Prescription drug ads have bad side effects

Q: Why do drug companies bombard TV viewers with ads for prescription drugs that we cannot buy on our own? My experience is that doctors don’t like patients telling them what they want for their problem. So whom are the ads really for? It has to be the doctors, but I cannot for the life of me understand how this works. If I still had small children, I would not want them exposed to the constant barrage of ads for vaginitis and ED.

A: Yes, you and I are sick of hearing about toenail fungus and irritable gut syndrome as we try to enjoy our stuffed pork chops during dinner. The American Medical Association hates them to the point of calling for their ban.

Yet for the past 30 years, TV ads that target drugs to consumers have turned out to be just the prescription that pharmaceutical companies were looking for to boost the health of their bottom lines.

Just look at the numbers. In the past two years, market research firm Kantar Madia says, drug makers have upped their ad spending in the United States by 30 percent to a whopping $4.5 billion per year. TV viewers now are subjected to an estimated 80 drug ads every hour every day, according to the Nielsen people.

What have the drug companies received in return? Plenty.

“Something like a third of consumers who’ve seen a drug ad have talked to their doctor about it,” Julie Drummond, a professor of public health at the University of Pittsburgh, said during an National Public Radio interview. And you can just bet that many or most of those consultations resulted in prescriptions being written and filled, the AMA believes.

After watching even a few of these ads, you might not think that would be the case. Half or more of each one is devoted to all of the drug’s side effects. In the case of the antipsychotic drug Abilify, for example, these can range from increased cholesterol and weight gain, to seizures, trouble swallowing and uncontrollable muscle movements that can become permanent or even lead to coma and death.

After hearing all that, you’d think most people would not even want to bring up the subject with their doctors. After all, most doctors really don’t want you to. Just last November, the AMA asked the federal government to consider banning such ads. The AMA said they are fueling demand for the newest and more costly drugs when older, less expensive and equally effective remedies are available.

Yet ever since such ads began, drug makers have seen how effective they can be. Just look at the very first drug marketed this way in the mid-1980s — Seldane, a new allergy medication that did not cause drowsiness. At that time, the Food and Drug Administration required all drug ads to include a list of all possible side effects, which, of course, can run several pages of fine print.

Since they couldn’t do that on television, Hoechst Marion Roussel did a sneaky end-around: The ad merely talked about a hypothetical medication that had all these wonderful benefits without mentioning its name. Then, they instructed viewers to ask their doctors about such a medication. Naturally, the only one fitting the description was Seldane.

The results were nothing to sneeze at. Even though the drug’s name was never mentioned, sales of Seldane soared from $34 million in 1986 to $800 million annually. And that was before 1997, when the FDA took Seldane off the market because it was found to cause potentially fatal heart arrhythmias.

Now, that’s a cautionary tale you might want to remember as you watch ads for the next wonder drug, but it has done nothing to slow drug company’s attempts to pressure patients to ask their docs for these medications. As a result, the AMA adopted its new policy supporting a drug ad ban.

Only two countries in the world allow direct-to-consumer advertising for prescription drugs: the United States and New Zealand. Most other countries banned the practice in the 1940s, and it wasn’t even a blip on the U.S. radar screens until Joe Davis had a brainstorm in the 1980s.

Perhaps surprisingly, Davis wasn’t a drug company CEO or some other high muckety-muck. He was a salesman, who did what drug salespeople did at the time — visit doctors and give them pens and notepads and free samples.

“Nobody had ever thought that these drugs should be or could be advertised to the patients,” Davis, now retired, told NPR in 2009. “It was just outside of people’s brains. They thought that only doctors could understand the products.”

More than that, though, there was a fear shared by both doctors and drug companies at the time that consumer advertising could be harmful. Patients might pressure doctors into prescribing inappropriate drugs. Even if the drugs helped, it might interfere with the time-honored doctor-patient relationship. So drug companies figured the only way to spur sales was to influence doctors to prescribe, say, their Viagra over someone else’s Cialis.

But companies also knew this was a terribly slow and inefficient process when they wanted a new drug to take off like a rocket. For example, the average doctor gets 3,000 pieces of mail a year, Davis said, so your pitch likely will wind up in the trash, perhaps unopened.

So in 1986, Davis and an advertising company exec found that loophole in FDA regulations, through which Seldane was marketed anonymously so that side effects didn’t have to be mentioned

“Our goal was maybe to get this drug up to $100 million in sales,” Davis said. “But we went through $100 million, and we said, ‘Holy smokes!’ And then it went through $300 million. Then $400 million. Then $500 million. ... It was unbelievable. We were flabbergasted.”

And that’s the way it has been ever since — with help from the government. In 1997, the same year Seldane was taken off the market, the FDA began to allow companies to name both the drug and what it’s for while giving only the most significant potential side effects.

As much as I tire of seeing them, I understand firsthand how effective the ads can be. A medication I had been taking for a short time a couple of years ago didn’t seem to be doing the trick, so I researched my problem online and found an alternative that many patients seemed to be happy with. I merely suggested it to my doctor, and she immediately agreed. Fortunately it worked, but it left me momentarily a little shaken over how easy it was for an untrained lay person to influence a potentially critical medical decision.

Now that the average American takes a dozen prescriptions a year, this ad proliferation likely will increase. Drug companies know that doctors often don’t want to create friction with patients, so if a drug won’t make things worse, the doctors might fire off an Rx if asked. So expect to see plenty more flowers and balloons and smiling faces designed to take your mind off the litany of potentially catastrophic side effects being read.

“Providing scientifically accurate information to patients so that they are better informed about their health care and treatment options is the goal of direct-to-consumer pharmaceutical advertising about prescription medicines,” industry trade group PhRMA spokesman Tina Stow once argued.

Besides, experts say, banning the ads likely would bring a massive dose of corporate legal eagles claiming First Amendment rights.

Today’s trivia

As it was being filmed, what classic movie was referred to as “Production 9401” or “Wimpy”?

Answer to Friday’s trivia: If you “climb halfway to the sky” on San Francisco’s cable-car system, you’ll be getting there at a steady 9 1/2 mph. Of the 23 lines established between 1873 and 1890, only three remain. The system employs 8.8 miles of cable that is 1.25 inches thick. During one recent year, the 40 cars took 8.3 million riders nearly 500,000 miles.

This story was originally published March 25, 2016 at 6:37 AM with the headline "Prescription drug ads have bad side effects."