Blogger of Jared

The United States is nearly unique among developed nations because it allows direct to consumer pharmaceutical advertising. The pharmaceutical industry is enormous and these companies ensure their ads are slick and alluring. To site just one example, I have often found myself nearly salivating for Claritin when I see ads for it on television. One particularly effective series of ads shows the world passing by as if obscured by a haze–it looks distorted and blurry, kind of like it might without glasses. Suddenly (upon taking Claritin, we are told), the haze disappears and the world shines with crystalline clarity. Anyone who suffers from hay-fever knows the truth of the first image and that same set of people, including me, can tell you how tempting Claritin becomes as a consequence.

In an attempt to counterbalance this barrage of advertising, I want to pass on a message from someone who is learning a little bit about drugs, disease, and health: don’t ask your doctor for drugs you have seen advertised, and especially don’t attempt to convince him the drug is a good idea if it is against his professional opinion.

In America, we pride ourselves on our independence. What’s more, we don’t tend to like experts because they carry with them a certain aura of arisotocracy–besides, who needs experts when we are certain we can get along pretty well by ourselves. This is one instance, however, where independence can be dangerous. Allow me to explain why.

Before a pharmaceutical company can sell a drug to consumers, it must subject the drug to a wide and demanding battery of tests. These tests include animal experiments, experiments on healthy humans, experiments on those who are sick with the disease the drug is meant to treat, and then large randomized trials where the drug is introduced into a subset of the population. During all this time, researchers keep detailed records of the effects–both good and bad–the drug has. If, at the end, the drug is deemed sufficiently therapeutic, the FDA gives the pharmaceutical company permission to sell the drug to the public.

At that point, the drug company launches an advertising campaign to introduce the drug to the public and boost sales. We, the consumers, see only the advertising–and, of course, advertising is meant to convince us to buy the drug. Yes, both print ads and commercials contain “small print” which informs us of potential side-effects. Let’s be honest, though, what is the effect of a bit of small print when compared to the powerful images created by expert advertising executives? It is not that the companies are being dishonest, they’re just being smart–they want money, and money only comes if they sell lots of the drugs. Consequently, the images promoting the drug are carefully crafted to make us salivate and the words disparaging the drug are carefully arranged so we can dismiss them as an afterthought.

Regardless of the honesty of the pharmaceutical industry, however, another problem is inherent in the FDA approval process: time. A normal drug will be in the testing pipeline for about ten years. Not all of those years, of course, even involve human subjects. Consequently, when a drug becomes available for purchase, we have only a very limited understanding, if any at all, of its long-term consequences on the functioning of mind and body.

Let’s look at a theoretical example. A pharmaceutical company develops a new pain-reliver which is shown to be wonderfully effective. Even better, the drug does not cause stomach ulcers or other gastro-intestinal problems. After testing and research, the FDA approves the drug and it becomes wildly popular. During fifteen or so years, millions of Americans per annum buy the drug. Some twenty-years after the introduction of the drug, it is shown that long-term exposure to the medicine leads to cerebral accumulation and, sadly, to a significant increase in the rate of Alzheimer’s disease. Such information simply could not have been obtained in initial studies–with this new information in mind, however, many of those who took the drug for relatively benign reasons would certainly have made a different choice.

I do not mean to create paranoia. I do hope, however, that we can be more discriminating in the drugs we take and for which we ask. FDA approval, unfortunately, does not guarantee a drug’s safety or efficacy. Consequently, it is generally better to stick with drugs that have been out for a long time (which are hopefully the ones your physician prescribes)–the more exposure we have had to the drug, the more we know about it’s long-term consequences. Certainly, there is a place for new drugs. Someone who is suffering from unbearable and/or terminal illness, for instance, may have little to lose by trying a new drug. We ought, however, to view drugs of convenience much more skeptically. We may do well to remember that, if we take drugs right as they come onto the market, we are essentially entering an experiment. Hopefully, the outcome will be wonderful; often, however, there may be hidden consequences of which we are simply not yet aware.