The great direct-to-consumer prescription drug advertising con:

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http://www.newstarget.com/010315.html Thursday, September 08, 2005 The great direct-to-consumer prescription drug advertising con: howpatients and doctors alike are easily influenced to demand dangerous drugs A cute, animated ball bounces around very sadly until he takes a magicpotion; suddenly, it becomes happier than ever. No, that isn't theplot of a new children's movie. On the contrary, it's the storyline ofa Zoloft commercial – yes, Zoloft, a powerful antidepressant drug. Inthe 1990s, direct-to-consumer advertising like this increased at acompounded-annually rate of 30 percent, according to Ian Morrison'sbook, Health Care in the New Millennium. In fact, by 1995, drugcompanies had tripled the amount of money they formerly allotted toconsumer-directed advertising, writes to Gary Null in Death byMedicine. Since then, pharmaceutical advertising has grown to anentirely new, pop culture-savvy level. These days, it's hard to tell the difference between pharmaceuticalcommercials and car commercials. Both are almost always intended tolook "cool." Car and pharmaceutical commercials use the same hooks --popular music, good acting and lofty promises -- to hook consumers andreel them in. Falling prey to car commercials results in little morethan hefty car payments; however, becoming seduced by pharmaceuticalcompanies can result in the consumer willingly taking powerful drugs,at the risk of serious illness and even death. In spite of thistremendous risk, pharmaceutical advertisements are becomingincreasingly common and, unfortunately, increasingly effective. In 2000, pharmaceutical companies spent $2.5 billion on mass mediapharmaceutical advertisements, according to Mike Fillon in Ephedra:Fact or Fiction. This number increased to over $3 billion in 2003,according to Dr. John Abramson's book Overdosed America. In his book,Death by Prescription, Ray D. Strand looks at these high figures andposes the question: "Why?" Why do pharmaceutical companies spendbillions of dollars on direct-to-consumer advertising, when consumerscan only obtain prescriptions for these drugs through a doctor?Wouldn't it seem that consumers have no influence whatsoever on thesuccess of a prescription drug, so advertising should be directedentirely toward doctors? That makes sense, but it's not the way things work. Pharmaceuticalcompanies wouldn't spend billions of dollars on direct-to-consumeradvertising if it didn't work. In fact, the advertisements are working… too well. Fillon writes, "The average number of prescriptions perperson in the United States increased from 7.3 in 1992 to 10.4 in2000. Along with this increase in demand, there has been a shifttowards the use of more expensive medications. It's more than acoincidence that many of the most expensive medications happen to bethose medications that are most heavily advertised." In fact, between1999 and 2000, prescriptions for the 50 most heavily advertised drugsrose six times faster than prescriptions for all other drugs,according to Katharine Greider's book, The Big Fix. So, how isdirect-to-consumer advertising so effective in a system in whichdoctors write out the prescriptions? Telling clever stories with misleading adsWell, first, let's explore direct-to-consumer advertising, namely thetelevision commercial. Most prescription drug commercials follow thesame script progression: First, the commercial shows how bleak lifewas for a person or character before taking whatever prescriptionmedicine the commercial is advertising. Then, the protagonistdemonstrates or tells how wonderful life is while on the drug.Finally, a voiceover obligingly lists the side effects, often speakingas quickly and inaudibly as possible. Take, for example, a Paxil commercial that was recently popular. Atthe beginning of the commercial, the typical 30-something-year-oldwoman is standing outside a house, looking through the window at thehappy party going on inside. She looks so lonely and depressed that itmust break nearly every consumer's heart. "What's wrong with her?" wecompassionate humans gasp in unison. The voiceover answers ourquestion as we think it: The woman has social anxiety disorder, acondition that can be treated with the prescription drug Paxil. Suddenly, the now-medicated woman rings the doorbell and, with a hugesmile on her face, joins the party. We see how much fun she is havingand we are so happy for her! Of course, the voiceover quickly goesthrough the list of Paxil's potential side effects, but how can weconcentrate on that, when we're so busy rejoicing at the woman's newhappiness? Whoever wrote that commercial should write Hallmark movies.After seeing it a few times, I was convinced that most of mynon-immediate family had social anxiety disorder and I even called onerelative up to suggest that she take Paxil. I'm not even a gullibleperson, yet I was persuaded by pharmaceutical company advertising. Doctors prescribe whatever the patient namesWe are what Strand calls a "self-medicated" society. Consumers do notactually write their own prescriptions, but they practically do, basedon whatever drugs they see advertised on television. Strand writes,"Surveys reported in our medical literature reveal that when a patientcomes into a doctor's office and requests a specific drug that he hasseen advertised in the media, the doctor writes the exact prescriptionthe patient requested more than 70 percent of the time!" So, let's say that a consumer who has been feeling a little sad latelysees a commercial for the antidepressant drug Zoloft. The commercialdemonstrates the symptoms for depression and the consumer identifieswith them. Suddenly, he or she thinks, "I'm not just sad. I'mdepressed, which is a 'medical condition that can be treated by theprescription drug Zoloft.'" With this in mind, the consumer goes to amedical doctor and says, "I've been really depressed a lot lately.I've been [the consumer recites the depression symptoms listed in theZoloft commercial]. I think I need Zoloft." So, according to Strand,there's a 70 percent chance the doctor will prescribe Zoloft, theexact prescription the consumer requested. That's how pharmaceuticalcommercials really work. They directly influence consumer behavior,yet drug companies claim they only "educate" patients, but don'tpersuade them to do anything. Doctors are easy to manipulate, drug companies discoverYou may be wondering why doctors base their prescriptions on therequests of their patients, who usually have no medical trainingwhatsoever. That's a good question with a simple answer. Thepharmaceutical-advertising machine seduces doctors, too. According to Burton Goldberg's book, Alternative Medicine, paidpharmaceutical advertisements are the main source of the Journal ofthe American Medical Association's revenues. The AmericanPsychological Association is equally under the pharmaceuticalcompanies' spell, as 15 to 20 percent of the American PsychologicalAssociation's (APA) income comes from pharmaceutical advertisements inits journals. In Innocent Casualties, Elaine Feuer calls these advertisements"intentionally misleading" because they promote the pharmaceutical by"exaggerating a drug's benefits while downplaying its hazards in smallprint in the addendum." This is very similar to the obligatory "sideeffects" voiceover recited