Like many doctors, Ron Ben-Ari thinks ads on TV for prescription drugs frequently go too far in touting a particular pill's benefits without adequately presenting the risks.
But Ben-Ari, who has a practice at USC's Health Sciences Campus in East L.A., accepts that the ads have fundamentally altered the doctor-patient relationship. He's found that it can be fruitless to try to talk a patient out of seeking some name-brand medication, even when a cheaper alternative is available.
"If it's an appropriate medicine for the person, I'd probably prescribe it," said Ben-Ari, who also teaches at County-USC Medical Center. "We're in an era of information. We have to evolve with it."
This changing dynamic, with patients seemingly calling the shots when it comes to prescription drugs, was the focus of a congressional hearing last week that asked the question, "Direct-to-Consumer Advertising: Marketing, Education or Deception?"
House Democrats who called the hearing said they hoped to lay the groundwork for legislation that would impose new rules on so-called DTC ads, including giving the Food and Drug Administration power to seek changes to ads before they're broadcast.
This isn't a new debate. But one particularly striking aspect of last week's hearing was that it pitted doctors against drug companies, with the former saying that DTC ads do more harm than good and the latter basically ignoring what the doctors had to say.
Nancy Nielsen, president-elect of the American Medical Assn., told me that doctors know full well why their opinions are going unheeded by the pharmaceutical industry.
"This is big business," she said. "There's a lot at stake here."
Nielsen recalled watching TV on Easter morning with her 8-year-old grandson. An ad came on for one of those pills that help men be -- how shall we put it? -- more manly.
It featured the usual images of happy couples rekindling the embers of intimacy and sexual desire, and included the usual hurried recitation of possible side effects (Important safety tip: Get medical attention for any manliness lasting more than four hours).
"I just thought, 'Give it a rest!' " Nielsen said. "At that time of the morning, on Easter Sunday, you're not exactly getting the right target market for a pill like that."
Most doctors dislike DTC ads, she said, because the campaigns typically place marketing ahead of education and force doctors to dissuade patients from demanding some drug they saw on TV rather than accepting a cheaper generic version or an alternative therapy.
"It takes a lot of time to have that conversation," Nielsen said, "and it can get a little confrontational."
Drug makers, needless to say, see things differently.
"Surveys show that DTC advertising brings patients into their doctors' offices and helps start important doctor-patient conversations about conditions that might otherwise go undiagnosed or untreated," Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, said in a statement.
"Raising awareness of treatment options through DTC advertising not only informs patients potentially suffering from disease, it also benefits the entire healthcare system in the U.S. by encouraging patients to seek medical attention that may help them manage their conditions and avoid unneeded hospital stays or surgeries," he said.
DTC ads have proliferated since 1997, when the FDA greenlighted such campaigns. These days, ads for prescription drugs are almost ubiquitous on TV and in print.
Spending on DTC advertising more than quadrupled from 1996 to 2005, from $985 million to $4.2 billion, according to a study by the University of Pittsburgh Graduate School of Public Health. Total promotional spending by the pharmaceutical industry rose to $29.9 billion in 2005 from $11.4 billion in 1996.
Last week's hearing was prompted by recent high-profile cases of drug advertising that contained questionable information. For example, Pfizer Inc. spent more than $250 million on ads for its anti-cholesterol medication Lipitor featuring artificial heart pioneer Robert Jarvik.
The ads conveyed the impression that Jarvik was imparting medical advice, although in reality he's not licensed to practice medicine. They also used a body double to depict Jarvik robustly rowing across a mountain lake.
Meanwhile, Merck & Co. and Schering-Plough Corp. spent more than $200 million hawking the anti-cholesterol drug Vytorin while failing to disclose a study that questioned the effectiveness of the drug for more than a year and a half. The companies said they needed extra time to verify the accuracy of the study.
The relationship between doctors and patients has clearly shifted. Patients, egged on by marketing-savvy drug firms, no longer present symptoms and await the physician's diagnosis.
Now they frequently bypass this step and get right to a discussion of which prescription drug is best for them.
Perhaps the FDA had no idea things would get so out of hand when it approved DTC ads 11 years ago. But policymakers need to recognize the obvious and apply greater safeguards to the practice.
The Government Accountability Office reported last week that the FDA sent out only two warning letters to drug companies last year related to potential violations of DTC rules. This compared with an average of 15 to 25 letters sent out annually between 1997 and 2001.
At the same time, the number of "advertising materials" targeting consumers soared from about 6,000 in 1999 to 21,000 last year, the agency found.
"These ads don't help a practicing physician," said Ben Ansell, a doctor at UCLA Medical Center. "When people get information in 30-second sound bites, it may not paint a realistic image of what that product can do for a patient."
He cited the example of the heavily promoted prescription sleeping pill Lunesta, which is touted by its manufacturer, Sepracor Inc., as being less likely to be habit forming than other such medicines.
"I received an e-mail from a patient last weekend asking for a refill for his Lunesta prescription," Ansell said. "The ads for Lunesta say it isn't habit-forming, but the patient said this couldn't be further from the truth."
Ansell said he "reluctantly" refilled the prescription.
David Lazarus, Los Angeles Times. May 14, 2008
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