If you’ve watched television recently, you’ve likely seen the commercials. A cancer patient shares their story of hope. Uplifting music plays. And then comes the rapid-fire list of potential side effects that stretches on for what feels like an eternity, but should cancer drugs be advertised on TV at all?
I recently viewed a TV spot for Keytruda’s use for bladder cancer. What really struck me was the ongoing list of side effects that would scare away most cancer patients. The most robust data (
Cancer-Related Direct-to-Consumer Advertising: Awareness, Perceptions, and Reported Impact Among Patients Undergoing Active Cancer Treatment) on the influence of pharmaceutical marketing commercials—specifically cancer-related direct-to-consumer advertising (CR-DTCA)—on cancer patients comes from a 2009 survey of patients undergoing active cancer treatment. In this cohort, 17.3% of cancer patients who were aware of CR-DTCA reported discussing an advertised medication with their provider. However, the proportion who actually received a prescription for the advertised medication was less than one-fifth of those who initiated such discussions, indicating that the direct impact on prescribing is lower than the rate for patient-provider debate prompted by advertising.
Pharmaceutical marketing commercials influence approximately 17% of cancer patients to the extent that they discuss advertised medications with their provider, but the proportion who ultimately receive the advertised drug is substantially lower.
The Gravity of Keytruda’s Side Effects
Keytruda (pembrolizumab) is an immunotherapy medication that activates the immune system to combat cancer. While it has provided meaningful benefits for many patients with certain types of cancer, its mechanism of action comes with substantial risks. The drug can cause the immune system to attack healthy organs and tissues throughout the body.
The potential side effects aren’t minor inconveniences. They include:
- Severe and potentially fatal lung inflammation (pneumonitis)
- Liver damage that can lead to liver failure
- Intestinal inflammation causing severe diarrhea or colitis
- Hormone gland problems affecting the thyroid, pituitary, and adrenal glands
- Kidney inflammation and kidney failure
- Heart inflammation (myocarditis) can be fatal
- Severe skin reactions
- Nervous system problems, including paralysis
- Diabetes, including diabetic ketoacidosis
Many of these conditions require immediate medical intervention and can be life-threatening. Some may be permanent, requiring lifelong treatment even after stopping Keytruda.
The Illusion of Consumer Choice
Cancer is terrifying. When someone receives a cancer diagnosis, they and their loved ones are desperate for hope, for options, for anything that might help. DTC advertising exploits this vulnerability by creating the impression that patients should be actively “choosing” their cancer treatment based on television commercials.
But cancer treatment isn’t like choosing a toothpaste. The decision to use Keytruda requires a sophisticated understanding of tumor biology, biomarkers, treatment history, overall health status, and the specific type and stage of the cancer. These aren’t decisions that should be influenced by emotionally manipulative advertising.
Minimizing Serious Risks
Despite the lengthy side effect disclosures required by law, television advertising has a remarkable ability to minimize the risks associated with them. The severe warnings are delivered in soothing voice-overs while images of patients living their lives flash across the screen. The format itself creates cognitive dissonance—our brains struggle to reconcile the dire warnings with the hopeful imagery.
For a drug with risks as serious as Keytruda’s, this minimization is hazardous. Patients may underestimate the genuine possibility of life-threatening complications.
Who Benefits from These Ads?
It’s worth asking: who actually benefits from Keytruda’s DTC advertising?
It’s certainly not the patients who aren’t candidates for the drug, but wasting medical appointments asking about it.
It’s not the patients who are the appropriate candidates—their oncologists would already be aware of and consider Keytruda based on clinical guidelines and medical evidence.
It’s not the healthcare system, which bears the cost of addressing advertising-driven patient demands.
The primary beneficiary is Merck, the manufacturer of Keytruda, which has turned the drug into a blockbuster, generating over $20 billion in annual revenue. DTC advertising serves to drive demand and maintain market dominance.
A Different Approach
Cancer drugs like Keytruda should be promoted where they matter: in medical journals, at oncology conferences, and through evidence-based clinical guidelines. Oncologists are capable of staying informed about treatment options without television commercials. They can evaluate the risks and benefits for individual patients based on medical science, not marketing.
For patients, education about cancer treatment should come from their healthcare team, from reputable medical organizations, and from evidence-based resources—not from pharmaceutical advertising designed to sell a product.
The fact that virtually every other developed nation has rejected DTC pharmaceutical advertising should give us pause. When the potential side effects include organ failure, paralysis, and death, perhaps the decision about whether to use a drug should rest entirely with qualified medical professionals who understand both the patient and the treatment.
Cancer patients deserve hope. They deserve access to effective treatments. They deserve honest, comprehensive information. What they don’t need is pharmaceutical advertising that turns life-or-death medical decisions into consumer choices influenced by marketing campaigns.
While DTC of cancer drugs may raise awareness, it’s time to reconsider whether drugs with serious, potentially fatal side effects should ever be advertised directly to consumers. Some decisions are too important, too complex, and too dangerous to be left to the influence of television commercials.
