I sat in my doctor's office a couple of weeks ago waiting for my annual physical. I soon grew tired of all the science and car magazines and started looking around. As in most doctors' offices, most things had pharmaceutical company logos on them: The clock, the Kleenex dispenser, the calendar. But what gave birth to this column was the doctor himself. He walked out of one of the examination rooms, clipboard in hand, talking to a patient. The guy was about my age and listening intently.
Then it happened.
The doctor opened up a closet in the waiting room and I peered in. The shelves were lined with small boxes and bottles. All samples of popular drugs. I swear, I knew every one of them from their TV ads.
There was the cholesterol one where the lady splits in two, the anti-depression one where the lady has a little windup doll of herself. The little purple pill was in there as was the one with the people in the bathtub.
Then the question popped into my head: Do pharmaceutical companies, through their commercials, promote medical conditions? Or do they educate consumers about conditions and send them to their doctors, thus performing a much needed service?
Once I began my research, I learned right away there is no general consensus. Every developed country in the world, save the United States and New Zealand, prohibits direct-to-consumer pharmaceutical advertising. Opponents of direct-to-consumer advertising (DTC) argue the FDA has limited resources and many claims make it on air.
They say that the ads are often not for life-threatening and treatable diseases like hypertension, but rather for "lifestyle" problems like thin eyelashes, insomnia, toenail fungus and erectile dysfunction, and that these drugs can have severe side effects. They cite ethical issues when a doctor accepts promotional products from pharmaceutical companies.
A study has shown DTC advertising is likely to increase the request rates of both the drug category and drug brand choices, as well as the likelihood the drugs would be prescribed by physicians. Some argue the potential for adverse affects is downplayed. Finally, they say real-life and longer-term safety studies are often in progress when DTC advertising begins. Two cases often mentioned are Zelnorm (for irritable bowel syndrome) and Vioxx (a painkiller) -- the products were voluntarily taken off the market in 2004 and 2007, respectively.
Zelnorm was found to be only 5 percent to 10 percent more effective than a placebo with a small risk of a cardiac event, according to the New England Journal of Medicine. Even though that risk was only 0.1 percent, the risk was considered too high, given the drug's limited effectiveness. The advertising, which showed very attractive women lifting their shirts to reveal "I feel better" written on their stomachs, worked pretty well. In 2005, 2.1 million prescriptions were written for Zelnorm.
Vioxx, an anti-inflammatory used primarily to treat arthritis, was aggressively marketed with over $100 million in promotion that featured Olympians Dorothy Hammill and Bruce Jenner. It became widely known and prescribed before being pulled off the market for doubling risk for a heart attack or stroke, but not before being prescribed to millions of people. The FDA estimates that Vioxx was responsible for as many as 139,000 heart attacks and almost 30,000 deaths from heart attack or stroke.