at the end of a pharmaceutical televisioncommercial; neither consumers nor doctors pay much notice to the"final voiceover" or "fine print." Just in case advertisements in the Journal of the American MedicalAssociation (JAMA) haven't properly seduced doctors, pharmaceuticalcompanies take an extra promotional step by aggressively "detailing"doctors, which involves promoting drugs through door-to-door giveawaysof free information and samples, according to Health Care in the NewMillennium. Morrison writes that "Pfizer alone has 4,500 people in itssales force," but these employees' salaries are small change comparedto the increased revenue they encourage. The next time you watch television or read a magazine, pay specialattention to pharmaceutical advertisements. Notice their promotionalhooks and be grateful that you, unlike most consumers, are no longersusceptible to their influence. That's what knowledge, unlike naiveté,brings you. The experts speak on pharmaceutical advertising:In the pharmaceutical area, DTC advertising has been increasing in thelate 1990s at a rate of around 30 percent compounded annually. Onceprevented by regulation from advertising aggressively, pharmaceuticalcompanies now see DTC advertising as a major source of stimulatingdemand for their product; they spent $1.3 billion on DTC advertisingin 1998 alone. This has had two key effects: (1) it has built brandawareness and product awareness in the minds of end users (consumers),who are increasingly taking medications for chronic conditions inincreasingly crowded and competitive therapeuticcategories—cholesterol management, cardiovascular diseases, asthma,allergy, and other forms of respiratory ailments; and (2) moredirectly, it has encouraged users to visit their doctors and ask forthe product by name.Health Care in the New Millennium by Ian Morrison, page 44 In order to reach the widest audience possible, drug companies are nolonger just targeting medical doctors with their message aboutantidepressants. By 1995 drug companies had tripled the amount ofmoney allotted to direct advertising of prescription drugs toconsumers. The majority of the money is spent on seductive television ads.Death By Medicine by Gary Null PhD, page 13 In 2000, pharmaceutical companies spent $2.5 billion on mass media adsfor prescription drugs. Admittedly, this is a small portion of the$101.6 billion spent on advertising of mainstream consumer products inthe United States.Ephedra Fact And Fiction by Mike Fillon, page 75 The stage could not have been set more perfectly for prescription drugadvertising to become a major force in American medicine. And so itdid. In 1991 the drug companies spent a paltry $55 million onadvertising drugs directly to consumers. Over the next 11 years, thisincreased more than 50-fold to over $3 billion in 2003. The ads appealto viewers as independent decision makers—capable of forming their ownopinions about which drugs they need—and resonate with the growingconcern that HMOs and managed care plans tend to withhold the bestcare to save money.Overdosed America by John Abramson MD, page 81 While $3 billion in advertising may seem like an awful lot, restassured that the drug companies aren't worried. Why? Americans areexpected to spend over $500 billion on drugs this year—not includingthe extra $100 billion estimated for the Medicare drug benefitprogram. Spending on prescription drugs is now the fastest growingportion of healthcare spending in the United States.Ephedra Fact And Fiction by Mike Fillon, page 176 Many of us don't find the amount of money spent on marketingprescription drugs to physicians surprising, but when considering thebillions of dollars spent on marketing prescription drugs to thepublic, don't you wonder why? After all, you can obtain prescriptionsonly through a doctor. Pharmaceutical companies are willing to spendthis kind of advertising money on only their most recently approvedmedication.Death By prescription by Ray D Strand, page 48 The average number of prescriptions per person in the United Statesincreased from 7.3 in 1992 to 10.4 in 2000. Along with this increasein demand, there has been a shift toward the use of more expensivemedications. It's more than a coincidence that many of the mostexpensive medications happen to be those medications that are mostheavily advertised.Ephedra Fact And Fiction by Mike Fillon, page 77 According to a report prepared by the National Institute for HealthCare Management, a nonprofit research foundation created by the BlueCross Blue Shield health insurance plans, the fifty most-advertisedprescription medicines contributed significantly last year to theincrease in the nation's spending on drugs. The increases in the salesof the fifty drugs that were most heavily advertised to consumersaccounted for almost half the $20.8 billion increase in drug spendinglast year, according to the study. The remainder of the spendingincrease came from 9,850 prescription medicines that companies did notadvertise, or advertised very little. The study attributed thespending increase to a boost in the number of prescriptions for thefifty drugs, and not from a rise in their price.Ephedra Fact And Fiction by Mike Fillon, page 77 Pharmaceutical companies are in business to make money; with theexception of over-the-counter medications that will be sold in greatnumbers, the only way a pharmaceutical company can make lots of moneyis by developing medications that can be patented. Natural herbs andfoods as well as medications that can no longer be patented won't be"pushed" in advertising because there's no real money to be made on them.Attaining Medical Self Efficiency An Informed Citizens Guide by DuncanLong, page 11 Not surprisingly the "super aspirin" have received lots of favorablepress on the TV since there's money to be made. With the dollarspharmaceutical companies make, translating into greater advertisingrevenues for broadcasters and publishers, the rush is push the superaspirin and play up the "dangers" of common aspirin.Attaining Medical Self Efficiency An Informed Citizens Guide by DuncanLong, page 13 The cheap-but-effective medications that can't be patented are alsokept out of the limelight by the big companies paying for advertisingand the mass media intent on making money through advertising.Attaining Medical Self Efficiency An Informed Citizens Guide by DuncanLong, page 19 When you go into a pharmacy to get a prescription filled, you canoften pay considerably less by choosing a "generic" drug over a brandname. The generic drugs are often made by the same manufacturer as thename-brand medication — the extra price is in the packaging andadvertising. Even when a different company makes the genericmedication, it is every bit as good as the brand name because it isrequired to meet certain standards before it can be sold in the US.Attaining Medical Self Efficiency An Informed Citizens Guide by DuncanLong, page 183 In contrast, most physicians are unaware of the considerable risks andlimited benefits of commonly used prescription cholesterol-loweringagents. In addition, since niacin is a widely available "generic"agent, no pharmaceutical company stands to generate the huge profitsthat the other lipid-lowering agents have enjoyed. As a result, niacindoes not enjoy the intensive advertising that the HMG CoA reductaseinhibitors and gemfibrozil enjoy. Despite the advantages of niacinover