Caveat Viewer: A Consumer's Guide to Drug Ads

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Sudden loss of vision, vomiting, headaches, dizziness, and rash are just a few of the delights that have droned out of the television or graced magazine pages since rules for direct-to-consumer ads for prescription drugs were loosened by the U.S. Food and Drug Administration [1] (FDA) in 1997. Of course, all these negatives come along with a big potential positive -- discovering a new treatment for what ails you.

For educators suffering from symptoms that smack of anxiety, depression, high blood pressure, or plain old stress (and heaven knows education can be stressful), the relief these ads promise may hold a certain appeal. Students, though they're too young for some of the drugs, may also absorb the notion, right or wrong, that medication is the cure for many ills.

Let's not forget that it is the drug makers suggesting the medications. The United States and New Zealand are the only countries that allow such advertising. Aiming a critical eye at these ads can yield lessons not only about the remedies, true risks, and merits but also about the power that comes with deconstructing media messages of all kinds.

What's a consumer to do? Here are answers to some frequently asked questions to help you find your way -- and to help educate your students about what they're seeing.

Which drugs are most likely to be advertised?

The ones that bring the companies the biggest profits, naturally -- those still under patent and often those without a generic equivalent. "While such ads used to be for 'lifestyle' products, such as antismoking drugs and sex enhancers, now you see them for things like rheumatoid arthritis, diabetes, insomnia, and high cholesterol," explains Donald L. Sullivan, associate professor of pharmacy practice at Ohio Northern University, in Ada, Ohio. "There are a lot more for chronic conditions." Chronic equals lots of prescriptions. A U.S. Government Accountability Office [2] report published in 2006 showed that a drug ad increased not only prescriptions of the given drug but also those for similar drugs to treat the same condition. The report cited a study that found that every dollar spent on these ads yielded a median return of at least $2.20 in sales.

Does the FDA regulate what the companies can claim or say?

Yes, the ads must be submitted for FDA review (though not necessarily before they're aired). Reviewers look for the ads to give a balanced profile of the drug's risks and benefits, and to accurately represent the drug's approved use (so, no images of children in ads for an adults-only heart disease medicine). Because drugs are now considered consumer items, Consumers Union [3], for one, vets the top sellers and helps you decide whether you are a candidate for them. Check out ConsumerReportsHealth.org [4].

One limitation in evaluating the ads is the FDA testing process itself, which has come under criticism lately for leaving out unfavorable results, approving powerful drugs without a sufficient testing period, and approving expensive new drugs that don't work much, if any, better than older medications.

Do people really make an appointment and ask for a drug?

A survey by Prevention [5] magazine in 1999 showed that 54.8 million consumers had "talked to their physician" about an advertised drug. Three-quarters of those surveyed welcomed the information in the ad, saying it helped them become more involved in their health care. Surprisingly, Sullivan's research has revealed that the longer the list of gross side effects and risks mentioned in the ad, the more likely a person is to ask about the drug.

How do doctors feel about being told their business?

"Usually, it's the older doctors who think this is getting into their territory and don't appreciate it," says Sullivan. "The other doctors like it and think it opens a dialogue and involves people in their own care." In a 500-physician FDA survey released in 2004, only 8 percent of the doctors said they felt "very pressured" to write a prescription for the requested drug, though many said they felt pressured to prescribe something. However, nearly 60 percent agreed strongly that the ads make the drugs sound better to patients than they really are.

Can children's medicines be advertised?

There is no prohibition. The problem is that most drugs have not been tested on children in well-controlled clinical trials and are often prescribed off label, meaning it's legal to prescribe them, but their intended use is not for children.

So, should I try a new drug, or not?

All together now: Ask your doctor. Caution is always indicated. The osteoarthritis painkiller Vioxx was heavily hawked on TV and in print, gaining millions of adherents by the time it was withdrawn from the market in 2004 due to increased cardiovascular risks.

Finally, you can always go to WorstPills.org [6] for a splash of cold water on your intended usage. No prescription necessary -- for the cold water, or for the grain of salt with which you may want to view these ads.

Star Lawrence is a health writer whose health humor blog appears at healthsass.blogspot.com [7].