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As Seen on TV

Author: Kirk Pappas, M.D.
December, 2014 Issue

When drug companies advertise directly to the public for what are generally new and very expensive prescription drugs, most doctors are peeved.

I’ve just about had it with direct-to-consumer TV ads for prescription medications. Big pharmaceutical companies have clearly decided that this form of marketing makes sense (and money), but isn’t it getting a little ridiculous? Here’s what happened not long ago when I saw a gentleman at an office visit:
“Good morning, Fred. What’s on your mind today?”
“Well, Doc, I was wondering if that pill they show on TV is right for me,” he started.
“Which pill are you referring to, Fred?” I gently asked.
“Oh, I think it’s the blue one…no, maybe it’s purple…”
“Oh brother,” I thought. “Here we go again.”
“Well, Fred, what is the pill for?” I asked. “What’s bothering you?”
“I’m having a problem down there,” he pointed down.
Now we were getting somewhere. “Oh, you’re having an acid problem with your stomach, that’s the purple pill. That medication can be…”
“Lower,” he interrupted. Fred pointed lower.
Now we were really getting somewhere.
“Oh, you want the blue one!” I was elated that I’d finally figured out what was wrong with Fred. He had erectile dysfunction (commonly referred to as “problems down there….”)
Many of the drugs promoted on TV are for very specific and uncommon conditions. When you see professional golfer Phil Mickelson chatting up his arthritis medication, the public has no way of knowing it’s for a severe form of inflammatory arthritis and not at all appropriate for the weekend hacker with achy joints. Another recent ad is for a blood thinner for the heart rhythm disorder called atrial fibrillation. That’s a common enough condition, but the decision-making process to use the drug is extremely technical and involves a thorough cardiovascular evaluation. It’s hard to understand how it makes sense to advertise those products directly to potential patients.
And what about all those side effects they list? I don’t know about you, but given the choice, I’d prefer to have an overactive bladder to avoid “belching, diarrhea, trouble breathing, irregular heartbeat, blurred vision and irritability.” (It seems pretty much every drug causes irritability. Heck, after the announcer lists the first 20 or so horrific side effects, I get irritable from the ad!)
When drug companies advertise directly to the public for what are generally new and very expensive prescription drugs, most doctors are peeved. The process a physician goes through to consider a new prescription medication isn’t trivial. In most cases, it requires a thoughtful evaluation of the problem, an examination and often some tests to clarify the diagnosis. Even then, it’s not automatic.
Patients deserve an explanation of what’s going on and a discussion of options and recommendations. Many times, the advertised drug is very expensive and doesn’t even deserve to be in the conversation. This is not the same as for a simple, over-the-counter (OTC) medication like Advil. That’s why some drugs are OTC and some aren’t. If the prescription drug is appropriate for a patient, and if it offers a cost-effect advantage over its competitors, there will be a market and doctors will prescribe it. This should occur through professional channels, not through the lay media.
I suppose there are reasons we’re getting bombarded with these TV ads. The business of selling prescription drugs is changing very quickly. There seems to be a feeling of desperation with pharmaceutical companies and their marketing strategies in this new, upside-down world of health care as they’re losing access to physicians. More and more doctors’ offices have closed their door to sales reps and the practice of stocking free samples for their patients.
Slowly, over the past decade, drug reps adopted much more aggressive and intrusive sales tactics. As a result, more and more doctors are saying, “No mas.” I remember the days when reps in my office were seen as friendly and collegial visitors who’d chat with the office staff, leave their samples and keep a generally low profile. Today, if left uncontrolled, there’d be a 30-something college grad in fine business attire, sporting a 10-page, glossy flip chart and a slick sales pitch chasing me down the hall between every patient. No mas!
Back in the exam room, the Abbott and Costello routine with Fred wasn’t over. But, by then, I was ready to deal with him on his own terms.
“Now, Fred, which would you prefer: The pill that will make you like the beautiful couple in the matching bathtubs enjoying their Chardonnay while overlooking the vineyard, or the one that will produce the urge to dance while you and your wife are chopping vegetables?”
Dr. James DeVore has been a full-time family physician in Santa Rosa since 1980. He’s medical director of St. Joseph Health’s Annadel Medical Group.


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