Does Every Teenager Need Trumenba®?

“The average American TV viewer watches as many as nine drug ads a day, totaling 16 hours per year, which far exceeds the amount of time the average individual spends with a primary care physician.”(1)

Here in New York, Pfizer has started an intensive TV advertising campaign to promote the use of their new Meningitis B vaccine, Trumenba®. It is a very emotional appeal. We hear the voice -over of a sad mother in a hospital room tell us that she must now resume caring for her son, just as she did when he was a young boy. The ad goes on to demonstrate how easily a meningitis infection can spread through common teenage behaviors: shared food, shared drinks, and kissing.

What the advertisement does not mention is the CDC recommendation that Trumenba® or Bexsero® (the other recently licensed Meningitis B vaccine) are not indicated for routine use, but rather for five groups “at increased risk for serogroup B meningococcal infection. “ For current CDC patient guidelines, see the MenB VIS at https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening-serogroup.html

Every travel health nurse knows how much time and effort we all spend educating our travelers about the value of vaccines. How challenging it can be for us to counsel patients to accept costly vaccines as part of their pre-travel preparation. Direct-to-consumer marketing makes that part of our role even more complicated. By advertising directly to the consumer, pharmaceutical companies add to that burden. We find ourselves having to spend additional time and energy countering false impressions with facts, correcting misunderstandings, and talking patients out of certain vaccines.  Trumenba® is just the latest example. In the past two years, many young adults have been convinced by ads that they need the shingles vaccine- years before it is indicated- and that also goes for the new Prevnar 13 ®vaccine.

Why must U.S. nurses devote precious minutes of a pre-travel visit to this effort? Direct-to-consumer pharmaceutical advertising (DTCPA) is considered at fault by many. DTCPA can be defined as an effort (usually via popular media) made by a pharmaceutical company to promote its prescription products directly to patients.  The United States and New Zealand are the only two countries that allow the pharmaceutical industry to directly advertise to the public. Over the years the FDA has loosened its regulation of DTCPA and the financial impact has been significant. Between 1995 and 2009, after the FDA allowed more flexibility in DTCPA, the amount of money spent by the pharmaceutical industry on DTCPA rose from $340 million to $4.5 billion. Porter (2) cites studies that show that for every $1 spent on DTCPA, the pharmaceutical industry earns $4.20.  According to Ventola (1), DTCPA “is now the most prominent type of health communication that the public encounters.”

While the pharmaceutical industry supports DTCPA, according to Porter (2), more than 60% of physicians want restrictions placed on DTCPA. Many providers want the practice eliminated altogether. When confronted with legal cases to curtail DTCPA,  proponents cite first amendment rights and evidence of these benefits of the practice: “informs, educates and empowers,” “encourages patients to contact a clinician,” “ promotes patient dialogue with health care providers,” “ strengthens a patient’s relationship with a clinician,” “ encourages patient compliance,” “ reduces under-diagnosis and under-treatment of conditions,” “ reduces the stigma associated with certain diseases,” and “encourages product competition and lower prices.” (1)

Opponents take a different view of DTCPA and believe there is also good evidence that this practice: “misinforms patients,” “ omits important information,” “overemphasizes drug benefits,” “promotes new drugs before safety profiles are fully known,” “manufactures disease and encourages drug overutilization,” “ leads to inappropriate prescribing,”  “strains relationships with health care providers,” “ wastes appointment time,” “ is not rigorously regulated,” and “ increases costs.”

As drug costs in the United States continue to rise faster than inflation, direct-to-consumer marketing continues to contribute to this problem. How many times have you had patients come into your office asking for a specific medication or vaccine only because they saw an ad? How often do you have to re-educate your travelers about the recommended indications for a given vaccine or drug? As recently as 2008, 22 of 27 EU countries joined Canada in vetoing DTCPA (1).

All nurses want their patients to have easy access to reliable information, but as it stands now, DTCPA  prioritizes pharmaceutical companies, not consumers and patients.

To learn more about the impact of DTCPA on health policy, clinical practice, and health care costs, here are two relevant articles:

  1. C. Lee Ventola. “Direct-to-Consumer Pharmaceutical Advertising: Therapeutic or Toxic?” P T. 2011 Oct; 36(10): 669-674, 681-684. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278148/ (includes references and some suggested remedies)
  2. Porter, Dayna M. (2011) “Direct-to-Consumer (DTC) Pharmaceutical Marketing: Impacts and Policy Implications,” SPNHA Review: Vol. 7: Iss. 1, Article 5. Available at: http://scholarworks.gvsu.edu/spnhareview/vol7/iss1/5

Gail Rosselot, NP, MPH, COHN-S, FAANP

September 27, 2016