Patients Need to View Drug Ads With Dose of Skepticism

Patients Need to View Drug Ads With Dose of Healthy Skepticism

Let's face it, we are addicted to our pills, deeming them an easy way to make us healthier, happier and even live longer.

Is that so bad? I don't think so. Easily ranking with the Internet and the cellphone among our most transforming of modern-day technologies, pharmaceuticals for such scourges as depression, heart disease, and diabetes are reducing untold misery.

But there is an understandable fear that aggressive marketing by drug makers, sharply on the rise, exploits and even promotes a distinctly American style of looking for a quick fix whenever something ails us. Health researchers are just now beginning to ponder how drug company promotion affects health-care decisions, with an especially close look at whether the deluge in drug advertising is a prescription for bad medicine.

The question is especially poignant this week. A federal study found that hormone therapy advocated to millions of women to treat the aggravating symptoms of menopause can be dangerous if used for an extended period. Researchers uncovered a slight increase in breast cancer and heart disease risk among those who used Prempro, a pill containing two hormones, estrogen and progestin.

The drug's maker, Wyeth, has propelled the use of Prempro and Premarin, the most popular estrogen-only pill, through subtle and overt marketing techniques, including more than $40 million in consumer ads last year. Premarin is approved only for relief of menopause and to prevent bone weakening resulting from estrogen loss after menopause, and Wyeth can pitch it only for those problems. Still, there is no question that there's been a buzz among many women and their doctors that extended use of hormone therapy can also promote longevity by preventing heart disease. And that buzz has come at least in part from Wyeth's savvy marketing machinery, which has a long history of turning consumer health products such as Advil into hugely popular brands. Clearly the buzz pays off: Wyeth booked more than $2.5 billion in Premarin and Prempro sales last year, about 15% of all its revenue.

We Americans recognize that advertising manipulates consumer choice. I recently experienced a sobering example of that when I found myself test-driving several sport-utility vehicles, even though the closest I come to off-road driving is when I accidentally jump a curb. Fortunately, there are numerous ways car buyers can counter the subliminal messages I was reacting to. After reading easily accessible car-buying tips, I came to my senses and bought a more useful sedan.

But marketing a drug using the same sophisticated techniques that drove me into an SUV dealer can have a potent effect on human health. In addition, even doctors can't easily get hold of the kind of comparative data that can empower a consumer, the way the car information lead me to a sedan.

The power that drug marketing has on consumers and their physicians is just now becoming apparent. An elderly relative who suffers a persistent form of heartburn asked me why her doctor had changed her prescription to the drug Nexium from Prilosec, both of which are sold by AstraZeneca PLC. Prilosec, she says, was working just fine, and research suggests the drugs are equally safe and effective. So, why the change? My relative says her doctor wasn't clear about it, but she says she had seen TV commercials touting Nexium as a newer (and therefore, she assumed) better version.

Prilosec, it turns out, is going off patent and will have cheaper generic competition. Nexium has patent protection for years and won't have to compete on the basis of price. While this medical decision won't likely affect my relative's health, it will have an impact on her pocketbook since she pays for a large part of her prescription drugs herself.

Even so, I don't count myself among consumer advocates who fret over the rise of drug ads, often in a manner I find paternalistic. Until about five years ago, the drug industry focused its ad muscle solely on health professionals. Patients rarely saw the behind-the-scenes promotions that swayed their doctors. Nowadays, a lot of that is in the open and some drugs, like Pfizer Inc.'s Viagra or Lipitor, are as well known as Britney Spears. The result, says a survey earlier this year from the Kaiser Family Foundation, is that 30% of consumers who saw a drug ad say they asked their doctor about the drug. Thirteen percent of those who saw the ads said their doctors gave them the medicine.

The point is that drug ads are an undeniably powerful force in the American health-care scene, perhaps as important as advances in biology in affecting treatment decisions. But there is no research showing whether this impact improves health. A bill passed by the House of Representatives last month to provide a prescription drug benefit to seniors would direct Congress's General Accounting Office to conduct the first study of the matter.

Until then, patients should use the same healthy skepticism we bring to buying other consumer products, exploiting the information we get from ads to help us to ask better questions of our health-care provider.

Write to Michael Waldholz at mike.waldholz@wsj.com²

Updated July 11, 2002 11:50 a.m. EDT