Working out in the gym in the mornings, I’m hostage to what ever the person who got there before me chooses to watch on TV. A part from a bit of news now and again, it looks like a stream of commercials for various types of insurance and medications, both prescription and over the counter (OTC).
Since I spend a fair amount of time on-line, I’ve noticed a wide array of drug advertising appearing in all sorts of places, with some being more intrusive than others.
This week’s New England Journal of Medicine contains an editorial by Jerry Avorn, M.D. “Teaching Clinicians about Drugs-50 Years Later, Whose Job Is It?” This year marks the 50th anniversary of the Kefauver hearings, the pivotal 1961 Senate debate that transformed prescription drug approval and use. When Senator Estes Kefauver (D-TN) introduced legislation to regulate the drug industry, the Food and Drug Administration (FDA) still did not have legal authority to require pharmaceutical companies to demonstrate that their products actually worked. What physicians knew about prescription drugs was shaped predominantly by the claims their manufacturers made about them, and the evidence base underlying such claims was often rudimentary, or worse.
An unsigned article in the NEJM 1961 noted with concern that ““manufacturers spend about four times as much on the promotion of drugs as the total cost of running all the medical schools.” As a result, the editorial continued, “the majority of physicians get their first and often their only information about newly available drugs from these sources, which at best may be strongly prejudiced and at their worst are unreliable and misleading.” Avorn goes on to question just what has changed since 1961 and whether physicians are in any better position today as far as their knowledge of medications and prescribing. Half a century later, the editorial’s question, “Who shall educate the physician?,” is still hotly contested. Opposition to a role for government did not carry the day then but has dominated debate ever since; the letter of Kefauver’s legislation about drug information has been followed in one narrow sense, though its spirit has not fared as well. The evidence base available to clinicians to guide their therapeutic choices is still heavily shaped by industry-sponsored studies that often compare new products with placebo, measure their worth in terms of surrogate markers such as laboratory test results, or both.
While Avorn focuses heavily on the pharmaceuticals role in conducting clinical trials and advertising to physicians, there is no mention of the consumer’s role in prescribing. Continually bombarded by commercials, in all media forms,-this is known as “direct to consumer advertising” (DTCA)- patients go to their doctor and ask for prescriptions for a condition they have self-diagnosed. Further, there are number of websites set up where users can purchase what they may believe is their drug of choice without a doctor’s prescription. If you live close to Mexico, many prescription drugs are over the counter there.
Even though there are controls on prescribing, the system encourages doctors to shoot the bugs first and ask questions later. Consequently, people are taking medications for all sorts of reason. It is no surprise that drug resistant bacteria has become such a major issue that the World Health Organization is devoting this year's World Health Day on April 7 to antimicrobial resistance in a bid to safeguard these drugs for future generations. MRSA alone is estimated to kill around 19,000 people every year in the US-far more than HIV and AIDS-and a similar number in Europe. Drug resistant tuberculosis is a lot more commonplace now and there is a new super bug called NDM 1, which is starting to appear in many countries. When the drugs don’t work
We are influenced by what we see advertised and promoted. Often these ads are based on biased sources of information. Some advertisements are literally making up a diagnosis in order to sell a drug.
Medical providers only have so much time in a day, so they too can be victims of marketers. A study in the Journal of Family Practice 59(11) 2010: 649-650 found that physicians often accommodate requests for DTCA medications. In some cases, they wouldn’t have considered such prescriptions for other similar patients.
To safeguard ourselves from being influenced to take medications for a real or possible condition, consider the following:
• Talk to your medical provider before trying an OTC medication, or substituting a prescription drug with an OTC one. Given the cost of prescriptions, and the state of the economy, many people are trying to find OTC alternatives to costly meds. Keep in mind that there are programs to help pay for medications. Ask your provider about them. You can also check out the post “No Job, No Insurance, No Health Care-What are my options?
• Explore “non-pill” measurers, such as making changes in diet and exercise.
• If a prescription is needed, ask about an older “classic” drug. These often work just as well and are cheaper.
• If it sounds too good to be true, it probably is. Be wary of claims for cures etc.
• Have a “brown bag” session with your doctor. This means taking your prescriptions with you to your medical appointment and review them .
• Keep a record of what medications you are taking, have taken, side effects, when you’ve stopped taking them and why. Be sure to note dosage and how you take them (e.g. twice a day with lunch and dinner).
• Discard medications that are out of date or are no longer being used. Do not flush them down the toilet. Follow proper disposal techniques.
• Change the channel. flip the page, or click the close button. Watch out for information over load.
Finally, the DTCA requires disclosure of side effects. When I see these commercials, I’m drawn to the voice-overs that accompany the happy person or scenic beauty. The list of possible side effects can be daunting. If this is a medication you are prescribed, talk to your provider if you find this confusing or concerning.
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