Pharmaceutical companies find new ways to reach anxious parents -- go direct

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Pharmaceutical companies find new ways to reach anxious parents -- go direct

 

Monday, December 29, 2003

©2003 San Francisco Chronicle | Feedback | FAQ

 

URL: sfgate.com/article.cgi?file=/chronicle/archive/2003/12/29/EDGGA3G8PD1.DTL

 

" WELCOME to Ordinary, " reads the full-page ad for Strattera, in September's

Family Circle magazine. Two smiling boys proudly hold up a model plane they've

just built.

" 4:30 p.m., Tuesday. He started something you never thought he'd finish, '' the

ad explains. " 5:20 p.m. Thursday. He's proved you wrong. "

The ad, with obvious appeal to any parent whose child is at all troublesome, is

for Eli Lilly's Strattera, the newest, and phenomenally successful, prescription

medication for attention deficit/hyperactivity disorder, now known as ADHD.

Elsewhere in the magazine are ads for Strattera's competitors -- Concerta,

manufactured by McNeil Pharmaceuticals, and Adderall, manufactured by Shire

Pharmaceuticals, which occupy the first and second place in the $2 billion

annual ADHD drug sweepstakes.

The ads are a manifestation of a huge push by pharmaceutical companies to boost

their sales by marketing drugs directly to consumers -- in this case to parents,

and ultimately, to their children.

" These ads are intended to convey the impression that if you're not checking

into a certain drug or obtaining it for your child, you are not doing everything

that you can for your children, regardless of whether it is appropriate or

not,'' said Gene Lee, a financial adviser in Mountain View, whose 9-year-old

daughter has been diagnosed with ADHD.

We do not question that children suffer from inattentiveness, impulsivity or

hyperactivity, the three key indicators of ADHD, or that many will benefit from

medication.

But we worry that those selling these drugs are using techniques that seem

better suited for pitching cars, fast food or beer. There's a possibility that

advertising is contributing to the huge surge in kids who are popping pills for

attention deficit disorders. By some estimates, prescriptions for ADHD drugs

have quintupled over the last decade.

Our concerns are shared by the President's Council on Bioethics, which in a

report issued in October titled " Beyond Therapy: Biotechnology and the Pursuit

of Perfection, " wrote, " In a major and worrisome change from previous practice,

drug companies have taken to marketing drugs directly to parents, with spot ads

depicting miraculous transformations of anxious, lonely or troublesome children

into very confident, honor-roll students. "

And as the council noted, " because there is no definitive biological marker for

ADHD, its diagnosis can be a matter of subjective judgment . . .. Indeed these

drugs have the capacity to enhance alertness and concentration in children

without any symptoms whatsoever. "

Advertising to parents has some obvious advantages. It may help them become

aware that their child has a treatable problem, or that other or newer treatment

options exist. It also helps de-stigmatize the use of psychotropic drugs which

have been shown to be helpful to large numbers of children.

At the same time, the clear purpose of marketing a drug directly to parents is

so they'll ask their physician about it -- or even pressure them to prescribe

it. " They're trying to force the gates open by having patients go and tell

doctors what they should prescribe to them,'' says Dr. Alvin Poussaint,

professor of psychiatry at the Harvard Medical School.

The dangers of inappropriate use are heightened because most children don't even

see a psychiatrist to get a complete diagnostic workup. Few health plans pay for

such visits, a problem compounded by a shortage of child psychiatrists in most

parts of the country, especially specialists in ADHD.

As a result, the majority of prescriptions are written by pediatricians and

family doctors, often with limited knowledge of the syndrome.

Ads inevitably raise expectations sky high -- implying that taking a pill will

create an obedient pliable child who will regularly do his homework and complete

chores around the house. Typical of this genre is an ad for Adderall, which

shows a smiling child sitting on a porch with his baseball gloves, below the

slogan " Already Done my Homework Dad. " (If you didn't get it, the first letters

in each word spell out ADHD.)

Ads also typically imply that one drug is better than another, when in fact

every child has different needs, and may respond better to one drug than to

another. Nor do the ads say that many children don't respond at all to these

medications -- in some cases as high as 30 percent.

The ads also leave out the fact that there has never been a head-to-head study

of the effectiveness of a drug like Strattera against others like Concerta or

Adderall. " At this point, there's no scientific evidence that one medication is

better than another, " says Dr. Anthony Rostain, a child psychiatrist and ADHD

expert at the University of Pennsylvania, who has made presentations on behalf

of Eli Lilly and other pharmaceutical companies.

What this means is that parents need to be aware that ads offer a one-

dimensional solution to a complex problem. " If a child is disorganized and

inattentive there are lots of reasons why he may have those symptoms,'' said Dr.

Russell Reiff, a pediatrician at Kaiser Permanente in San Francisco. " Taking a

pill in the short run is a Band-aid to make the problem look better. "

At the very least, pharmaceutical companies should voluntarily disclose in their

ads how many children are likely to have no response or a clinically

insignificant response to a medication.

The Food and Drug Administration, which approves these drugs, should consider

implementing additional controls on how they're marketed. The so- called " brief

summaries " that appear in tiny type alongside print ads must be more complete

and user friendly. The FDA should also help set up databases to study the impact

of ADHD drugs on all children who take them.

" Direct-to-consumer " marketing may work well for adults. But children are

uniquely susceptible, especially when they face being medicated for a disorder

as vaguely, and broadly, defined as ADHD.

 

 

RECLAIMING CHILDHOOD

This is a one in a series of editorials on the commercialization of childhood.

To read previous editorials, go to www.sfgate.com/childhood.

-- Share your views -- What are your views on and experiences with the direct

marketing of ADHD drugs to children and parents? E-mail The Chronicle at

editorials.

-- Get informed -- Information is available at the National Resource Center on

AD/HD, www.help4adhd.org.

-- Take action -- If you think there should be more controls on marketing of

ADHD drugs, contact the Food and Drug Administration at

www.fda.gov/cder/comment/commentdrug.htm

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