What’s worse? The pill or the side effects?
Inspired by ubiquitous ads for prescription drugs that take longer to list potential side effects than purported benefits, I initially intended this column to take a tone of amused concern.
The thesis was, essentially, do we really want to take a drug to help us quit smoking that might cause suicidal thoughts? (When I quit smoking 25 years ago, I had primarily homicidal thoughts … is this better?) Do we want to take an anti-stroke medicine that can cause brain hemorrhage, abdominal bleeding or giant hives? (Giant hives?!) A drug to address painful sex for women that carries a risk, even as slight as 0.72 per thousand, of stroke?
It didn’t take long researching this topic to decide that very little about it is funny.
I did not know, for example, that only the United States and New Zealand allow direct consumer advertising for prescription drugs. In 2014, this estimated U.S. ad spending was $4.5 billion.
Maybe all the other countries in the world are wrong, but maybe also they recognize the harm possible from creating demand for potentially dangerous drugs that might help only a handful of people.
(Disclaimer: Drugs often are needed. I am in no way advocating against doctors’ advice or truly needed prescriptions.)
Not surprisingly, Food and Drug Administration regulations are considered pretty weak.
Federal law does not bar drug companies from advertising any kind of prescription drugs, even those that can cause severe injury, addiction or withdrawal.
Companies are not required to say how many people have the condition the drug treats, how many people who take it might be helped or what it costs.
They aren’t required to say whether a condition might be treated effectively without drugs, even though many severe conditions — including many cases of depression, chronic pain, high blood pressure and high cholesterol — can be managed without pills with less collateral damage and better long-term health.
While TV ads are required to list potential side effects, many people are concerned about the use of potentially distracting images during the statement of risks — say heartwarming scenes of playing in the yard with grandchildren and the beloved family dog.
Spending on these ads rose 330 percent from 1996 to 2005, which “coincided with a wave of new FDA drug approvals, including approvals of ‘blockbuster’ drugs such as Lipitor, Nexium and Vioxx. This led to a proliferation of drug advertisements on TV and in print to which the vast majority of Americans were exposed, likely prompting patients to request a promoted drug from their physician,” Tim K. Mackey and Bryan A. Liang wrote in the January-February edition of the Annals of Family Medicine.
As lightly as drug ads are regulated on TV or in print, digital pharmaceutical ads that stalk us as we browse the Internet have even fewer rules, Mackey and Liang note.
So what’s the big deal? You have to see a doctor to get a prescription — won’t the doc look out for you?
Maybe. Doctors are swamped and are as vulnerable as any of us to not being able to keep up with the modern firehose of information — but in their case, not knowing about a drug or trusting what they are told by pharmaceutical company sales reps and literature can have deadly consequences.
Vioxx, for example, was the hot anti-inflammatory of the early 2000s. I was prescribed it for a running injury, and once on the bus ride to the start of a race, I talked with a couple guys who had taken it that morning to help stave off soreness during the run.
It was withdrawn from the market in 2004 because of heart attack and stroke risk. I took up yoga and now rely on ice as an anti-inflammatory.
America’s greatest modern public health fiasco is the explosion of painkiller prescriptions, which rose 300 percent between 1999 and 2010.
As a result, since 2009, more Americans have died from opioid overdoses than in traffic crashes. Opioid use is so mainstream now that drugs are being advertised to counteract opioid-induced constipation — even though natural laxatives such as senna are tremendously effective and getting off opioids is better still.
Doctors have told me that they don’t learn to treat pain in medical school and learn little about nutrition. Most lean on drugs in part because they have financial and time-management incentives to do so and in part because a patient is more likely to take a pill than to make a lifestyle change.
The way our capitalist, lobbyist-dominated society works, don’t expect a reduction in drug advertising. So we have to look out for ourselves. If you dig deeply enough on the FDA website, it offers some suggested questions:
• Is there a less costly drug I could use to treat my condition?
• What else can I do to help deal with my condition? For example, should I exercise or change my diet?
Perhaps most importantly, choose a doctor whose philosophy concerning drugs is to limit them as much as possible. And don’t believe what you see on TV. A pill is not going to give you a perfectly groomed lawn and happy family life while a warm voice murmers warnings about rare but nonrecurring fatal side effects.
Randy Essex is editor of the Post Independent.
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