other lipid-lowering drugs, niacin accounts for only 7.9 percentof all lipid-lowering prescriptions.Encyclopedia Nutritional Supplements by Michael T Murray ND, page 90 In addition, since niacin is a widely available "generic" agent, nopharmaceutical company stands to generate the huge profits that theother cholesterol-lowering drugs have enjoyed. As a result, niacin isnot intensively advertised like the other drugs. Despite theadvantages of niacin over the cholesterol-lowering drugs, niacinaccounts for only 7.9 percent of all lipid-lowering prescriptions.Encyclopedia Of Natural Medicine by Michael T Murray MD Joseph LPizzorno ND, page 352 In 1996 Russia spent about $1.75 million on testing. But 1997 openedwith a smaller HIV/AIDS budget, unpaid doctors and nurses countrywide,and hospitals with empty pharmaceutical shelves. Far from being ableto afford $10,000 to $40,000 a year to treat HIV patients in ways thatmet U.S. standards, or to continue a nearly $2 million testingprogram, Russia couldn't even find the wherewithal to buy televisionadvertising time on national television to promote AIDS education.Betrayal Of Trust By Laurie Garrett, page 205 According to the study, Vioxx, an arthritis drug sold by Merck & Company, was the most-heavily advertised prescription drug and alsoaccounted for more of last year's increased drug spending than anyother single drug. Merck spent $160.8 million to promote Vioxx toconsumers—more than PepsiCo spent to advertise Pepsi or Budweiserspent to advertise its beer, the study said. With the help of theadvertising, Vioxx sales quadrupled to $1.5 billion last year fromabout $330 million in 1999.Ephedra Fact And Fiction by Mike Fillon, page 77 And if that weren't enough, the British pharmaceutical companyGlaxoSmithKline spent more on consumer advertising than any othercompany. It spent $417 million on advertising last year—an increase of40 percent from the previous year.Ephedra Fact And Fiction by Mike Fillon, page 178 Hundreds of millions of dollars are spent by pharmaceutical companiesto research and then advertise their patented medical drugs tophysicians and consumers. No such bankroll exists for nutritionalsupplements. That's because nutritional supplements, based onvitamins, minerals, herbs, and natural substances such as MSM, are notpatentable.The Miracle Of MSM by Stanley W Jacob, page 13 The reason drugs cost more in America than in any other country boilsdown to one simple factor: the pursuit of maximum profit. Thepharmaceutical industry has taken every opportunity, used every ploy,to deceive the American people. To derail efforts at makingpharmaceutical benefits an integral part of Medicare, they spent tensof millions of dollars on an advertising campaign to discredit theCanadian system, and even created a bogus organization, "Citizens forBetter Medicare," to try to lend credibility to their efforts. And nowthey are introducing piecemeal discount card programs in an effort todefuse efforts for more comprehensive change.Health Care Meltdown by Robert H Lebow MD, page 263 But Canada's system has born the brunt of negative advertisingcampaigns in the U.S., campaigns which have been successful incoloring Americans' perceptions of the Canadian system. The AmericanMedical Association spent several million dollars in the early '90s todiscredit the Canadian system and create doubts in the mind of theAmerican public about a government-managed system for universalcoverage. And in 2000, in a somewhat less successful ad campaign thatcost perhaps $60 million, the American pharmaceutical industry triedto discredit the Canadian system. A ubiquitous "bus from Canada"appeared in a plethora of TV spots and full-page newspaper ads acrossthe U.S. The goal was to derail efforts to make pharmaceuticalbenefits an integral part of Medicare.Health Care Meltdown by Robert H Lebow MD, page 149 Most, but not all, megasites support themselves with ads forprescription drugs, vitamins, and medical sundries, as well aslaptops, life insurance, and books — typical Internet commerce.Therefore, advertisers may influence the information you find on the site.Healthcare Online for Dummies by Howard and Judi Wolinsky, page 23 With annual U.S. revenues of about $100 billion and worldwide revenuesof $300 billion, the pharmaceutical industry is one of the largest,most powerful industries, producing some of the most sophisticatedmarketing and advertising anywhere. Marketing is the economicequivalent to waging war—sizing up your own forces, your enemy's (thecompetition), and emphasizing your own strengths and your enemy'sweaknesses. Marketing strategy meetings are akin to war rooms wheregenerals map out their plans for attack and defense.Syndrome X by Jack Challem Burton Berkson MD and Melissa Smith, page 55 The reason that prescription drugs are not recognized as one of thebiggest killers in America is complex. Drug companies who make hugeprofits from the sale of drugs spend more than $10 billion a yearpromoting drugs, and spend next to nothing warning the public aboutpotential risks. Drug companies also engage in misleading advertisingcampaigns which make outright false or unrealistic claims, but whichconvince that vast majority of the public that most or allprescription drugs are not only safe, but the key to better health anda better life. The doctors themselves are also a part of the problem.Doctors chronically under-report and even ignore the deaths or adversereactions to the drugs they prescribe because it is not in theirprofessional self interest to raise public awareness to the danger.Doctors are afraid of being sued, they maintain a culture of denial,and they also profit from there relationships with the big dragcompanies. The government is also part of the problem because it doesnot have the resources or the political will to do more about thedangers of prescription drags. Also, powerful members of the Americangovernment, from the President on down, are all lobbied heavily by thecash rich drug companies.Prescription Medicines, Side Effects and Natural Alternatives byAmerican Medical Publishing, page 16 First of all, consider the fact that the American prescription drugindustry - the giant pharmaceutical companies — is the most profitableindustry in the world. Drug companies make more money than banks, moremoney than oil companies, more money than Ford or GM, more money thananybody. Drug companies spend billions of dollars on advertising andpromotion -- some $10 billion every year. This advertising is directedat both doctors, and directly to the public.Prescription Medicines, Side Effects and Natural Alternatives byAmerican Medical Publishing, page 11 The United States is currently the only country in the world thatallows drug companies to advertise prescription drugs directly to theconsumer. It used to be that prescription drugs could only be toutedto physicians. But now consumer ads on TV tantalize you with greatpromises of health and well-being, skim through the side effects asquickly as possible and then suggest you contact your physician or adrug company hotline for more information. The drug companies are alsoresponsible for the expensive, slick, four-color ads you now see inconsumer magazines and newspapers. You are bombarded with $3 billionworth of advertising for prescription and over-the-counter drugs everyyear. That should give you an idea of how valuable you are as a drugconsumer