Aging Begins at 30

TV Advice for What Ails You

The FDA has regulated the advertising of prescription drugs since 1962. About 15 years ago the rules of advertising to health care professionals changed and in 1997 alone, the pharmaceutical industry spent over $600 million on direct, usually TV, advertising, directly to the consumer. Before the new rules, they stated the name of the prescription drug only and suggested the patient talk to his or her physician thereby avoiding the FDA regulations.

Now drug companies are allowed to include prescription drug use without detailed drug risk information (which is needed in printed ads) but with a brief "major statement" regarding toxicity. Can bad effects be glossed over? A reference to further information in print ads, a statement that doctors and pharmacists can tell you more, and where more information can be obtained on the web are all required. Also needed is a toll-free number you can call "for more information," but one of these gives a recorded message: "This is the world's best medicine for disease Y and nine out of ten clients get positive results." No other form of advertising can find as many people as TV does.

Does this bring the patient to the doctor with questions and establish a good doctor-patient relationship or is the busy doctor funneled querulous patients who don't have the disease they think they have? Now that doctor's time is limited, so shareholders can make profits, every minute is monitored.

Let's use the toenail fungus ad, I have seen frequently, as an example. A young glamorous woman has her toes covered by a paper bag while she interacts with her boyfriend. But surely the elderly have much more toenail fungus disease than young healthy adults? Then a follow-up after treatment with expensive drug X shows her playing open-sandaled under-the-table footsie with her more adoring boyfriend! By the way, no cheaper generic drugs are ever mentioned. The excuse is "Even if she doesn't have a toe fungus perhaps the doctor will find a life-threatening melanoma cancer on the back of her neck that would otherwise have been missed." The editorialist slipped in a comment "Should future regulations cover people," such as me, "who try to educate the public about health care?"

What should you expect from your doctor when you go advertisement in hand or talking about last night's TV to consult him or her? Time-consuming explanations can be bypassed by having a take-home handout for later study. Or should the patient be handed the formidable description from the Physicians Desk Reference better known as the PDR. A rule of thumb I use, if the medicine is very new, and "has no side effects," I am fairly certain that rare bad effects will show up later, which makes me very cautious. If the problem is not life-threatening I ask, "Can you wait a while?"

I remember hearing of patients with dreadful effects ranging from chloramphenicol to only a common cold. One doctor says "In a capitalistic society, he who sells the most drugs usually takes home the most money." He continues, "But I work in a modified capitalistic society where we must maintain the highest ethics, not the highest payment!" And later in his article he says, "I truly believe that I am the one who should be able to prescribe--not the patient, not the pharmacist, not the neighbor, and certainly not the television." But direct-to-the-consumer advertising is here to stay. How should it be regulated? Are we sliding back into the era of snakebite-curing charlatans or are we improving the patient's knowledge of health and disease?

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