Rx for Confusion


For five years I've been taking a prescription arthritis drug with which, according to an ominous sounding voice on television, "serious, sometimes fatal events have occurred."

Speaking as a non-professional, I concur that death qualifies as a serious event. Then again, I've been assured by my doctor that few people actually suffer this event, or most of the numerous other events rattled off by the TV announcer.

The drug, known as Enbrel, definitely succeeds in making me feel better. But the television commercial, shown with alarming regularity, is enough to make me sick.

The U.S. and New Zealand are the only nations to allow consumer-directed advertising of prescription drugs. The door in the U.S. was opened in 1997 when the FDA relaxed its ad policies, leading to what is now $5 billion in annual spending by drug companies seeking to influence consumers to in turn influence their doctors to prescribe specific drugs.

The head of the American Medical Association, Dr. Nancy Nielson, told Congress last year that most AMA members are against direct-to-consumer ads. Such ads, she said, "often portray drugs through rose-colored glasses by including more information about a drug's benefits than risks."

On the other hand, you'd need a rose-colored hearing aid to ignore the TV warnings about side effects – ranging from the common (dizziness, drowsiness and nausea), to the unusual (compulsive gambling and suicide), to the one that seems to have garnered the most attention (erections lasting more than four hours).

There is little reason to allow consumer ads for prescription drugs other than to protect a $5 billion marketing business. And now that the pharmaceutical industry agreed, as of Jan. 1, to stop giving doctors free pens, mugs, T-shirts and other promotional tchatchkes, enlisting patients to lobby on behalf of advertised drugs is more valuable than ever.

Virtually all American adults (91%) indicate having seen prescription drug ads, and 32% of them say they asked their doctor about a specific drug they saw advertised, according to a study by the Harvard School of Public Health. Among those who spoke to their doctor about an advertised medicine, 44% percent say they were given a prescription for that drug.

Critics argue that such doctor-patient exchanges waste time and encourage the use of costly and possibly unnecessary medications.

Moreover, relentless warnings on television are frighteningly lacking in context, and may be counterproductive. A serious side-effect could be to dissuade patients from taking treatments for which their doctors believe the benefits outweigh the risks.

The FDA requires that TV ads for prescription drugs include "a fair balance between information about effectiveness and information about risk." The major risks are to be covered in "consumer-friendly language."

Madison Avenue's response to these regulations frequently involves video scenes of "effectiveness" – such as a patient with arthritis playing the piano - coupled with audio covering "risks" – such as death. This is a prescription for confusion.

Research by Duke University found that 80% of viewers can recall benefits of drugs promoted in commercials, but only 20% successfully remember the stated risks. A UCLA study suggests that TV ads may be influencing viewers to believe they are sicker than they really are, and this could lead to taking medicine in excess.

While pouring money into consumer advertising, the drug industry continues to bend to public pressure by expanding its list of voluntary guidelines. New in 2009 are guidelines stating that viewers should be informed when actors portray doctors; that ads featuring real doctors should disclose that they have been paid; and that celebrity endorsements should reflect the individuals' actual opinions about the drug.

But The Pharmaceutical Research and Manufacturers of America refused to include one guideline, requested by several members of Congress, that companies wait until drugs have been on the market for two years before advertising them directly to consumers.

The FDA is now planning to create a fake commercial for blood pressure medicine and will test the ad on 2,400 adults to determine to what extent the warning statements are getting through. I expect the results will underscore the problem with ads for prescription drugs: some viewers become overly worried by ominous warnings, while others are oblivious and don't focus on the warnings at all.

Sixty-second commercials are not suitable forums for presenting the weights and measures of complex medical issues. Although an unrestricted flow of information is always desirable for the public good, a barrage of ads promoting confusion and fear is certainly not healthful.

© Peter Funt. This column first appeared in The Monterey Herald.

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