and of the staggering profits the drug companies rake inevery year.Prescription Alternatives by Earl Mindell RPh PhD and Virginia HopkinsMA, page 531 Pharmaceutical companies spent $2.5 billion in 2000 promotingprescription drugs, an increase of nearly 45 percent over 1999. Theseadvertisements contribute to rising costs by inducing consumer demandfor newer, higher-priced drugs, when the older ones may work just as well.Prescription For Dietary Wellness by Phyllis A Balch, page 285 Claritin, a formerly prescription antihistamine used to controlallergic symptoms, was far and away the most heavily advertisedprescription drug in the two years following the FDA's 1997 ruleschange. They resisted the idea that there were equally good andperhaps even better ways to relieve their allergy symptoms than a new(and therefore less well tested) drug. Moreover, they were unconcernedabout Claritin's cost (more than $2.10 per day): most had prescriptiondrug coverage as part of their health insurance. With an advertisingbudget greater than that of Budweiser beer or Coca-Cola, Claritin tookoff: sales grew from $1.4 billion in 1997 to $2.6 billion in 2000.Overdosed America by John Abramson MD, page 153 Thus, it is not surprising that direct-to-consumer prescription drugadvertising is expected to increase to $7.5 billion by 2005, a 1,200%increase over a decade, as drug manufacturers decide, as Vodra put it,to "fight fire with fire in the marketplace. It's only a small stepfrom that to the adoption of an 'offense is the best defense' policyas marketing pressures intensify."Overdose by Jay S Cohen, page 162 The medication marketplace is a very competitive world. Atpharmaceutical companies, doctors usually don't make the finaldecisions—business people make them. In order to sell medications,good and bad, elaborate marketing and advertising strategies arenecessary, and impressive rates of effectiveness are essential.Overdose by Jay S Cohen, page 35 A self-medicated society Not only are we an overmedicated society, we are a self-medicated one.It's true, physicians are prescribing more drugs than ever before, butnot only is the pharmaceutical industry effective in advertisingprescription medications, it has overwhelmingly persuaded the Americanpublic to buy tons of over-the-counter medications.Death By prescription by Ray D Strand, page 169 Surveys reported in our medical literature reveal that when a patientcomes into a doctor's office and requests a specific drug that he hasseen advertised in the media, the doctor writes the exact prescriptionthe patient requested more than 70 percent of the time!Death By prescription by Ray D Strand, page 49 But, again, there is a problem. While TV ads for drugs do indeed listpotential harmful side effects, the slickly produced ads gloss overthem so fast, and with such finesse, it creates an overwhelmingimpression among the public that these potential dangers are all butnothing to worry about. Also, TV ads do not list all of the potentialside effects, but rather, just the most common side effects. So ineffect, advertisements for prescription drugs on television areliterally lying by omission.Prescription Medicines, Side Effects and Natural Alternatives byAmerican Medical Publishing, page 13 30 percent of consumers reported having talked with their doctor abouta drug they'd seen advertised. Nearly half of those who asked for anadvertised drug—13 percent of all consumers—came away with a script.In another Kaiser study, co-sponsored by The NewsHour with Jim Lehrer,nearly half of American consumers said they trust advertisements toprovide them with accurate information. But perhaps most telling arethese results of a recent NIHCM study: Between 1999 and 2000,prescriptions for the fifty most heavily advertised drugs rose at sixtimes the rate of all other drugs. Sales of those fifty intensivelypromoted drugs were responsible for almost half the increase inAmericans' overall drug spending that year. Makers of the newarthritis drug Vioxx spent $160 million pushing it to consumers in2000, more advertising dollars than were dropped on Pepsi Cola,Budweiser beer, Nike shoes, or Campbell's soups. Vioxx sales shot up360 percent.The Big Fix by Katharine Greider, page 30 Only the United States and New Zealand permit advertising ofprescription medicines to consumers.Ephedra Fact And Fiction by Mike Fillon, page 255 This practice of massive advertising campaigns for drugs in order toconvince us and our doctors that we "need" various drugs andspecifying which drugs we do need should be a great concern for us.CONSUMER REPORTS discussed this issue at length in two articles whichran concurrently in the February and March 1992 issues entitled"Pushing Drugs to Doctors" and "Miracle Drugs or Media Drugs?" Theyestimate a figure of 5 billion dollars was spent in 1991 for this typeof advertising and add, "Though doctors insist their scientifictraining, high intelligence, and sophistication enable them to resistmanipulation, the truth is that skillful marketers can influence M.D.sjust as easily as they can sway the rest of us.." The pharmaceuticalcompanies spend more on this advertising than they spend in researchand development of products.PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 43 Merrell Dow pharmaceuticals mounted a massive advertising campaignadmonishing, "If you want to quit smoking for good, see your doctor. .. . Now your doctor can provide a treatment to help control nicotinewithdrawal symptoms." The smoking industry is too vast and the numberof smokers wishing to quit too lucrative for smoking to be overlookedas a medical problem.Diseasing Of America by Stanton Peele, page 119 The unnecessary surgery figures are escalating just as prescriptiondrugs driven by television advertising. Media-driven surgery such asgastric bypass for obesity "modeled" by Hollywood personalitiesseduces obese people to think this route is safe and sexy. There iseven a problem of surgery being advertised on the Internet. A study inSpain declares that between 20 and 25% of total surgical practicerepresents unnecessary operations.Death By Medicine by Gary Null PhD, page 19 Since the mid-1990s, pharmaceutical companies have tripled the amountof money they spend on direct-to-consumer advertising prescriptiondrugs. From 1996 to 2000, totals rose from $791 million to nearly $2.5billion. And despite the huge increase, drug companies spend even farmore dollars in advertising their products to physicians, notconsumers. The $2.5 billion figure for consumer ads is concentrated ona relatively small handful of medications.Ephedra Fact And Fiction by Mike Fillon, page 176 Eli Lilly's advertisements in the general media for Prozacspecifically state: "Like other antidepressants, it isn't habitforming." No wonder so many patients are not informed either aboutserious withdrawal syndromes or dependence. Obviously such statementsby pharmaceutical companies and drug advocates are attempts to"educate" the public out of their healthy concerns about drugs ingeneral, including Prozac-type medications. Although aggressivelyadvanced, such pronouncements are at odds with the clinical realityfor many patients on the drugs.Prozac Backlash by Joseph Glenmullen MD, page 89 Yet the healthcare industry — as with most other industries — is slowto recognize the Internet's potential business opportunities andthreats. In addition, there is