The power of ads in medicine article

[Guest guest]

Here is another great article just sent to me.

 

 

Mike W. Bowser, L Ac

 

 

Doctors Influenced By Mention Of Drug Ads

 

By Shankar Vedantam and Marc Kaufman

 

 Actors pretending to be patients with symptoms of stress and fatigue were

five times as likely to walk out of doctors' offices with a prescription

when they mentioned seeing an ad for the heavily promoted antidepressant

Paxil, according an unusual study being published today.

 

The study employed an elaborate ruse -- sending actors with fake symptoms

into 152 doctors' offices to see whether they would get prescriptions. Most

who did not report symptoms of depression were not given medications, but

when they asked for Paxil, 55 percent were given prescriptions, and 50

percent received diagnoses of depression.

 

The study adds fuel to the growing controversy over the estimated $4 billion

a year the drug industry spends on such advertising. Many public health

advocates have long complained about ads showing happy people whose lives

were changed by a drug, and now voices in Congress, the Food and Drug

Administration and even the pharmaceutical industry are asking whether

things have gone too far.

 

Nearly every industrialized country bans such advertising, and physicians

said the new study raises new questions.

 

" It is a haphazard approach to health promotion that is driven primarily by

the pharmaceutical industry's interest in turning a profit, " said Matthew F.

Hollon, an internist at the University of Washington in Seattle, who wrote

an editorial accompanying the study in today's Journal of the American

Medical Association. " The most overlooked problem in the health care system

today is the extent to which it is permeated by avarice. "

 

Hollon and the researchers who conducted the study said it was not realistic

to expect such marketing to be abolished, given the climate of deregulation

in Washington. But they said the ads should be tempered by educational

messages funded by a tax on the industry and better training of doctors, or

by a moratorium on ads for new drugs until their risks are fully known.

 

" We can do a much better job with the advertising, " agreed W.J. " Billy "

Tauzin, president and chief executive of the Pharmaceutical Research and

Manufacturers of America (PhRMA). " The ads can do a great job making sure

people who need medications and are undertreated get help. We can also make

it clear that a particular product is meant for people with this particular

problem and for those people only. "

 

The study found that the ads did help patients with a stigmatized illness

such as depression get treatment, even as they prompted overmedication of

people who did not need treatment. Such marketing in effect exploits the

diagnostic gray zone that characterizes many conditions in medicine,

including heartburn, arthritis and allergies.

 

" There is a segment of individuals who would really benefit from

pharmacological therapy; there is another large group that won't, " said

Richard L. Kravitz, lead author of the study and a professor of medicine at

the University of California at Davis. " The easiest thing from a marketing

standpoint is to increase use in all the categories, and that is what we are

seeing. "

 

The researchers sent actors with hidden tape recorders into general

physicians' offices in three cities between May 2003 and May 2004. The

physicians had previously consented to participate but were not told when

they would be tested.

 

Half the actors simulated patients suffering from depression, describing

lengthy periods of sadness, low energy, poor appetite and sleep, and

early-morning awakening. The others described having suffered a career

upheaval and having fatigue, stress and difficulty sleeping, symptoms that

did not warrant medication.

 

More than half of those without simulated depression who mentioned Paxil got

a prescription, underscoring how willing doctors are to go along with

patients' requests.

 

Concerns have recently grown about the safety of antidepressants after

disclosures that the pharmaceutical industry withheld studies that found the

drugs were no better than sugar pills. The FDA recently concluded that the

drugs increase suicidal thinking and behavior among children and required

them to carry black-box warnings -- which have greatly reduced

direct-to-consumer advertising of such drugs.

 

Advertising could be useful for drugs with large benefits and few risks,

said researcher Ronald M. Epstein, but the industry's bias against negative

studies raises questions about which drugs ought to be marketed in this

fashion. Epstein is a professor of family medicine at the University of

Rochester.

 

Nancy Leone, a spokeswoman for GlaxoSmithKline PLC, the maker of Paxil, said

physicians are not unduly influenced by ads, and denied that such " education

campaigns " lead to inappropriate prescribing. It was " difficult to draw

conclusions " about the new study, she said, because Paxil was not being

heavily advertised during the study period.

 

In his editorial, Hollon said 80 percent of physicians believe such ads

prompt patients to seek medications they do not need, and less than 10

percent believe the ads are a good thing.

 

Johnson & Johnson's chief executive, William C. Weldon, now chairman of the

PhRMA board, said last month that the industry ought to revise its approach

to drug ads because they " may inadvertently minimize the importance and

power of medicines and their risks. "

 

Direct-to-consumer (DTC) advertising soared after the FDA allowed drug

promotions on television for the first time in 1997. Efforts to limit such

advertising have run afoul of Supreme Court rulings protecting commercial

speech.

 

The ads are regulated by the FDA's Division of Drug Marketing, Advertising

and Communications. The office, which has barely three dozen employees, must

review 30,000 to 40,000 ads a year. Acting commissioner Lester M. Crawford

said recently that " our patience is sometimes worn thin " by the advertising

claims.

 

Dan Troy, chief counsel for the FDA in President Bush's first term and now

with a Washington law firm, said laws on drug advertising written by

Congress in the 1960s have made it difficult to change policy. He added that

most FDA professionals were " quite pro-DTC. "

 

PhRMA's Tauzin said companies are working on a new code of conduct that

would be preferable to federal regulation.

 

The FDA has moved against scores of ads that it found to be inaccurate or

misleading. In 2001, it warned Merck and Co. that its ads for the arthritis

drug Vioxx were misleading and did not adequately warn viewers of

cardiovascular risks. After Merck took Vioxx off the market last September,

Pfizer Inc. aggressively increased advertising for its competing painkiller,

Celebrex, but also got a warning from the FDA.

 

 

Would you like to send this article to a friend? Go to

http://www.washingtonpost.com/ac2/wp-dyn/emailafriend?contentId=AR2005042601624 & \

sent=no & referrer=emailarticle