Oh, I wish I were an Oscar Mayer Wiener

An essay from ACEP News Columnist Dave Baehren, MD, FACEP

Around twelve years ago, the FDA, that wise government agency that gave the thumbs up to the likes of Trovan, Fen-Phen, and Vioxx, decided to allow pharmaceutical companies to advertise directly to the public. Since then we have seen a wide variety of drugs marketed with the same zeal as sports cars, beer, and laundry detergent.

It’s truly amazing how the people in these advertisements are cured of their ailments. One moment a women is staring blankly into space thinking about how much it would hurt if she jumped off the Sears Tower. Her Golden Retriever reclines at her feet, leash in his mouth, wishing she would. Soon after, she is skipping along the beach, dog leaping for joy, and life is good. Of course, the unsuspecting public doesn’t know that the only drug that will do this is cocaine…then after a few hours you want to jump off the Sears Tower again.

You can’t watch an evening television program without seeing at least three ads for drugs that enhance erectile function. You would think that every graying 50 year old guy in the country can’t run the flag up the pole any more. Never mind that it wasn’t all that long ago that one couldn’t utter the word pregnant on television. These ads have messed with the minds of middle aged men almost as much as the bursting bust line of Barbie did to two or three generations of young women. And the cosmetic surgeons are still reaping the benefits.

So what’s wrong with a few drug ads? Isn’t it all just good information that the consumer can take or leave? People learn all sorts of things about post chemotherapy anemia, heart disease, peripheral vascular disease, and the satisfied couple in twin bathtubs thing.

I guess the advertising would be a good thing if you could buy these drugs one aisle over from the beer and chips and all by yourself you had to choose between Lipitor and Crestor. I can see people studying the packing inserts and comparing p-values of the studies. Look hear, Marge, this study didn’t have nearly enough patients entered to be significant. Yeah, right. Most people would just choose one because they like the color of the box. This whole scenario, of course, is not the case. Patients rely on their doctor to make recommendations. Why do they need to be sold on what antihypertensive to take?

The drug companies know that marketing is extremely powerful. Marketing affects presidential elections, sways public opinion on major issues (remember Harry and Louise?), and affects a lifetime of beer consumption. I can still sing the Oscar Mayer wiener jingle from the ad done 35 years ago.

Marketing is so powerful that most academic institutions have banned those scary little high-heeled drug reps from their hallowed halls. We can’t have doctors being unduly influenced by a low cut blouse, big hair, and a free pen. We can, however, have the entire country mislead by amplified claims of effectiveness in slick television spots.

Marketing affects behavior and the gurus from Madison Avenue know that a certain number of patients will ask for the purple pill or that pill that eliminates zits and prevents pregnancy simultaneously – man if it could only make her look like Barbie too. They also know that rather than taking five minutes to explain to the patient why a cheap diuretic is preferred over the fancy new drug, a certain number of doctors will just write the script – especially if they recently got a free pen from the hot drug rep.

What I find most interesting is the information the companies must disclose about adverse effects. By the end of the ad, you wonder if they are trying to dissuade you from taking it. In rare occurrences Bonagra has made teeth fall out and caused men to buy a new sports car for no apparent reason. Don’t take Bonagra and marijuana together because the next morning you might regret what you did the prior evening. Call your doctor if you can’t wipe the smile off your face after four hours. I think it’s like the jumbled talk at the end of the car ads. People just ignore it.

I’m sure this whole situation drives the family doctors and the internists crazy. If every third patient was asking why I was not prescribing the cholesterol drug he saw on television, I would become aggravated. Luckily for us they don’t advertize opiates and antibiotics. I can understand why opiates are taboo, plus they sell themselves anyway. Still I would like to see what they would come up with for OxyContin. Yes, it’s long acting, but if you crush the tablet, it’s just like heroin. Plus you can sell half your stash to pay next month’s rent. The disclaimers about lonely and crushing addiction might be a bit discouraging.

In the end, I believe these ads are a colossal waste and do nothing to improve the overall health of the country. If the drug companies wanted to do that, they would just run ads telling us to stop smoking, stop overeating, exercise regularly, and buckle our seatbelts.

We are a free society, yet even in a free society there are reasonable controls that work for the common good. This is why, for example, prostitution is illegal (if you don’t count certain expert witnesses and certain holders of emergency medicine contracts). These ads do nothing for the common good and probably contribute to the obscene cost of health care in this country.

I suspect Mr. Obama will figure this out and the ban will be reinstated. If that was the only change on the horizon, though, I think I would sleep better.

Be Happy.

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