countries in the world where pharmaceutical direct-to-consumer advertising is legal.
I am a fan of consumer engagement and education, don’t get me wrong. It’s great to get knowledge into the hands of people who need to interact with the medical system, especially people with serious conditions like cancer and hepatitis. I believe that there is some good in helping consumers be aware of certain medication options and to arm them with questions about their condition for the conversation they have with their doctor. But should People Magazine readers be so inundated while reading about Taylor Swift and who wore it best at the Grammys? I don’t really know what the “right” amount of pharma advertising is and, if it were eliminated in favor of ads that featured super skinny models that make women feel bad about themselves, maybe that would lead to even higher drug use.
Somehow there needs to be a better balance. I have to imagine that readers would not appreciate it if 19% of People Magazine was occupied by ads for alcoholic beverages or cigarettes (and it’s as big a shame that so many of these appear in Rolling Stone where 15% of readers are not even legally old enough to buy alcohol or tobacco in most places in the U.S.
I’d be very curious to know readers’ view on this topic so feel free to use that comments section below.