Waving the Red Flag: FTC Regulation of Deceptive Weight-Loss Advertising 1951-2009

This article documents the historical role of the Federal Trade Commission (FTC) in regulating deceptive weight-loss advertising, which the commission began to prioritize in the 1990s after a dramatic rise in complaints. It also includes the results of a content analysis of more than 150 FTC complaints filed between 1951 and 2009, which were used to analyze trends in advertising content, liability for deceptive practices, and outcomes. Regulatory efforts may not have curbed the use of bogus weight-loss claims, which have only increased over time. The FTC has made attempts to apply broad liability, but advertisers and corporate leaders continue to be named most frequently over other respondents, including advertising agencies, media outlets, and product endorsers. Although the number of complaints that result in financial penalties is increasing, the FTC lacks systematic and specific policies to adequately deter advertisers and address what continues to be a growing problem.

A Closer Look at the North Carolina Board of Dental Examiners and Who Can Practice Dentistry

On February 25, 2015, the U.S. Supreme Court rendered a six-to-three opinion in favor of the Federal Trade Commission in their dispute with the North Carolina State Board of Dental Examiners concerning teeth-whitening services provided by nondentists. That decision was the culmination of almost nine years of arguments and allegations that began with a disagreement regarding the definition of the practice of dentistry. The ethical aspect of this dispute resides in the one's perspective regarding the motivation behind the actions taken in the North Carolina State Board of Dental Examiners.

High-cost generic drugs--implications for patients and policymakers

Some older generic drugs have become very expensive, owing to factors including drug shortages, supply disruptions, and consolidations in the generic-drug industry. But generics manufacturers that legally obtain a market monopoly can also unilaterally raise prices.

Internet claims on dietary and herbal supplements in advanced nephropathy: truth or myth

BACKGROUND

The use of complementary/alternative medicine has garnered rising interest in recent years. Natural products including herbs, vitamins, and minerals are the most popularly consumed. The Internet is a ubiquitous source of information/market for these supplements.

AIM

To systematically evaluate the dietary and herbal supplement recommended for patients with CKD and ESRD on the Internet, and try to distinguish between the claim of the manufacturer and proven scientific data.

METHODS

A questionnaire assessing each website was formulated. Each product ingredient was recorded in the questionnaire by two independent reviewers and statistically analyzed.

RESULTS

Of the 184 websites, 28% claimed to decrease CKD progression, 60% did not advise to consult a doctor before taking the supplement, and >90% did not mention any potential drug interaction, disease interaction, or caution in use during pregnancy or in children. The ten common plant ingredients claiming to be beneficial in kidney diseases were uva ursi, dandelion, parsley, corn silk, juniper, celery, buchu, horsetail, marshmallow, and stinging nettle. In contrast to their claims, these substances were not adequately studied in humans. The available animal studies showed detrimental effects and potential drug interactions with commonly used medications in the CKD/ESRD population.

CONCLUSIONS

Nephrologists need to be cognizant of the lack of substantiated proven benefits of these substances and of the potential adverse effects in the animal models that can translate to the patients. Most importantly, the policy needs to change regarding the regulation of these products to prevent patient harm and misinformation.

Pulled in two directions. Providers pursuing coordinated care confused by antitrust actions

Providers pursuing mergers to better coordinate care for patients are becoming exasperated by antitrust actions, saying recent FTC cases have left them confused. "You can't know ahead of time whether something is or is not OK. There are certain extremes where you can know if something is extreme or perfectly OK, but there is a wide range of possibilities in between," says Dr. David Pate, left, of St. Luke's Health System, Boise, Idaho.

Long-term Medicaid excess payments from alleged price manipulation of generic lorazepam

BACKGROUND

Cost savings from the use of generic drugs versus brand-name drugs are well known. Both private and public prescription drug plans encourage the use of generic drugs through a variety of mechanisms. The magnitude of cost savings for a given generic drug is dependent on the degree to which the generic market is competitive. Should the competitive structure become compromised, higher prices and reduced cost savings may result. An alleged conspiracy between Mylan Laboratories and its active-ingredient suppliers in 1997 was associated with an increase in seller concentration in the generic lorazepam market. The Federal Trade Commission (FTC) alleged that Mylan raised costs to consumers by $120 million because of price increases for generic lorazepam from March through December 1998 and for generic clorazepate from January through December 1998. In November 2002, a settlement with Mylan was approved by the FTC, and a federal district court required Mylan to pay $147 million, including $28.2 million to state agencies including Medicaid.

OBJECTIVES

To (a) describe the seller concentration in the national Medicaid generic lorazepam market over a 19-year period from January 1991 through December 2009, (b) estimate the excess payments for generic lorazepam by Medicaid between 1998 and 2009, and (c) investigate potentially increased utilization and prices of 2 substitute pharmaceuticals: branded lorazepam (Ativan) and generic alprazolam (another widely used intermediate-acting benzodiazepine).

METHODS

Using Medicaid State Drug Utilization Data from the Centers for Medicare Medicaid Services, we calculated the 4-firm concentration ratio (CR₄) and the Herfindahl-Hirschman Index (HHI) for the Medicaid generic lorazepam market, along with pre-rebate reimbursement for pharmacy claims, number of claims (utilization), and average pre-rebate reimbursement per claim (average "price") for generic lorazepam, from 1991 through 2009. Medicaid's excess payments were estimated under 2 different assumptions regarding what the average generic lorazepam price would have been in the absence of the alleged conspiracy. To find counterfactual prices, the average per-claim reimbursement for lorazepam for the 4 quarters prior to the alleged conspiracy, $6.80, was inflated using (a) the quarterly change in the average per-claim reimbursement for generic alprazolam and (b) the Consumer Price Index (CPI) for all urban consumers, all goods. Potential impact of the alleged conspiracy on the branded lorazepam and generic alprazolam markets was investigated.

RESULTS

The average pre-rebate reimbursements per claim for generic lorazepam were $10.25, $23.12, and $8.48 in 1991, 1998, and 2009, respectively. For the same 3 years, CR₄ = 52.80, 76.02, and 86.74, while HHI = 905.71, 2,166.25, and 2,233.36. Medicaid's excess payments from 1998-2009 were estimated at approximately $625-$657 million. The data also suggest the possibility of small impacts on the utilization of branded lorazepam and the price of generic alprazolam.

CONCLUSIONS

Prior to the alleged conspiracy in 1997, average pre-rebate reimbursement per claim for generic lorazepam was declining, while seller concentration was rising. After a jump in average payment per claim in the years immediately following the alleged conspiracy, prices have gradually returned to their pre-1998 levels. However, the generic lorazepam market was more concentrated in 2009 than prior to the alleged conspiracy.