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The First Pill’s Free

In post 9/11 days it may be almost sacrilegious to share my sharpest memory of actually being at the intact World Trade Center. It’s not the view from the top, which I last saw at 13. (I was going to take a college friend up when she visited in 1998, but we balked at the $12 charge to ride up the escalators to the viewing platform and went to my partner’s office window instead.) It’s not shopping at the mall underneath, which I usually just rushed through as I switched from the PATH train to the subway on my twice-a-week reverse commute from Brooklyn to New Jersey.

Nope. It’s the 50-foot-high Prilosec woman-in-purple who was dangled over the very long escalators down to the PATH station. She was also plastered on walls, underfoot, and in similar places across the country. If I’d watched TV, I would have seen her there as well. And despite my best intentions, despite being perfectly well aware that this was exactly what they wanted me to think, as I made my slow businessmen-surrounded descent, I thought “I wonder what that’s an ad for?” The original ads gave practically no information. They were clearly for a drug though, and boy were they purple. The company clearly got its money’s worth out of its psychological experts, because I don’t even remember where I got the answer to my question, but it stuck, and like the rest of the country I know that the little purple pill is a (far more powerful than most people need and very expensive) heartburn remedy.

Direct-to-consumer pharmaceutical advertising has always made me queasy. Still, given my healthy skepticism (OK, I’ll say it, distrust) of doctors in general, the argument about respecting patients by giving them information directly has a momentary appeal. The number of times I’ve known more than a doctor about some condition worries me, especially because I know how little I know.

And then I remember that no pharmaceutical ad campaign I’ve seen has actually contained useful information. As currently carried out, pharma ads are the quintessential example of creating demand out of thin air.

But it works. And there’s been little enough ruckus raised about it that at least one company has decided that the coast is clear and it can relax a little about appearing like a drug pusher. A couple weeks ago, Quinn Norton of (disclosure: Norton is a family friend), did a little background research on an ad for “Ambien” that she was seeing over and over on TV.

Here are the basic facts: Ambien is an insomnia drug produced by Sanofi- Aventis. Ambien, like most sleep drugs, is addictive (a Schedule IV controlled substance, to be specific). It is recommended for use only for 7 to 10 days at a time, except under unusual circumstances. The company is, however, pushing its new 30-pill pack to doctors and pharmacists, noting on its own Web site (shortly after the recommendation about 7 to 10 days) that 70 percent of the prescriptions for it are written for 30 days. And now, thanks to a special offer from the company, the first two pills are free.

Having turned more than once to Benadryl in the face of my own insomnia, I’m not against sleeping pills, per se. But given our caffeine-addicted, high-strung, overworked, normal-sleep-schedule deprived culture, and our historical cavalierness about using pharmaceutical sledgehammers when a gentle tap will do, I have a lot of trouble believing Sanofi-Aventis when it says that the incidence of addiction to Ambien is negligible.

Norton has trouble believing it too. And she’s got a little anecdotal back up, as she describes: “One pharmacist, speaking very anonymously, said, ‘You want to see a soccer mom shake like a crack whore? Tell her she’s out of refills on her Ambien.’ ”

Where are the doctors in these cases? Complicit? Not paying attention? Swayed by the onslaught of advertising themselves? Giving in to pushy patients demanding immediate prescriptive relief?

“Most physicians tended to view DTC advertisements negatively, indicating that such advertisements rarely provide enough information on cost (98.7%), alternative treatment options (94.9%), or adverse effects (54.8%),” notes the journal Arch Intern Med. in 2004, reporting the results of a study of nearly 800 doctors. But wait, there’s more: “Most also believed that DTC advertisements affected interactions with patients by lengthening clinical encounters (55.9%), leading to patient requests for specific medications (80.7%), and changing patient expectations of physicians’ prescribing practices (67.0%).”

So we have doctors who are grumpy about having to correct misconceptions and do more extensive education, and nervous about saying “No, that’s not appropriate for you.” Poor babies. But wait, isn’t that their job? Wasn’t it always their job? If it forced doctors to level more fully with their patients, and work through all the options with them in detail, I might even be convinced that DTC drug advertising could be a good thing.

But that doesn’t seem likely; even before DTC took off, it’s not like most doctors (in my humble experience) were wont to give their patients much more information than the advertisements do. Planned Parenthood, bless them, told me far more about the interaction of birth-control pills and migraines than any neurologist I’ve seen (including some pretty fancy-pants Manhattan headache docs).

The pharmaceutical industry should certainly be called out for its constant push to make and re-patent and promote new drugs that aren’t any better than the old ones, or that treat disorders that are not necessarily best treated with a pill.

But perhaps lazy doctors share some of the blame when a quick-fix-seeking population turns to other sources of information—even drug-pusheresque ads for sleeping pills.

—Miriam Axel-Lute

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