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Jewish World Review Sept. 2, 2005 / 28 Av, 5765 Drug Money and Advertising: Ask your doctor if these drugs are right for you By Drs. Michael A. Glueck & Robert J. Cihak
http://www.JewishWorldReview.com |
Not so many decades ago (ah, nostalgia) no American child could sit for
long in front of the TV without hearing a cheerful refrain.
Say, kids, when your Mom goes to the store, ask her to get ..."
Today, those same kids (ah, reality) and the rest of the nation are
listening to another refrain, less chirpy perhaps, but far more important.
"Ask your doctor if [Viagra, Levitra, Cialis, Nexium, Nasocort, Paxil,
Zoloft, Ambien, Hemlock, Allegra Di-Hydrous-Oxide, whatever] is right for
you."
We've been listening to it since 1997, when the Food and Drug
Administration first allowed advertising of prescription drugs to the
general public. Since then, these commercials have become a $4.5
billion/year business, supplementing the more traditional forms of
pharmaceutical marketing to physicians and health care providers, such as
free samples and ads in professional journals.
But now the practice has come under increasing attack from the government
and a variety of "public interest" groups. And the day may come when you'll
no longer be able to listen to some low-pitched, rapid-fire voice-over
inform you that "results may vary" and that a drug's dozen or so side
effects are "generally mild" and may, on occasion, include both
constipation and diarrhea.
This would be unfortunate, and for more reasons than the public's "right to
know."
On one matter, there is complete agreement. Pharmaceutical advertising
works. A recent Kaiser Family Foundation study, reported in the July 31
Boston Globe, found that "every dollar spent on drug advertising creates an
extra $4.20 in drug sales."
But there's a catch. To work, drug advertising must be extensive and
intensive and, as your Medicine Men never tire of asserting, it's the
dosage that determines the toxicity. Is this advertising toxic?
Not hardly, at least when it's "fair and balanced" (We Report. Your Doctor
Prescribes).
Pharmaceutical advertising serves three vital purposes. The first addresses
the fact that drugs cost an enormous amount to develop and certify. Big
sellers not only recoup the costs, they also make possible development of
other drugs.
The second pertains to the medical information explosion generally, and the
desire of patients and their families to educate themselves.
The third helps counter an unfortunate trend in managed care and insurance
reimbursement: to restrict their formularies for cost-cutting purposes.
Sometimes you have to ask your physician about a drug because he or she is
not permitted to prescribe or even mention it.
So, what's the problem? Some consumer advocates fret that advertising
forces doctors to write too many prescriptions as though there were some
"proper" number. Others worry about false and misleading claims.
Following a floor speech by Senator Bill Frist, a physician, the
Pharmaceutical Research and Manufacturers of America, a drug industry
lobbying group, issued a set of voluntary advertising guidelines.
The FDA has been making noises about greater regulation in the wake of the
pain-killer meltdown: drugs such as Vioxx that had been heavily advertised
for years. And the industry itself seems to be pulling back a bit, probably
due to the present wave of lawsuits and the possibility that the companies
(and their ad agencies) could be ruined by these and future predatory
lawsuits.
But the most interesting aspect of the controversy concerns advertising's
status under the First Amendment. Until the 1940s, advertising was legally
deemed "mere commercial speech" and not entitled to full protection. Since
then, the courts and the Federal Trade Commission, which has primary
responsibility for overall regulation, have contorted advertising's status
in three ways.
They've radically expanded First Amendment protection in some ways. They've
radically constricted the right of advertising some legally saleable
products, such as cigarettes and liquor. And they've adopted a curious
standard of truth, based upon the premise that the average American is an
idiot.
In other words, a detergent can claim that it's the best cleaner in this or
any universe: no problem. But if Boffo claims than it cleans 25 percent
better than Penumbra, Boffo can expect to end up in a hearing and/or
courtrooms. Thus, the whole trend in advertising for decades now has been
away from useful information and toward glitz, nonsense and the display of
youthful female flesh.
For pharmaceutical advertising to have real public value, it must deal in
facts. But facts get you into trouble, especially with drugs whose problems
may become apparent only after years and decades. So perhaps the real
question is which direction possible regulation will push this advertising.
Toward the providing of information that rational people need, sometimes
desperately? Or toward garbage that may meet government standards, but is
worthless?
Editor's Note: Michael Arnold Glueck wrote this week's commentary.
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Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here. © 2005, |
Arnold Ahlert | |||||||||||
