Dr. Robert M. Centor (the genus behind the curtain at DB’s Medical Rants) penned an Op-Ed article in USATODAY summing up his long held position that DTC of prescription drugs should go the way of the Marlboro Man. The opposing opinion only briefly mentions the pitfalls of DTC drug advertising including overuse, increasing health care costs, and messing with the doctor patient relationship and then dismisses these concerns with, “There’s no doubt some truth to that.”

WOW! Now there’s a devilish argument! These problems are exactly why physicians like Dr. Centor and I oppose DTC drug advertising! Have you ever heard of Celebrex and Vioxx, you dolt? These painkillers are no more effective than regular over the counter ibuprophen and several times more expensive. So how do you explain that fact that the sales of these medications went into the Billions of dollars annually? It’s because of millions spent on DTC advertising of these meds.

Defenders of DTC advertising will claim that the ads help to “educate” patients. That’s nice. In the case of Celebrex and Vioxx the ads helped to educate patients on how to screw themselves (or their insurance company) out of a lot of money for a medication that was not any better than their old medication for arthritic pain. With education like this, who needs any misleading drug ads?

Gosh darn! I’ve racked my tiny brain and I can’t come up with a single massively advertised 6 O’clock news drug that represents a major therapeutic breakthrough that patients need to be informed about least their physicians keep this information from them in some sort of diabolical scheme to screw them over and that would never have been uncovered if not for the courageous efforts of the pharmaceutical advertisers! Hail, Hail the all-enlightening drug ads!

Most sarcasm aside, I simply can’t understand the reasoning behind efforts to defend DTC drug ads on the basis of “education” or “awareness”. Are these people aware that “education” occurs only when a buck is to be made? Have you ever heard of niacin for control of cholesterol levels? Of course not! There is proof that niacin can lower cholesterol levels as well as expensive statin medications but you wouldn’t know about this if you only watched expensive pharmaceutical advertising! It’s not because the drug companies conspire to keep this information from you. It’s because niacin is too cheap to bother advertising it! Do you feel informed now?

Are physicians to blame? Absolutely! We see the same ads as our patients. When I was just a little medical resident I would recommend that my patients first try ibuprophen or other over the counter NSAID. But back then was the golden age of the COX2 inhibitors (Celebrex and Vioxx) and usually my patient would give me that “Celebrex stare” as if to say, “You want me to take that store bought crap when you have samples of the miracle drugs right here in the clinic?” So I easily gave in. Hey! It’s not my money and I’d rather not have them come back an sue me when they develop a bad ulcer later on even though they have no history of stomach ulcers, no symptoms, and no other risk factors.

The pressure on physicians to prescribe the COX2 “miracle” drugs was even greater on private physicians who had to worry about their patients going to another doc to get the drugs they saw on TV. Now we know that COX2 inhibitors are not completely safe and not nearly as gastric protective as previously thought but the biggest problem may have been the Billions wasted on drugs no better than OTC meds. It’s a phenomenon driven by DTC ads and we are a set up to have this happen again. The AMA in particular needs to reverse its collective cranioproctology and take a stand against DTC drug ads.

1. Dan | June 19, 2008, 1:52 pm
   

   Published on http://www.brainblogger.com

   Your Television as you doctor?

   Often, usually on television, one viewing will often at times see an advertisement for some type of medication- usually one involved in a large market disease state and the commercial is sponsored usually by a big pharmaceutical company for a particular network. This is called direct to consumer advertising, and doctors would prefer they did not exist.

   Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry spends around 5 billion annually on this media source now. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns. And involves money spent that could be applied to greater uses, according t many, but we are dealing with a corporation here.

   The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective, which is to increase sales and grow their market and, in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads, in relation to their accuracy and clarity, as well as their effect on the health care system.

   DTC advertising is also a catalyst for and similar to disease mongering.

   Disease mongering is the creation of what some believe to be medical flaws, and illustrated by the creators through exaggeration and embellishments through media sources as an avenue for suc propaganda, as is often seen with DTC advertising. Yet the flaws may not be medical, but corporate creations of these questionable human ailments that do not require treatment, possibly, and may be an attempt to develop a particular medical condition to acquire profit. One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. And it is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.

   Also, DTC ads discuss only one treatment option normally, so it seems, when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the doctor, as they assess your health, not your television or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of our country and New Zealand.

   Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome for the doctor chosen for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads require a prescription.
   Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some over-prescribing, which will benefit everyone in the long term. And the Health Care System can regain control of their purpose, which is far from financial prosperity.

   “Do every act of your life as if it were your last.” —- Marcus Aurelius

   Dan Abshear
   Author’s note: What has been written was based on information and belief