Marketing Makes Medicines Worse?

Medicines are sometimes withdrawn from the market or heavily restricted in their use, when the risks are judged to outweigh the potential benefits. Is this just a case of bad luck or an unavoidable risk when it happens, or is it something more?

According to a fascinating article in the American Journal of Public Health (Am J Public Health. 2011;101: 399–404) there may be a more systematic reason. The authors argue that there is an inverse benefit law in operation – that the overall benefits of a medicine are inversely proportional to the extent to which it is marketed.

The key to their argument lies in the number and condition of people treated with the medicine. Good clinical trials may indicate (correctly) that a medicine is beneficial for the patients in the trials but when the medicine reaches the market, does the population treated reflect the same condition and degree of severity as the trial patients? If a very low proportion of the population are as “sick” as the trial patients, the market for the medicine will be small – unless the numbers to be treated can be increased. The authors cite six ways in which this can be achieved through marketing.