First Pill’s Free
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 ambiguous.org
(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
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
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.