Saturday March 31, 2007
Direct to consumer drug adverts in America are a proper joy, and especially the TV ones: your life is in disarray, your restless legs/migraine/cholesterol have taken over, all is panic, there is no sense any where. Then, when you take the right pill, suddenly the screen brightens up into a warm yellow, granny’s laughing, the kids are laughing, the dog’s tail is wagging, some nauseating child is playing with the hose on the lawn spraying a rainbow of water into the sunshine and laughing his head off as all your relationships suddenly become successful again. Life is good.
They even have celebrity endorsements for drugs, on chat shows, conveying important treatment information on odds ratios and relative risk – if I can slip into 1990s teen slang for a moment – “not”.
It couldn’t happen here. But now, excitingly, it looks like it might. The pharmaceutical industry has consistently been knocked back in the EU, and was turned away on its last request to “educate” the public in 2004, but the EU “Pharmaceutical Forum” is reconsidering, and reports next month.
Like the rest of the advertising industry, pharmaceutical companies look at their nails innocently when you suggest that adverts might affect behaviour, even though they know – that we know – that they’d only spend money on it if it worked. In fact, specific campaigns have been shown to affect prescribing practice, because modern doctors listen to their patients’ demands, and pharmaceutical consumer advertising is growing twice as fast as advertising direct to doctors, for one simple reason: history has shown that you are stupid and easily led, although your education in bad science may stand you in good stead.
Doctors are trained to spot bullshit, and this is one area where paternalism, I would argue, is acceptable. Pharmaceutical companies produce next-level, postgraduate bullshit. Drug reps brandish literature that is the comedic parallel of the promotional stories you get in the media for supplement pills, but the tricks are far more complicated: they cherry pick the literature – looking only at the positive studies – they use surrogate endpoints – a blood test rather than a stroke – they use inadequate controls – a lower dose of the competitor’s drug. They do all this far more subtly than the homeopaths, or the fish oil gang, because they are addressing a critical audience.
The best the public and journalists can offer in the face of big pharma’s advanced hustling is a rather infantile set of conspiracy theories that all drug company research must be “biased”; but they can’t quite explain why, because it’s boring and largely impenetrable, and so they only focus on the few clear examples of corporate fraud, where safety data has been mischievously withheld.
But the move the drug companies are demanding is far more interesting than the right to produce straight adverts. They want the opportunity to “educate” the public, directly, building awareness of disease, and biological treatments, and re-framing our understanding of our bodies. This is a far more sinister project, and one pursued by all flavours of pill peddler.
The nutritionists and food supplement industry – whom the newspapers continue to picture as a quaint cottage trade, rather than a multibillion-dollar pill industry – run about telling everyone they’ve got food intolerances, or hidden dietary deficiencies, or frightening disease risks, for which they have the solution, in a pill.
The drug companies, meanwhile, overplay the role of medication in the treatment of mild depression, and sell new conditions like “restless legs syndrome”, or “female sexual dysfunction”, for treatment with pills which they, too, already had in the warehouse.
Pills are seductive and easy, especially for problems with a strong psychological or social component; but the tragedy is, in the UK, there is nobody advocating against this disempowering pill mentality: only different groups, some of whom claim to be “alternative”, squabbling over who can sell the most pills.
Please send your bad science to firstname.lastname@example.org
You can hassle your European MEP on this issue very easily from this link:
An MEP will be astonished and flattered at your remembering their existence, so this kind of lobbying may well have some impact.