strong and irrational Internetresistance from physicians, who control about 80 percent of healthcareresources. Not surprisingly, pharmaceutical companies are switchingtheir advertising budgets to target consumers rather than physiciansin an attempt to influence how consumers determine their medicaltreatment needs.Future Consumer com by Frank Feather, page 190 The pharmaceutical companies have been quick to realize the potentialof this expanding market and are beginning to target advertising forprescription medicines directly to consumers, on television and inprint. These developments can be positive, but they do require moreeffort and responsibility from all of us.Graedons Best Medicine by Joe Graedon & Dr Terasa Graedon, page 111 Among the wealthy nations that support the global pharmaceuticalindustry, the United States is by far the most permissive in itsregulatory scheme. As other countries move to control prices andsharply limit advertising, the industry increasingly turns to Americanconsumers for its profits.The Big Fix by Katharine Greider, page 172 The Kaiser Family Foundation reports that with thousands of drugs onthe market, 60 percent of DTC spending in 2000 went to plug justtwenty products. This intensive exposure creates what ad people call"brand awareness." A recent survey by market research firmInsight-Express found that, for example, 74 percent of respondentsknew Claritin by name. More than half recognized Paxil, 45 percentknew the cholesterol-lowering Zocor, and nearly 80 percent were awareof the pharmaceutical phenomenon Viagra. All have been among the mostheavily advertised drug products.The Big Fix by Katharine Greider, page 91 This translates to a likelihood that prescriptions are being given fordrugs that are more dangerous and less effective than patients—or evendoctors—realize. Until changes are made, both physicians and patientswill be harmed by prescribing decisions based on all-too-frequentlygeneralized and misleading information from advertisements.Ephedra Fact And Fiction by Mike Fillon, page 178 Pharmaceutical companies have overcome the obstacles of managed care.They have sophisticated pharmacoeconomic teams to negotiate thepresence of their products on the formulary, and they have understoodhow to use both legislative action and sophisticated marketing toensure that their products are not cut out of either Medicaid orprivate sector formularies. They have been significantly investing inDTC advertising as well as expanding their sales forces for detailingphysicians. This is the business model for the pharmaceutical industryin the late 1990s, and industry leaders anticipate that these goodtimes will continue rolling into the future.Health Care in the New Millennium by Ian Morrison, page 48 Yet the mainstream media operate with somewhat of a double standard.They are willing, even eager, to use the video news releases from thepharmaceutical and medical technology industry. The morning talk showsare full of medical technology miracles; they cover the wonders of newdrugs and medical devices and technology using the canned televisionimages provided by the industry. More recently the media have beengiven further conflicting incentives with the enormous explosion ofdirect-to-consumer advertising; page after page of pharmaceuticalindustry supplements appear in popular media. For example,pharmaceutical giant Pfizer purchased all of the advertising space inan entire issue of Time magazine on the "Future of Medicine."Similarly, Johnson and Johnson purchased the advertising space of anentire issue of Newsweek.Health Care in the New Millennium by Ian Morrison, page 79 Another issue associated with the cultural view of menopause has to dowith issues of youth and femininity. As Dr. Andrew Weil writes in hisSelf Healing newsletter, "there is an unstated selling point that isquite clear in pharmaceutical company advertisements: that it is achemical fountain of youth offering persistent beauty, attractiveness,and satisfying sexuality in the face of advancing age.Herbal Defense by Ralph T Golan ND, page 210 Anyone who watches television cannot but help notice a new trend inthe past couple of years — suddenly our TV programs are flooded withadvertisements for dozens of new prescription drugs. And they seem topromise everything. Night after night, television commercials paid forby drug companies are promising to fix or cure everything fromdepression and sleeplessness, to arthritis and allergy problems. Youname it, they've got a drug for it, be the problem as serious ascancer, or as trivial as baldness and unattractive toenails.Prescription Medicines, Side Effects and Natural Alternatives byAmerican Medical Publishing, page 12 The 1997 change unleashed an unprecedented onslaught of commercials.By 1999, the average American was exposed to nine prescription drugadvertisements on television every day. The number of television adsincreased 40-fold between 1994 and 2000. Suddenly it became a normalpart of our everyday experience to be confronted with the idea that weor a loved one might be suffering from ED (erectile dysfunction, forthose not in the know), arthritis pain, high cholesterol, nasalcongestion, osteoporosis, heartburn, or even the heartbreak of toenailfungus. In the "teachable moments" created by these skillfully raisedconcerns, consumers are "educated" about readily available drugs tosolve the problem.Overdosed America by John Abramson MD, page 152 Pharmaceutical advertising in medical journals and though 'detailing'seduces doctors By 1900, there were 22 homeopathic medical schools and nearly 100homeopathic hospitals in the U.S. In fact, 15% of all Americanphysicians practiced homeopathy at the turn of the century, accordingto Trevor Cook, Ph.D., D.I.Horn., President of the British HomeopathicMedical Association." However, by the same time, the bond between theAMA and the pharmaceutical companies was firmly established. Paidadvertisements from pharmaceutical companies in the AMA's journal werethe AMA's main source of revenue (as it is today). Prominentphysicians were paid to endorse proprietary drugs and doctors weredeluged with free samples of pharmaceutical drugs. Through a series ofmaneuvers including a new rating system for medical schools aimed ateliminating homeopathic colleges, the practice of homeopathy hadnearly disappeared as a force in American medicine by 1930.Alternative Medicine by Burton Goldberg, page 520 Drug company money influences every aspect of modern-day psychiatry.The American Psychiatric Association is literally built on afoundation of drug money: millions of dollars of pharmaceuticaladvertising money are poured into the APA's publications, conferences,continuing education programs, and seminars. In return, the APA bendsover backward to help drug companies promote their products. And 15 to20 percent of the APA's income in recent years has come directly fromdrug company advertising in APA journals—another means of guaranteeinggood press for new drugs.A Dose of Sanity by Sydney Walker III MD, page 230 Pharmaceutical ad campaigns and the distribution of free samplesusually determine the drugs doctors use to treat patients with.Advertisements in prominent medical journals are intentionallymisleading, exaggerating a drug's benefits while downplaying itshazards in small print in the addendum. Although the FDA requiresadvertisers to present a "fair balance," Cheryl