Your Television as you doctor?

Often, usually on television, one viewing will often at times see an advertisement for some type of medication- usually one involved in a large market disease state and the commercial is sponsored usually by a big pharmaceutical company for a particular network. This is called direct to consumer advertising, and doctors would prefer they did not exist.
Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry spends around 5 billion annually on this media source now. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns. And involves money spent that could be applied to greater uses, according t many, but we are dealing with a corporation here.
The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective, which is to increase sales and grow their market and, in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads, in relation to their accuracy and clarity, as well as their effect on the health care system.
DTC advertising is also a catalyst for and similar to disease mongering.
Disease mongering is the creation of what some believe to be medical flaws, and illustrated by the creators through exaggeration and embellishments through media sources as an avenue for suc propaganda, as is often seen with DTC advertising. Yet the flaws may not be medical, but corporate creations of these questionable human ailments that do not require treatment, possibly, and may be an attempt to develop a particular medical condition to acquire profit. One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. And it is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.
Also, DTC ads discuss only one treatment option normally, so it seems, when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the doctor, as they assess your health, not your television or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of our country and New Zealand.
Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome for the doctor chosen for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads require a prescription.
Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some over-prescribing, which will benefit everyone in the long term. And the Health Care System can regain control of their purpose, which is far from financial prosperity.

“Do every act of your life as if it were your last.” —- Marcus Aurelius

Dan Abshear

Of course, there is a wider debate about the drug discovery process. I have some sympathy for the view that it is getting progressively harder, and more expensive, to develop new entities to tackle currently untargetted diseases, and that that explains to some extent why there are so many “me too” drugs around these days. I reckon it has been a while since the last new small molecule / novel target blockbuster drug. But when you see the myriad ways the Pharmas go about pushing pretty marginally effective (or better) compounds it is hard not to get a bit cynical. Nonetheless, one shouldn’t forget that drugs like modern antihypertensives have saved many lives. To hear some of the Alt lobby idiots talk you would think the only reason doctors gave out pills at all was to make money for the PharmaCos. This seems to be the line Lionel “Quantum Homeopathy” Milgrom is favouring lately, though in the light of the rest of his delusional worldview I can’t say I’m surprised.

Can you post the slides up as well, just so I can get the gags as well.

cheers

j

Andrew.

Nexium is, as I remember a recent survey I read (anyone got the link?) currently the MOST direct-to-consumer marketed pill in the repertoire, at least in the US. As I recall the spend to plug Nexium direct to the punters in the US runs to hundreds of millions of $$$ annually.

The cynical interpretation: when there is zero evidence the pill is cost-effective vs. cheaper alternatives, and it is so flat-out obvious that you can’t flannel / bribe the doctors to go along, go to DefCon Two and blizzard the end-users with “ask your doctor for the LATEST state-of-the-art medication for your stomach grumbles!”… and then watch the patients do the work for you.

Nothing new, of course. When I worked in the States a decade ago I remember being amazed by the incessant TV Ads for Losec, which were fairly obviously directed at anyone with “functional gastric disorder”, aka a “nervous stomach”. At the time I am pretty sure you had to have an endoscopically diagnosed ulcer to get Losec in the UK.

Andrew.

As far as enantiomers go, you have to be sure they don’t racemise in the body a la Thalidomide. It was originally marketed as a racemate, but it turns out only one enantiomer that’s teratogenic. Only problem is if you were to give the non-teratogenic form it quickly interconverts, so whilst it is finding many new uses, they have to be very careful about to whom it is given.

I thought any compound that has enantiomers and is going to be used as a drug has to have all the enantiomeric forms tested nowadays as the FDA and the like don’t want a repeat of Thalidomide. Therefore any company that develops a drug that is enantiomeric will have all the data on all enantiomeric forms. If they are identical in action, but separately patentable, then they’re definitely going to be using that to prolong it’s on-patent life.

50mg (0.5mg/kg) IV when you’ve been reading an Ian Banks `Culture’ SF novel is a good combination. The Colonel that administered it had the decency to escort my wife out of the room for half an hour: his advice was that hearing the babble can be quite upsetting. The hallucinations weren’t that scary, but having lived to 42 without taking any hallucinogens they were quite exciting.

US defence procurement has traditionlly been a money-burning snouts-in-trough gravy train of legendary proportions – hence the old jokes / urban legends about the three thousand dollar toilet seat for the B-52 bomber – the seat was supposed to be “nuclear blast resistant certified”.

Anyway, if even the US Military isn’t taking “blue chip” Nexium over racemic omeprazole you can bet there’s no worthwhile evidence the single enantiomer is better.

As a sometime lecturer in pharmacological things and other half of an ex-anaesthetist was fascinated to recently read a med student blog describing the student giving iv ketamine infusions for anaesthesia during an elective stint in the South Seas.

You didn’t say much more about enantiomers than the 5th paragraph above but I thought it was worth mentioning that enantiomers are more than marketing tools.

One of the advantages of being an anaesthetist is that I have very few drugs to choose from, and me-too drugs almost unheard of in my field.

With regards to Ketamine, it is the excitatory effects that are caused by one enantiomer whilst the sedation is caused by the other. Sadly, apart from developing countries, there is insufficient demand for ketamine (in anaesthetic practice) to drive the development of this.

Think this might be the study –
http://tinyurl.com/2ow43s