BOB GARFIELD: If it seems to you that suddenly prescription drug commercials are everywhere, you're not the first to notice. [MUSIC FOR COMMERCIAL]
ANNOUNCER: Nozula may cause the following symptoms: itch rashes, full body hair loss, projectile vomiting, gigantic eyeball, the condition known as hot dog fingers--
BOB GARFIELD:That side-effects warning happens to be a joke from E-Trade, a discount broker using the "ever-presence" of drug ads to make a point about investments. Five years ago there was no such genre to make fun of, but thanks to rule changes by the Food and Drug Administration, direct-to-consumer pitches for prescription medications -- DTC for short --now are everywhere -- 2.5 billion dollars worth in the year 2000 -- one percent of all advertising expenditures in America. Claritin, Viagra, Celebrex, Prilosec, Xenical. How in the world did Xenical become a household name? Actually -- I can answer that question. [COMMERCIAL MUSIC]
ANNOUNCER:Since Xenical blocks about one third of the fat in the foods you eat, you may experience gas with oily discharge, increased bowel movements, an urgent need to have them and an inability to control them, particularly after [...?...]--
BOB GARFIELD:Possibly the most famous disclaimer since "batteries not included," but some people are willing to put up with an acceptable level of a bowel leakage in exchange for weight loss, and the stuff is selling, and it's selling in part because patients are walking in to their doctors' offices and asking for it.
JOHN KAMP: One of the things that advertising does is create demand. Is that necessarily a bad thing? I don't think so.
BOB GARFIELD: John Kamp, a lawyer with Wiley, Rein and Fielding in Washington, has lobbied for drug advertisers in Congress.
JOHN KAMP: Advertising doesn't make people buy a product. It sometimes helps them make a decision to try it once, but if it doesn't work, they're not going to do it again.
BOB GARFIELD:If Kamp sounds defensive, that's because he's on the defensive. The explosion of DTC advertising has led to a corresponding barrage of criticism. It can be summarized as follows: Drug companies are using advertising to seduce patients with unnecessary drugs and gouging them in the bargain, driving prescription costs as a percentage of overall health care expenditures through the ceiling. Last year an article in Mother Jones Magazine posed the question: What does it mean for our health care when serious medicine is marketed like soap? The magazine's answer, naturally, was ominous. "DTC advertising," concluded author Lisa Belkin, "is wrong, unseemly, and potentially dangerous." Not a lonely position.
DR. SIDNEY WOLFE: The number of circumstances in which a patient has a problem for which no drug should be prescribed, let alone whichever one is being advertised, is enormous.
BOB GARFIELD:Dr. Sidney Wolfe is director of Public Citizen's Health Research Group in Washington, an organization with many qualms about how medicine is practiced in this country. Wolfe believes that advertising greatly exacerbates a general over-reliance on pharmacological therapy and does so intentionally. "Doctors pressured by the cost restraints of managed care," he says, "have been transformed from orders-givers to order-takers."
DR. SIDNEY WOLFE: The visit itself has gone from 20 minutes to 15 minutes to 10 minutes -- whatever else. Patients walk in to a doctor's office and prescriptions get written.
BOB GARFIELD:Dr. George Lundberg, former editor of the Journal of the American Medical Association, is founder of the health care web site Medscape and author of Severed Trust: Why American Medicine has to be Fixed, which broadly criticizes direct-to-consumer advertising. I asked him to describe the most hellish hypothetical of DTC gone wrong.
DR. GEORGE LUNDBERG: Well hell in that sort of situation would be a patient sees an ad for a drug, a tendency towards hypochondria is ignited, and the patient goes running off to the doctor insisting that they have this problem which they don't have at all. Doctor does some tests and one of the tests comes back and shows an abnormality. It turns out the abnormality is a false positive and the patient gets prescribed that medication or some other medication. Patient has an adverse reaction to that particular chemical and drops over dead. That's hell.
