Docs fire back on drug pushing - and have a point

seen in the New Sentinel

Conventional medicine took a beating last month after several recent studies highlighted the cozy connections between physicians and sales reps for drug companies.

One article, published in the New England Journal of Medicine, showed that virtually all doctors have some type of relationship with makers of drugs and medical devices, and it often involves free office meals and drug samples.

Another report, "Following the Script: How Drug Reps Make Friends and Influence Doctors," provided a unique glimpse into drug companies' playbook. This article, published in the journal PLoS Medicine, detailed in first person how pharmaceutical sales reps use flattery, favors, fake friendships and freebies to manipulate unwitting doctors into prescribing their drugs.

"Every word, every courtesy, every gift, every piece of information provided is carefully crafted, not to assist doctors or patients, but to increase market share for targeted drugs," wrote co-author Adriane Fugh-Berman, an assistant professor of physiology and biophysics at Georgetown University. As you might expect (and hope), many good doctors resented being portrayed as naive and shallow. In fact, some said, often it's not the drug reps who are the hardest pushers; it's the patients.

That's because direct-to-consumer prescription drug advertising, banned throughout the developed world except in the United States and New Zealand, is working like a charm. I've never understood why anyone would ask for some of these drugs after hearing the list of side effects, but spending on such marketing has surged to $5 billion annually. And studies show that doctors are more likely to prescribe drugs when patients ask for them by name.

The ads aren't just a free-speech issue. Proponents argue that they strengthen the health-care system because they help us take control of the situation, they de-stigmatize conditions such as depression, and they provide useful information about diseases and treatment so we can have informed conversations with our doctors.

But what happens is that aggressive direct-to-consumer ad campaigns push drugs that aren't needed or are more expensive than equally effective drugs or lifestyle changes. They medicalize conditions previously considered normal. They can be misleading; about a third of them don't contain references supporting their medical claims, according to UCLA researchers.

Or they're simply wrong. Last year a commercial for the antidepressant Zoloft featured a listless creature and a voice-over that said depression may be caused by a chemical imbalance in the brain. "Zoloft," the ad said, "works to correct the imbalance."

But critics charged that the claim that depression is caused by a "serotonin imbalance" is unsubstantiated by scientific research. Yet it has been repeated so many times that people believe it's true, something that could lead to overreliance on these drugs for depression treatment, according to an article in the journal Public Library of Science Medicine.

In some cases, ads increase sales of drugs that later are discovered to be dangerous, as in the case of Zelnorm, the medication used to treat conditions of irritable bowel syndrome. Last year, Zelnorm was honored as one of the best prescription drug ads by IAG Research, a company that rates TV ad effectiveness. The "tummies" campaign, which turned women's bellies into billboards, was credited with boosting sales growth to $561 million in 2006.

But then - oops! The drug was pulled off the market because federal officials concluded that it could increase risks of heart attacks and strokes.

If you're having a flashback to Vioxx, that's because the same thing happened. After Vioxx was withdrawn from the market because of links to heart attacks and strokes, a study showed that more than 70 percent of patients who were prescribed arthritis drugs such as Vioxx didn't really need them in the first place. These patients could have used "non-prescription alternatives" or older, cheaper medications.

Cases like these illustrate why some health and consumer groups want such advertising banned. Congress is considering legislation to force the drug industry to delay advertising newly approved prescription drugs to give physicians more time to review safety and efficacy.

But delays won't address ad content - often deliberately vague about who is at risk of disease - nor the fact that doctors get most of their education about new drugs from drug companies themselves. Delays also don't protect consumers from the power of advertising. Buying the wrong brand of toothpaste may have a minor health consequence. But taking a prescription drug, which your doctor is more likely to prescribe because you asked, can raise serious health issues. Drug ads are of little educational value, and they minimize the benefits of nutrition and lifestyle changes. They also, ultimately, give pharmaceutical reps another way into a doctor's office: through you.