Graham, ActingDirector of the FDA's Marketing Division, admits that one-half of thejournal ads violate this standard. And since the FDA screens only 10to 20 percent of all drug promotions, physicians are forced to takedrug companies at their word.Innocent Casualties by Elaine Feuer, page 73 Direct-to-consumer marketing increased 30 percent in 1998 alone.Through TV, magazine, and newspaper advertising, pharmaceuticalcompanies are taking their message directly to the public. If itweren't for pharmaceutical advertising supplements, Newsweek would beonly three pages long. Similarly, pharmaceutical companies havefocused on "detailing" physicians very aggressively (that is,promoting products through sales calls to doctors to provideinformation and free samples). Pfizer alone has forty-five hundredpeople in its sales force. Bristol-Myers Squibb and Hoffman-La Roche,for example, added over one thousand salespeople over the last coupleof years. Drug companies know that putting sophisticated detailingteams in the field to promote their products to doctors makes adifference in prescribing behavior. Doctors may find this offensive,but detailing works.Health Care in the New Millennium by Ian Morrison, page 30 The FDA's bias is further shown by its selective implementation ofpolicy directives. Its duty, by law, is to set standards for drugadvertisements. Yet, according to a study conducted at the Universityof California and published in The Wall Street Journal, 60% of thepharmaceutical ads from medical journals violated FDA guidelines. Butthe FDA, to this day, has done nothing about these violations.Alternative Medicine by Burton Goldberg, page 48 Such results can be reported by medical journalists—which are alsohired by these PR firms—in unsuspecting medical journals. HealthcarePR firms also undertake conventional lobbying strategies, such asopposing restrictions on "direct-to-con-sumer" advertising, whichallows companies to market prescription and OTC drugs using the sametechniques as toiletry items. They can also move very quickly anddeftly to "squash" any negative news about their clients, as well asto promote damaging news about others. Could it be this is a strategybeing deployed against the dietary supplement industry?Ephedra Fact And Fiction by Mike Fillon, page 146 Furthermore, physicians who abide by a conventional Western medicalperspective are more likely to publish papers and be on editorialboards of scientific journals than their peers who hold to differentphilosophies. "There is kind of a self-selection process wherephysicians who are against alternative medicine end up being on theeditorial boards of the journals," Dr. Gaby says. It's important tobear in mind that many medical journals receive a substantial amountof revenue from the advertising dollars they get from thepharmaceutical industry, whose interests would not be served byarticles and studies that recommended the use of alternative medicineover drugs and surgery.Alternative Medicine by Burton Goldberg, page 51 We are fully aware that what stands in the way of change are powerfulpharmaceutical companies, medical technology companies, and specialinterest groups with enormous vested interests in the business ofmedicine. They fund medical research, support medical schools andhospitals, and advertise in medical journals. With deep pockets theyentice scientists and academics to support their efforts. Such fundingcan sway the balance of opinion from professional caution touncritical acceptance of a new therapy or drug. You only have to lookat the number of invested people on hospital, medical, and governmenthealth advisory boards to see conflict of interest. The public ismostly unaware of these interlocking interests. For example, a 2003study found that nearly half of medical school faculty, who serve onInstitutional Review Boards (IRB) to advise on clinical trialresearch, also serve as consultants to the pharmaceutical industry.Death By Medicine by Gary Null PhD, page 10 Yet doctors repeatedly make new drugs bestsellers within months. Drugreps fill doctors' cabinets with "free" samples, knowing that ifpatients do well on them, they won't want to switch. Drug advertisingseizes upon any difference, no matter how trivial, to sway doctors toprescribe expensive new drugs with no track records, and doctorsreadily oblige. You'd think that after recent disasters with Baycol,Rezulin, Lotronex, Duract, Redux and Fen-Phen, doctors would learn,but they keep prescribing new drugs like Clarinex, Nexium, and Bextraat greater risk and cost. These repeated problems compelled Drs.Marcia Angell and Arnold Relman, another former editor of the NewEngland Journal of Medicine, to warn, "Few Americans appreciate thefull scope and consequences of the pharmaceutical industry's hold onour health care system."Disease Prevention And Treatment by Life Extension Foundation, page 725 At first, pharmaceutical companies stepped up advertising, some ofwhich ran for four pages, in the medical journals and weekly magazinessent to doctors' offices. Soon, such ads constituted the medicaljournals' major source of funding, and while they continue to deny it,publishers are influenced by the pharmaceutical industry in choosingwhich articles to print. Articles concerning alternative treatments,such as the use of nutritional supplements, are few in number inclinically oriented journals, and usually are routinely rejected infavor of articles extolling the virtues of a prescription drug orsurgical procedures.Health And Nutrition (see related ebook on nutrition) Secrets byRussell L Blaylock MD, page 344 Recently, pharmaceutical companies have launched an even clevererplan. Whereas, in the past they depended on frequent visits to thedoctors' offices by drug reps to convince doctors to use their drugs,now they've bypassed doctors altogether and advertise directly ontelevision and the radio, urging people to tell their doctors theywant to try the advertised drug.Health And Nutrition Secrets by Russell L Blaylock MD, page 366 If you scan most clinical journals, you will see that they are filledfrom cover to cover with ads from pharmaceutical companies and medicalsupply dealers. These are very expensive ads. In addition, many ofthese companies give grants to the journals in which they advertise.Unfortunately, this is also true of many nutrition journals as well.Doctors tend to read the articles that deal with new drugs beingdeveloped, new surgical techniques, and advances in diagnosis. Thescattered nutritional or biochemical articles are rarely read.Health And Nutrition Secrets by Russell L Blaylock MD, page 367 This subtle type of bias sometimes becomes more blatant. For example,a former editor of the Journal of the American Medical Association(JAMA) alleged that Pfizer, a major pharmaceutical company, hadwithdrawn $250,000 worth of advertising because an article appearingin JAMA had cast one of their drugs in an unfavorable light.Preventing And Reversing Osteoporosis By Alan R Gaby MD, page 249 Another area in which pharmaceutical companies wield enormousinfluence is medical "education." Most doctors in this country arevisited on a regular basis by "representatives," salesmen from largepharmaceutical companies. In surveys, doctors list pharmaceuticalsalesmen as one of their most important sources of information aboutnew drugs. Salesmen and drug company "literature" are where