BOB GARFIELD:Yeah, that would be hell. But there is heaven as well. Even Mother Jones acknowledges that the presence of DTC in the health care eco-system drives patients to treatment. For instance, for every million men who appear seeking Viagra for erectile dysfunction, 30,000 are discovered to have previously undiagnosed diabetes; 50,000 heart disease; and 140,000 high blood pressure. In other words -- just because you're a hypochondriac doesn't mean you're not sick. If you present for treatment and the doctor does a proper history and examination you may discover that your impotency or your heartburn or your mood swings or your obesity has saved your life. Harry Sweeney is chairman of Dorland Sweeney Jones, a public relations agency specializing in health care.
HARRY SWEENEY: Of all the people who go into a doctor as a direct result of DTC, about 75 percent of them - 3 out of 4 - don't get into the prescription drug aspect of things at all. Of the people who do, about 1 in 4 don't get the drug that they asked for. So you're talking about a fraction of a fraction who actually wind up getting the prescription drug the advertisement for which brought them into the doctor's office.
BOB GARFIELD:Brandishing these statistics from a Prevention magazine survey, Sweeney scoffs at the charge that DTC ads have turned the nation's physicians into a corps of Dr. Feelgood's merrily dispensing prescriptions on demand.
HARRY SWEENEY: My doctor is not a wimp. I can go in and describe symptoms to him and say I saw a television commercial and it's -- I think my symptoms kind of match up. My doctor's not going to take my word for it. That's a bad doctor! That doesn't have anything to do with the advertising.
BOB GARFIELD:Furthermore, let us not give too much credit where too much credit isn't due. FDA rule changes and the corrosive effects of managed care and 2 and a half billion dollars per year of advertising may have converged to boost these drugs, but let's not forget the drugs themselves -- Prozac for depression, Prilosec for gastrointestinal reflux disease, Lipitor for cholesterol. These are life-altering, sometimes life-saving treatments. They are hugely profitable blockbusters not because advertising is tricking consumers and doctors but because the drugs themselves are revolutionary. With an eye to bringing the revolution to the people, the American Medical Association, with qualifying caveats to its members, endorses DTC advertising. Still, that doesn't end the argument either, because the money raises big red flags. Critics such as Mother Jones Magazine harboring an almost quaint leftist suspicion of the profit motive take offense at just how much lucre drug companies are hauling in. That condemnation may be reflexive, but it isn't necessarily irrelevant. Prilosec, the antacid, costs 4 dollars and 50 cents per capsule retail. Blockbusters are also budgetbusters, driving up the cost of care perhaps intolerably. To finally determine if DTC advertising is a boon or properly the bane of its critics, someone needs to evaluate the costs and benefits -- not to individual patients but to the health care system as a whole. George Lundberg.
DR. GEORGE LUNDBERG: If I were the head of the FDA today, I would try to map the best direct data I could as to the harms and, and benefits that happen to the American populace, and then I would survey the public at large and physicians at large about the benefits, harms and costs and come up with a recommended decision at that point, expecting to be assailed from all sides no matter what that decision was on direct to consumer advertising or prescription drugs.
BOB GARFIELD: And if the whole endless argument gets him depressed, well [THEME MUSIC UP AND UNDER] there's Prozac from Eli Lilly -- available only by prescription. Ask your doctor.
BOB GARFIELD:That's it for this week's show. On the Media was produced by Janeen Price and Katya Rogers with Sean Landis and Michael Kavanagh; engineered by Dylan Keefe, Irene Trudel and George Edwards, and edited-- by Brooke. Our web master is Amy Pearl.
BROOKE GLADSTONE:Mike Pesca is our producer at large, Arun Rath our senior producer and Dean Capello our executive producer. Bassist/composer Ben Allison wrote our theme. You can listen to the program and get free transcripts at onthemedia.org and e-mail us at firstname.lastname@example.org. This is On the Media from National Public Radio. I'm Brooke Gladstone.
BOB GARFIELD: And I'm Bob Garfield -- dot org. [MUSIC TAG] ************