[Paleopsych] NYT: Can Bob Dole Save Your Life? Ask Your Doctor
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Wed Apr 27 01:28:25 UTC 2005
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Health > Personal Health: Can Bob Dole Save Your Life? Ask Your Doctor
By JANE E. BRODY
I'm not normally much of a television viewer, but while I was
recovering from painful surgery, watching TV for several hours a night
was a welcome distraction, though not always enough. Every 10 or 15
minutes, it seemed, some screen personality was urging me to ask my
doctor about one drug or another.
In two months of watching programs from 9 to 11 p.m., I was treated to
scores of advertisements for about two dozen prescription drugs
intended to treat ailments common to 21st-century Americans.
Among them were drugs to fight blood clots, cholesterol, allergies,
diabetes, stomach acid, eczema, depression, erectile dysfunction,
urinary urgency, insomnia, irritable bowel, Crohn's disease,
psoriasis, genital herpes, arthritic pain and the symptoms of
Since the Pandora's box of direct-to-consumer (D.T.C.) televised ads
for prescription drugs was opened in 1997, pharmaceutical companies
have spent billions telling consumers to "ask your doctor" about
various patent-protected prescription drug.
The Learning Curve
Presumably, if you did discuss these drugs with your doctor, you'd
learn much more than a 30- or 60-second commercial could possibly
relate about the potential benefits and risks of the medication, not
to mention the nondrug alternatives.
I say "presumably" because in some cases, viewers learn about new
drugs faster than doctors. And when doctors are aware of new or even
not-so-new medications, they may not know any more about them than
their TV-watching patients.
But even well-informed doctors may not have the time to go into the
details demanded by patients convinced that certain advertised drugs
are an answer to their prayers.
If, say, patients wish to fully discuss one or two of these drugs with
their doctors in an ordinary office visit, the conversations could
easily consume the 7 to 15 minutes that insurance plans allot to each
patient, with no time left for the main reason for the visit.
Consumer ads for prescription drugs initially appeared only in
newspapers and magazines accompanied by a federally required page-long
list of indications, risks and precautions that few without a medical
education could hope to understand.
In 1997, when the Food and Drug Administration loosened its reins in
the name of free speech and conceded that it could not block
prescription drug ads on radio and television, the detailed lists of
warnings fell to broadcasting time constraints.
Contrary to what many consumers think, the drug agency does not screen
these commercials, though it does insist on a balanced presentation of
benefits and risks and has forced some companies to modify or
discontinue their ads.
All such ads are required to contain a "brief summary" of the drug -
side effects, effectiveness and the conditions that make its use
inadvisable. Unless an ad mentions only the name of the drug and makes
no benefits claim, it must disclose all major risks associated with it
or tell consumers exactly how they can get such information.
Thus, you may hear that a given drug is unsafe for pregnant women or
people with diabetes, or may cause blood clots or dangerous bleeding,
or may interact badly with other medications.
Only the United States and New Zealand now permit direct-to-consumer
advertising of prescription drugs. So far, the European Union has
resisted, seeing more risks than benefits. Too often, the ad conveys
unrealistic benefits or distracts viewers from the risks and warnings.
So before you are swayed by the ads to "ask your doctor" about a
prescription drug, consider what experts say about the pros and cons
of direct-to-consumer advertising.
Drug makers have stated repeatedly that a major goal of
direct-to-consumer advertising is educating potential customers. In
theory, when people hear a brief description of symptoms and learn
that a treatment may be available to reverse them, some may be
prompted to ask their doctors about conditions they might otherwise
have ignored or thought of as untreatable.
Finding Another Ailment
Seeing a doctor about a symptom described in an advertisement
sometimes also results in the diagnosis of another, perhaps more
serious, health problem.
The commercials for Viagra are a classic case in point. Of course, men
with erectile dysfunction nearly always know they have it, but they
are often too embarrassed to discuss the matter, even with their
doctors. Or they may have thought that nothing as simple as taking a
drug could be done about it.
But when someone as prominent as former Senator Bob Dole came right
out and said he had been helped by this drug, millions of men likewise
afflicted came forth.
Through their medical visits, some of these men learned that the
underlying cause of their impotence was diabetes, a heart disorder,
depression or some other serious health problem that needed treatment.
For them, the Viagra ads were especially beneficial and possibly
For those without a treatable underlying cause of their lost potency,
simply being able to function sexually was reward enough. (Now a new
drug, Cialis, unlike short-acting Viagra, remains effective for about
36 hours; the ads depict a romantic scene and ask men, "When the time
is right, will you be ready?")
Likewise, advertisements for cholesterol-lowering statins, which
studies have shown can cut cardiac deaths by about one-third, bring
undeniable benefits. Millions of men and women who may gain from
statins, however, have yet to be treated, and televised pleas to ask
their doctors about these drugs could indeed be lifesaving.
Patients swayed by glossy advertising, however, may turn a deaf ear to
the risks involved with a drug.
Doctors afraid to disappoint patients can also be negatively
influenced by drug advertisements. The doctor may recommend that other
approaches - like changing habits to lower blood pressure or
controlling high cholesterol - are preferable to taking drugs. But
patients hoping for prescriptions may pressure their doctors to write
We are already a highly medicated society, and the costs of
prescriptions are rising faster than any other aspect of medical care.
The price companies pay to market prescription drugs directly to
consumers certainly adds significantly to their costs, even though the
costs of consumer-directed advertisements still pale next to the
amounts spent on marketing to doctors.
New drugs are among the most heavily advertised, and these ads can
greatly increase their popularity before the risks are fully known.
For example, direct-to-consumer advertising of the so-called cox-2
inhibitors Vioxx, Bextra, Celebrex and the like to treat arthritis and
other pain problems turned these drugs into mega-billion blockbusters
before it was known that some users were at risk of potentially fatal
heart attacks and strokes.
This widely publicized problem prompted the Food and Drug
Administration's acting commissioner, Dr. Lester M. Crawford, to
announce last month that his agency would be more aggressive in
monitoring ads that made unrealistic promises with scant mention of
Meanwhile, let the consumer be wary.
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