Many years ago the tobacco industry was told to cease and desist: No more
advertising on television for cigarettes. The consumer was being endangered.
And so we all lost that ride-along on the plains with that steady, strong cowhand, cigarette dangling from the lower lip as he swaggered across our television screens.
A generation later the Marlboro man has been replaced by the baby-boomer who cannot achieve an erection without the help of a pill.
But are we consumers any safer?
A recent study shows the power of the pharmaceutical industry's Direct-to-Consumer (DTC) advertising campaigns: The Kaiser Family Foundation survey discussed in the article found that 44% of patients who asked for a particular drug that they learned about through advertising received the prescription for that drug; for over 50% of the patients the prescribing doctor gave the requesting patient a different drug.
The bottom line is that 82% of patients received some sort of a prescription as a result of a request which was triggered by seeing a drug company advertisement.
The record $4.8 billion (in 2006) the drug companies spent on DTC advertising is working: Patients are approaching their doctors with requests for the latest drug they saw advertised during the evening news, and this in turn is triggering prescription writing behavior on the part of the doctor. My guess is that the resultant increase in drug sales makes that $4.8 billion a very worthwhile investment.
The profits of the drug companies do not concern me. But what does concern me is the possibility that a patient is taking one more pill that he perhaps does not need. Perhaps the doctor is being accommodating, and thus fulfills the patient's request, particularly if the drug seems relatively harmless.
I feel, however, that any prescription has the potential to cause side effects. I do understand that my being a rheumatologist might cause me to be a little biased here, as the Vioxx debacle is still fresh in my mind.
In rheumatology, five different billion-dollar drugs have emerged in recent years, making my specialty the focus of extensive advertising campaigns.
The so-called Cox-2 inhibitors came to market soon after the United States Food and Drug Administration (FDA) loosened the restrictions on DTC advertising as a result of legislation in 1997. DTC advertising helped to drive the huge consumer demand for these drugs, resulting in worldwide sales of Vioxx and Celebrex into the billions of dollars. By 2002, 61% of anti-inflammatory medication prescriptions were for either Vioxx or Celebrex; an increase from the 35% in 1999. It should be noted that none of the Cox-2 inhibitors has been shown to be more effective than old stand-bys such as ibuprofen or naproxen.
And so pain is pain, treated with old anti-inflammatory drugs, or new anti-inflammatory drugs.
The most disturbing thing about the Cox-2 DTC-driven mania is that there were early concerns regarding cardiovascular risk. In 2001, the FDA recommended that the Vioxx label be changed to reflect an increased cardiovascular risk. However, it required 14 months of discussions between the maker of Vioxx (Merck) and the FDA before that label was changed, in 2002. During that time, and up until the withdrawal of Vioxx from the market in 2004, aggressive DTC marketing of Vioxx continued. And doctors, pressured by both patients and drug company sales people, continued to write prescriptions for a drug which had no therapeutic advantage over, say, Motrin, but did have a cardiovascular risk for certain segments of the population.
Vioxx is now not available. Merck has been bogged down in litigation regarding the harm Vioxx did to some patients. And, unfortunately, those patients who derived great benefit because of Vioxx no longer have the drug.
In conclusion, advertising is fantastic if it stimulates patients to learn more about staying healthy and treating disease. But it is my opinion that advertising should not result in pressure to prescribe. Patients deserve better.
