Prescription drugs

Making sense of the media hype

You’ve been feeling a little off lately, a little down, maybe even depressed. And you’re not really sure why. Then you come across a television commercial where a little oval creature, perhaps an egg or a rock, is also feeling depressed, even antisocial, until it takes the featured medication. It’s still a strange little oval, but now it’s a happy one. You make a note to ask your doctor about the drug.

There was a time in the rather recent past when what we knew about our health and well-being, what we understood about medicine and its implications for us, was just what the doctor ordered. We did what he or she said and took what he or she prescribed with little investigation or understanding about what we were taking. As long as we felt better in the morning, wasn’t that all that mattered?

For many, this still holds true. For others, it is no longer enough to be told what to do. We want to know why the doctor suggests taking a particular drug and the consequences of not doing it. We want to know not only cause but effect — the effectiveness of the drug, the potential side effects, and the cost of our treatment.

So we ask questions. We ask because we now know we can and probably should. We ask because we now know we have choices. We ask because we now have access to answers.

The new “Age of Enlightenment” was ushered in by the pharmaceutical companies, which now promote their branded products directly to consumers.

The thinking behind direct-to-consumer promotion, as it’s called in the industry, is to arm patients with sufficient information about pharmaceutical products to help them make educated decisions about their own healthcare. It also invites a whole other population besides doctors to investigate and consider its products; in this case, those with the most vested interest — the patients themselves. Quite simply, it is marketing at its best.

Direct-to-consumer promotion also attempts to provide consumers with just enough information to spark interest in a drug and to perhaps request it from their doctor or purchase it over the counter.

“It’s always very important for a patient to be well-informed,” says infectious disease specialist Dr. Robert Geise. “But you just can’t get all the information you need in a 30-second commercial or a magazine ad. They don’t always talk through the potential side effects, unless quickly at the end of the commercial. With HIV drugs, for instance, ads don’t always portray the total picture of what taking these drugs is like. They show somebody looking the picture of health, but it doesn’t actually mean you can climb a mountain tomorrow. Sometimes, the slick advertising loses or avoids the true benefits and purpose of
what the drugs are designed to do.”

Yet for all the general information you might encounter in the advertising or packaging of a drug, you still need to know whether it’s right for you. A discussion with your doctor is essential. He or she will be able to put everything into context, taking into account your personal medical history, other medications you might be taking, and possible side effects from the drug you just saw advertised during the evening news.

As recently as 10 or 15 years ago, pharmaceutical advertising was all but nonexistent. Any attempts were usually vague and untargeted, with limited information and no overlapping or comparison of brand names. Since the U.S. Food and Drug Administration relaxed its regulations, pharmaceutical brand advertising has become increasingly bold and direct to the consumer.

“When I was in pharmacy school 30 years ago,” says Mariann Novarina, pharmacist and director of Pharmacy for Community Hospital, “ the consumer knew very little about the availability and effects of prescription drugs. There were no drug ads at the time. What we knew was what the doctor told us. There was no list of side effects, and for a long time we didn’t know what they were. Now, due to potential litigation, companies have to list every conceivable possibility, whether it is probable or not. It is then up to doctors to help us weigh the potential side effects against the overall effectiveness or value of the drug.”

With the advent of the internet, television and radio advertising, and the wealth of print advertising, which includes direct mail, brochures, and magazine ads, today’s consumers have access to a plethora of information about diseases and the pharmaceutical options designed to help control them, which has the potential to help us become better participants in our own healthcare and, therefore, better patients. But we must remember to stay informed and consult with our own doctor before taking any new drug.

According to the Centers for Medicare and Medicaid Services, HealthCare Industry Market Update (January 2003), pharmaceutical companies spent $19.1 billion on promotion in 2001, $2.7 billion of which was invested in direct-toconsumer advertising. And in 2002, the New England Journal of Medicine acknowledged that drugs with the greatest amount of promotion often have the highest sales. It stands to reason that advertising aimed directly at consumers versus promotion only to doctors can yield an increase in sales.

A recent study found that approximately 30 percent of adults have talked with their doctor about an advertised drug, 44 percent of whom received a prescription for that medication.

The information is available, and consumers are paying attention. Whether designed to treat social phobia or serious heartburn, low energy or high cholesterol, patients are becoming increasingly aware of what’s available. The challenge then, for both consumers and their doctors is to evaluate
and determine what’s appropriate for each individual — his or her circumstance, health, or particular body chemistry. Just because a drug is marketed to the depth and breadth of a television audience doesn’t mean it is right for everyone.

“The last generation took what the doctor gave them,” says Novarina. “The Baby Boomer generation, by and large, is able to keep up with information about available options for healthcare. But they still have to
have a way to evaluate what’s given to them or what they’re requesting — to find out if it will benefit them, how it will make them feel, and what side effects it may have for them. That’s where the doctor comes in.”
 

Medications are the vehicle on his road toward health, but someone has to steer the car.

Back in 1987, Patrick V. Brown was 27 years old and coming into renown as a fine-art photographer when he learned that he was HIV positive. In those days, many considered the diagnosis a death sentence. And for many, it was.

Brown did not discount the possibility, but he saw death more as an outcome he would work to avoid — at least in the short term. While he acknowledges the importance of the medications he has taken to maintain his health, he recognizes that it is the doctors, nurses, and
healthcare providers who have really enabled him to navigate the disease by leading him in the right direction and by teaching him which medications might be beneficial to him and how they would interact with his life.

“The pharmaceutical industry has provided the products,” says Brown. “But my healthcare professionals, along with my own research and my own intuition, have been my guide. It’s not just the drugs that I count on, also the trained professionals, asking difficult questions, and creating a dynamic dialogue that allows for more information to be exchanged and appropriate protocols to be established.

“What works for one person doesn’t necessarily work for someone else. The distinction is made by those trained in the field — the healthcare
providers — and those who know themselves best — the patients — not by the pharmaceutical industry.”

Brown did not need medication until just four years ago, when he contracted pneumocystis, a temporary illness that caused the T cells in his blood to drop below 200, the guidepost used to shift an HIV-positive diagnosis to AIDS.

“I went through a graduate program, became exhausted, and got sick,”
he says. “I knew of the risk, but I had spent so many years of intense
focus and study on HIV/AIDS, I just had to get a life. I felt I had my Ph.D. in HIV, and I wanted my M.F.A. in photography.”

For Brown, who continues to live his life without symptoms of the disease or side effects from the medications he takes, the pharmaceutical industry has provided a tremendous benefit. So has the hospital’s Outpatient Immunology Services clinic (OPIS), which Brown has
been utilizing for the past year and a half. And, admittedly, health
insurance has played a supportive role.

“This medicine is prohibitively expensive,” Brown says. “If I didn’t have insurance to get these medicines, I’d have to sell my house and ask my family for help. Those who don’t have insurance have to find another source or get less of their medication. And still some people here in the United States are dying because of lack of access to both insurance and medication.”

Brown has benefited, too, from living in Monterey and pursuing the things he enjoys, and from the support of his family, his friends, and even, he says, his family’s pets.

“I have sought and found whatever level of support I’ve needed from all
these places,” he says. “And I have chosen a healthy way of living,
including regular exercise, good nutrition, and surrounding myself with people who are proactive not reactive. I feel very fortunate to live a healthy and vibrant life with HIV disease for as long as humanly
possible.”