doctorsfirst learn about things like "serotonin imbalances" and serotonin"selectivity." Lavish advertisements in medical journals carry similarmessages.Prozac Backlash by Joseph Glenmullen MD, page 226 Doctors have access to many other sources of medical information. Someinvite pharmaceutical representatives into their offices andconferences, and some attend industry-sponsored conferences. Someavidly read free pamphlets and journals sent to them by pharmaceuticalcompanies. By contrast, some read only the journals that come as partof membership in a professional society, and pay their own money to to sources that are not dependent on pharmaceutical companysupport, contain no advertising, and are funded entirely bysubscription fees.On The Take by Jerome P Kassirer M.D., page 84 Dr. Richard Smith, editor of the British Medical Journal, has raisedthe concern that lucrative advertising and reprint sales can be acorrupting influence. One experience at the Annals of InternalMedicine in 1992 sent a chill down the spines of editors andpublishers alike. When the (then) editors, Drs. Suzanne and RobertFletcher, published a study sharply critical of the pharmaceuticalindustry, pharmaceutical advertising in the journal declinedsubstantially, and remained lower than usual for months thereafter.For editors of many journals whose profit margins are not robust, thatexperience might lead them to be chary about criticizing theadvertisers who support their publications.On The Take by Jerome P Kassirer M.D., page 91 Drug companies often claim that they are just helping the public byproviding physicians the best information possible. They admit thatthey might make friends and generate goodwill for their companies inthe process, but their primary goal, they claim, is education, notmarketing. One provider of medical education, Joe Torre, the chiefexecutive of an advertising agency that owns its own clinical researchcompany, said, "Very often doctors are more influenced by what otherdoctors say than what pharmaceutical companies have to say. Socompanies work through medical education companies to have doctors whosupport their products talk about their products in a favorable way.That's called medical education."On The Take by Jerome P Kassirer M.D., page 93 In effect, the publication is more a paid advertisement for industrythan a publication of a learned medical society. In fact, themisleading headings are only part of the deception. The title,Symposia Excerpts, misleads the reader to thinking that he is readingselected summaries of key talks on the formal schedule of theconference. In fact, they are summaries of after-hours conferencessponsored by pharmaceutical companies. Despite the assertion on thecover that the Symposia Excerpts is a publication of the ATS, the ATScarefully disavows responsibility with a disclaimer that reads: "Theopinions expressed in this publication are those of the speakers anddo not necessarily reflect the opinions or recommendations of theiraffiliated institutions, the publisher, the American Thoracic Society,or any other persons."On The Take by Jerome P Kassirer M.D., page 121 The PDR, free meetings and gifts, and direct contact by drug-companyrepresentatives constitute three major ways that drug companiesinfluence physicians' choices of medications. A fourth way isadvertising. Most of this advertising is done in medical journals,which also serve as an important source of information for physicians.Overdose by Jay S Cohen, page 56 In fact, pharmaceutical companies spend more than 21 billion dollars ayear on promoting and marketing their products, of which about 88percent is directed at physicians. With approximately 600,000physicians in active practice this amounts to more than $30,000 spenton each physician. Although industry market research data areunavailable, studies of physicians show what common sense predicts,namely that physicians are influenced by all kinds of marketing tactics.On The Take by Jerome P Kassirer M.D., page 78 Beyond these direct influences, drug companies exert broad influenceover the drug information received by doctors and consumers. The vastmajority of everything physicians and consumers read and know aboutmedications comes from the drug companies. Medication package inserts,drug advertising toward physicians and consumers, and the informationin the ubiquitous Physicians' Desk Reference come directly from thedrug companies. Where do most doctors turn for medication and dosageinformation? To the PDR, to drug company representatives who make therounds of doctors' offices, and to advertising in medical journals.Yet, the medication information offered by thesedrug-company-supported sources is often biased, incomplete, andsometimes inaccurate.Overdose by Jay S Cohen, page 16 A cursory look at almost any medical journal will reveal dozens ofadvertisements by the drug companies. Glossy ads promote the efficacyor ease of usage of drugs. Some ads boast that physicians don't haveto bother reducing the drugs' dosages for older people, not even forthose with other disorders or taking other medication. The content ofthese ads is based on the information in package inserts, with thesame limitations or omissions of important side effects and/or lower,safer doses.Overdose by Jay S Cohen, page 56 A historical perspective of pharmaceutical advertising One may guess that papers taking advertising dollars from poppers'pharmaceutical source were in no hurry to dig up the unflatteringhistory of animal experiments that did see immune damage stemming fromuse of the drug.Aids A Second Opinion by Gary Null PhD with James Feast, page 200 Back in the World War II era, it was the same for tobacco. Pagethrough a few magazines of the day to look at the advertisements forPall Mall or Lucky Strike and you will find that smoking is not onlyproclaimed to be safe but even said to promote health! Moreover,everybody was lighting up, just as in a certain strata, everybody wasinhaling. Poppers and cigarettes were sexy, for god's sake. What isbeing asserted, then, is that certain practices that now seemunconscionably risky were once seen as innocent, as innocent as, indays gone by, puffing on a Lucky.Aids A Second Opinion by Gary Null PhD with James Feast, page 265 Fishbein was the most powerful man in American medicine in his day.The AMA (and Fishbein) consolidated their hold over American medicine.Subscriptions to the Journal had increased from 13,078 in 1900 to over80,000 by 1924. Income from pharmaceutical advertising was already inthe hundreds of thousands of dollars. Yet AMA leaders were consciousof the threat posed by irregular practitioners. Ironically, thelong-time General Manager of the Association, George H. Simmons, MD,had himself been a homoeopathic practitioner in Lincoln, Nebraska,"and one of a rather partisan hue."Herbs Against Cancer by Ralph W Moss PhD, page 75 FDA control (or lack or control) of pharmaceutical advertising Another connection between the FDA and the pharmaceutical industry isthrough the pharmaceutical Advertising Council (PAC). In 1985, the PACteamed up with the FDA to solicit funds from the pharmaceuticalindustry for the purpose of combating medical quackery. "Thepharmaceutical Advertising Council and the FDA also issued a jointstatement addressed to the presidents of advertising and PR agenciesnationwide asking them to cooperate with a joint venture anti-fraudand