BOB GARFIELD:
This is On the Media. I'm Bob Garfield.
BROOKE GLADSTONE:
And I'm Brooke Gladstone. Once, makers of prescription drugs didn't market direct to consumers. The FDA requirements for listing side effects were prohibitive, and, anyway, it seemed inappropriate.

Then, in 1985, a couple of ad men working on a new antihistamine called Seldane figured out a workaround. Their ads peddled the condition but never mentioned the drug. And it worked. People, once content to sniffle, made appointments with their allergists, and sales skyrocketed.

Eventually, the FDA loosened restrictions, and now we all swim in a sea of carefully choreographed drug marketing. Some save people's lives. Others just complicate them.

Shannon Brownlee has authored a new book called Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer. Among other drugs, she examined the marketing of the sleep drug Lunesta, approved in 2005 and launched with a $60 million ad campaign.
SHANNON BROWNLEE:
The first ad that appeared was on Desperate Housewives, which was quite appropriate, I think. And it featured a black-and-white ad where a man and a woman are in bed, and the woman gets up, obviously restless in the middle of the night, and she's wandering around the room.

And then in through the window comes this incredibly beautiful little Luna moth. And then the voiceover says something like -
[MUSIC UP AND UNDER]
[CLIP]:
WOMAN:
Do you lie awake exhausted but still can't sleep? Maybe it's time to ask your doctor if Lunesta's right for you.
[END OF CLIP]
SHANNON BROWNLEE:
It's the only drug that's approved for long-term use. And the market analysts are predicting this explosion in sales in the sleep drug industry, and, in fact, that's exactly what happened.
BROOKE GLADSTONE:
And let's talk about why. It isn't because of the beautiful green moth, however memorable [LAUGHS] it may have been. It's really because of the third-party strategy.
SHANNON BROWNLEE:
As one doctor put it, calling what the drug industry does "advertising" is like calling D-Day a bunch of guys waiting in the surf. [BROOKE LAUGHS]

So this third-party strategy, what you want to do is you want to get your marketing message into the mouth of an authoritative third party. One of the third parties are patient advocacy groups, and another third party that they like to use are the media.
BROOKE GLADSTONE:
All right. Well, let's stop and examine those. First of all, the patient advocacy group in the Lunesta case was the National Sleep Foundation. What was interesting to me in your book was that when the organization was launched in the early '90s, it claimed that a little more than a quarter of Americans suffered from a sleep disorder. And by the time Lunesta launched in 2005, it was claiming - go ahead.
SHANNON BROWNLEE:
[LAUGHS] It was claiming that 75 percent of American adults suffer from some insomnia and that it was ruining their sex lives, which obviously got a few headlines.

Well, the National Institutes of Health says, at most, 25 percent of Americans are suffering from insomnia either regularly or occasionally.
BROOKE GLADSTONE:
And that was the National Sleep Foundation's initial statistic.
SHANNON BROWNLEE:
That's right. So you sort of wonder whether or not this poll is biased. But then you take the question the next step, which is: why would the National Sleep Foundation have this apparently biased poll?

And one reason is perfectly understandable. The National Sleep Foundation is genuinely concerned about people getting enough sleep. So they have this sort of natural desire to get people to take sleep seriously, and one way you do that is you exaggerate, A) how many people are suffering from not enough sleep, and B) the dangers of not enough sleep.
BROOKE GLADSTONE:
Whatever their motivations may have been, if you're accusing them of, in a sense, you know, perpetrating a deceit upon the American people - and we should mention along the line that I don't know what their funding was initially, but during the Lunesta launch it was already being funded quite a bit by drug manufacturers - it makes you feel queasy.
SHANNON BROWNLEE:
Yes. Innocently or not, most of them seem to be taking money from the drug industry. One of the marketers for one of the competitor drugs, Sonata, she told me that they very deliberately told organizations like The National Sleep Foundation how to do their polls because they wanted the result that comes with saying lots and lots of people have this disorder called sleeplessness.
BROOKE GLADSTONE:
We should also note that The National Sleep Foundation gives the press something to cover when it releases its polls and the press is an important additional third party that you refer to in your book. How do the drug companies make use of the press?
SHANNON BROWNLEE:
Let me answer the question by kind of going at it from the perspective of the media, who are bombarded with information from a variety of sources. One of those sources is The National Sleep Foundation, which sends out its poll and wants us to write about the results of that poll.

Number two, we get information from universities. So one of the places that did some of the research on Lunesta was Duke, and what Duke’s P.R. office did is it offered the press a patient who said Lunesta was the greatest thing that ever happened to her, and it offered up a researcher, a Dr. Andrew Krystal.

And it turns out that Dr. Krystal is paid by the company that makes Lunesta, and the press is offered these people as if it's all coming completely independently out of Duke University. So then a bunch of people wrote stories on Lunesta based on that press release.
BROOKE GLADSTONE:
This is the last thing I want to do is to quote from a book that you quote [LAUGHS] called Selling Sickness. "With many medical conditions there is great uncertainty about where to draw the line that separates the healthy from the sick. The wider you draw the boundaries that define a disease, the wider the pool of potential patients and the bigger the market for those making the drug."

That all seems sort of straightforward, but how does it affect the way we see ourselves as people?
SHANNON BROWNLEE:
I think over the last 30 years the pharmaceutical industry and the patient advocacy groups have, in effect, made us think we're sick and that we have to be constantly vigilant. It leads to the medicalizing of [LAUGHING] all of human existence. I mean, every little woe that we have, every worry we have might be depression. You know, every heart palpitation we have might be heart disease. Every headache we have might be cancer. And that's a lousy way to go through your life.
BROOKE GLADSTONE:
Shannon, thank you very much.
SHANNON BROWNLEE:
Thank you.
BROOKE GLADSTONE:
Shannon Brownlee is a senior fellow at the New America Foundation. Her new book is Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.