quackery campaign," according to Mark Blumenthal, ExecutiveDirector of the American Botanical Council.Alternative Medicine by Burton Goldberg, page 48 The primary culprit in promoting the misprescribing andoverprescribing of drugs is the pharmaceutical industry, which nowsells about $80 billion worth of drugs in the United States alone. Byintimidating the Food and Drug Administration (FDA) into approvingrecord numbers of me-too drugs (drugs that offer no significantbenefit over drugs already on the market) that often have dangerousadverse effects and by spending well in excess of $12 billion a yearto promote drugs, using advertising and promotional tricks that pushat or through the envelope of being false and misleading, thisindustry has been extremely successful in distorting, in a profitablebut dangerous way, the rational processes for approving andprescribing drugs. Two studies of the accuracy of ads for prescriptiondrugs widely circulated to doctors both concluded that a substantialproportion of these ads contained information that was false ormisleading and violated FDA laws and regulations concerning advertising.Worst Pills Best Pills by Sidney M Wolfe MD and Larry D Sasich PharmDMPH, page 10 The division at FDA responsible for policing prescription drugadvertising has not been given adequate resources to keep up with thetorrent of newly approved drugs. As a result, the drug industrycorrectly believes it can get away with more violative advertisingthan in the past. The role of the U.S. Congress in pushing the FDAinto approving more drugs, and passing, with the FDA's reluctantapproval, legislation to further weaken the FDA's ability to protectthe public, cannot be overlooked.Worst Pills Best Pills by Sidney M Wolfe MD and Larry D Sasich PharmDMPH, page 10 Though broadcast advertising of prescription drugs has been legal foryears, guidelines released by the FDA in 1997 clarified the rules foradvertising directly to consumers. According to these guidelines, drugcompanies can fulfill their obligations for informing consumers aboutprescription drugs by referring in advertisements to four sources ofadditional information: their doctor, a toll-free number, a magazineor newspaper ad and a website.Ephedra Fact And Fiction by Mike Fillon, page 77 Health care advocates were shocked by the decision of the Food andDrug Administration (FDA) to allow drug makers to advertiseprescription drugs on television giving only minimal information aboutthe risks involved.Under The Influence Modern Medicine by Terry A Rondberg DC, page 70 And for the first time in decades, pharmaceutical companies areadvertising heavily direct to the public. The 1962 Harris-KefauverAmendment to the Federal Food and Drug Act imposed strict regulationson pharmaceutical company advertising. The requirements brought to ahalt the aggressive marketing of notorious drugs like amphetamineantidepressants and barbiturates. But in the mid-1990s, the FDAliberalized the requirements pharmaceutical companies have to meet.The result has been a surge of advertising drugs direct to consumers.Prozac Backlash by Joseph Glenmullen MD, page 231 Wilkes and a group of colleagues had earlier conducted a study ofprescription drug advertisements which showed "many claims prove to beinaccurate or misleading." The study was published in the June 1,1992issue of the Annals of Internal Medicine. For the study, Wilkes' groupasked medical experts to review 109 advertisements from the country'sten leading medical journals. Using the FDA's guidelines forpharmaceutical company advertising, the reviewers "indicated that 92%of advertisements were not in compliance in at least one area" of theFDA's guidelines. Wilkes' group speculated "that the FDA is unable orunwilling to enforce adequately its rules relating to drug advertising.Prozac Backlash by Joseph Glenmullen MD, page 232 For years the pharmaceutical industry was allowed to market its drugsonly to doctors. It did this through medical journals, continuingmedical education, sponsored events, sales calls, and junk mail. Then,in 1981, the drug industry proposed that the FDA allow advertisingdirectly to consumers, arguing that the public should not be deniedaccess to the "knowledge" that would be provided by such marketing.Four years later, the pharmaceutical industry got its foot in the doorwhen the FDA agreed to allow "direct-to-consumer" (DTC) advertising.But the rules were strict, and the content of the ads was, therefore,limited: Drugs could be mentioned by name, but advertisements thatdiscussed the treatment of specific conditions were required toinclude a lengthy list of side effects and contraindications(situations in which the drug should not be used). As a result, theads were vague and unfocused, primarily brand-awareness campaignsdesigned to smooth the way at the doctor's office.Overdosed America by John Abramson MD, page 151 In the fall of 1971, the FDA also made a serious attempt to halt thegrowth of the increasingly popular field of alternative medicine. Bydefining all unorthodox medical treatments as "quackery," which theyinterpreted as "misinformation about health," the FDA attempted toprevent physicians, manufacturers, and consumers from practicingalternative therapies. The federal government's war against quackerywas supported by the pharmaceutical companies and the AMA. In 1985 thepharmaceutical Advertising Council and the FDA solicited funds fromthe pharmaceutical industry to combat medical quackery; they alsoissued a joint statement addressed to the presidents of advertisingand PR agencies nationwide, asking them to cooperate with theanti-quackery campaign.Innocent Casualties by Elaine Feuer, page 11 Although it is entirely legal for a doctor to use a drug off-label, itis illegal for a drug company to advertise a drug for any purposeother than the one or ones approved by the FDA. By recruitingphysicians to discuss off-label uses, therefore, the drug companies,in essence, bypass official channels and create a potent marketingforce of physicians. One flagrant example of physicians aiding inmarketing came to light when a whistleblower charged thatWarner-Lambert had engaged in unlawful off-label marketing of theanti-epilepsy drug, Neurontin. In May 2004, Pfizer pled guilty toMedicaid fraud and agreed to pay fines of approximately $430 million.On The Take by Jerome P Kassirer M.D., page 28 Government intervention is also warranted on industry-initiated andindustry-sponsored "front organizations." These groups, often led byfinancially conflicted physicians, sponsor ventures such as pamphlets,brochures, pocket books, Web sites, and registries, and they havegotten out of hand, often subtly recommending off-label drugs andpromoting expensive drugs. Although federal agencies have control overdrug advertising, these ventures apparently have escaped detection andoversight. Nonetheless, they may have even more impact on the use andmisuse of drugs than pharmaceutical advertising in medical journalsand in the lay media. These publications masquerade as educationalmaterials, but many are largely marketing efforts that deserve as muchscrutiny as drug advertisements.On The Take by Jerome P Kassirer M.D., page 207 Overview: * The great direct-to-consumer prescription drug advertising con:how patients and doctors alike are easily influenced to demanddangerous drugs Source: http://www.newstarget.com/010314.html