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Ghost in the Machine, Part 2 — Success Breeds Greed That Gets in the Way of Ethics, Common Sense and Caution

    December 28, 2017 • 13,718 views

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drug advertising
Story at-a-glance

    Direct-to-consumer drug advertising has led to wider use of prescription drugs by American adults and children
    FDA conflicts of interest result in approvals of increasingly dangerous drugs
    Pharma defends high drug prices with high-priced PR campaigns and patient front groups

By Dr. Mercola

Direct-to-consumer (DTC) drug advertising, which began in 1997, has done a lot more than make Pharma arguably the most profitable industry in the world and a Wall Street success story. It has greatly increased the number of prescription drugs that Americans take. In 1992, five years before DTC advertising began, Americans took an average of seven prescription drugs a year. A mere 15 years later that number had nearly doubled to 12 per year.1,2

To sell drugs, aggressive drug advertising whips up fears over rare diseases like exocrine pancreatic insufficiency (introduced at the 2017 Super Bowl) and make a disease out of common, nearly universal conditions to frighten and motivate people into taking prescription drugs.

Another DTC advertising tactic is convincing people to take drugs simply because they might be "at risk" of a condition. Sadly, drug advertising is not the only way Pharma gets dangerous drugs into the nation's medicine chests. Thanks to outrageous conflicts of interest at the U.S. Food and Drug Administration (FDA) — the new FDA Commissioner, Dr. Scott Gottlieb, is a drug company consultant — drugs that would once have not been approved fly through their approvals.
DTC Advertising Does More Harm Than Good

Pharma-funded "patient groups" also create a false sense of demand for an expensive drug. And, last year, the FDA began clearing the way for Pharma "off-label" speech, once illegal.3 Now marketers and drug reps can claim benefits to their drugs not backed by the FDA, raising the question of "why have an FDA?"

Aggressive drug ads telling people to get medication from their doctors are especially unethical in the middle of an opioid epidemic and war on drugs. Moreover, the 21st Century Cures Act, passed in 2016, allocates $1 million to "opioid addiction" treatment drugs to address the opioid crisis Big Pharma created, allowing the industry to profit twice.4

Pharma's marketing of dangerous drugs, often which is often completely unnecessary, does not just harm overmedicated people. Poor people who legitimately need medical care and medication are also neglected because no profits can be made from them.
DTC Advertising Creates Patients

As previously noted, DTC advertising has greatly increased the number of prescription drugs taken in the U.S. A decade and a half after DTC began, the use of prescription medication went up 71 percent, adding $180 billion to U.S. medical spending.5

By 2014, 70 percent of adults and 25 percent of children in the U.S. were on at least one prescription drug.6 Today, 20 percent of Americans are on five or more prescription drugs.7 DTC drug advertising "is now the most prominent type of health communication that the public encounters," reported Pharmacy and Therapeutics, adding:8

    "The average American television viewer watches as many as nine drug ads a day, totaling 16 hours per year, which far exceeds the amount of time the average individual spends with a primary care physician."

Pharma is legally required to include risk information about drugs in its ads, but the info seldom scares patients away. Everything from actors who use an appealing voice tone, to beautiful images and music choices is designed to make you tune out the risks.
DTC Ads Are Highly Effective

DTC ads are so effective, the average number of prescriptions for advertised drugs is nine times greater than prescriptions for non-DTC advertised products.9

DTC ads have put tremendous pressure on doctors who are aware that denying a prescription request can decrease patient satisfaction and cause patients to switch doctors. "Refusal skills" have even been taught to doctors, says an article at the Center for Health Journalism:10

    "Writing a prescription may seem quicker but 'explaining to a patient why a highly-advertised drug might not be appropriate only takes three minutes,' said [Dr.] Richard Pinckney, professor at the University of Vermont College of Medicine where such a program existed.

    'The insurance savings could pay for programs like these,' he said. The Vermont project included 'secret shoppers' who asked doctors for an expensive brand name drug they had seen on TV after the refusal training.

    'Doctors have a hard time saying no if a drug is effective, even if it is expensive,' said [Dr.] Audiey Kao, vice president of ethics at the American Medical Association at a 2010 conference. Doctors are 'nervous' that rebuffed patients will go elsewhere, agreed Dr. Pinckney."

Highlighting Symptoms Sells Pills

Once upon a time, a medical professional sought to reassure patients and tell them they were not sick. Who remembers, "Take two aspirins and call me in the morning?" Today, thanks to DTC advertising, patients receive the exact opposite message: You probably are sick and should see your doctor.

Normal conditions like sad moods or indigestion are now said to signify potentially serious conditions, and when someone has no symptoms at all they could still be "at risk" of silent killer diseases, say DTC ads. Some DTC ads even tell you what to tell your doctor when you visit him or her and provide coupons to provide a discount for the drug being promoted.

This type of advertising is called "disease awareness" and Pharma says it is "educational" since it acquaints people with conditions and symptoms they may not know about. The truth is it increases hypochondria, self-diagnosis and the pool of patients who might use a new, advertised drug.

Sometimes disease awareness ads are "unbranded," meaning they do not even mention the drug they are selling. This leads people to believe they are hearing public service messages from a government agency instead of calculated Pharma messages to make people think they are sick.

One example of a disease "grown" by DTC advertising is gastroesophageal reflux disease (GERD). If you have heartburn, acid reflux, GERD, peptic ulcer disease or any acid-related condition, chances are you've been offered a prescription for a proton pump inhibitor (PPI) like the best-selling Prilosec.

Contrary to Pharma marketing, PPIs actually cause the very symptoms they're intended to prevent by creating "rebound acid hypersecretion" when you stop taking them; built-up acid can be unleashed with a vengeance. In one study, more than 40 percent of healthy volunteers experienced heartburn, acid regurgitation and dyspepsia (pain and fullness in your abdomen) in the weeks after stopping PPIs; these were symptoms they did not have before.
Other Diseases Grown by DTC Advertising

One of the clearest examples of how DTC advertising "grows" the amount of people identifying with a condition has been the statin drug class, prescribed to reduce the risk of cardiovascular disease and mortality.

Until it went off patent, Pfizer's Lipitor was the best-selling drug in the world.11 The popularity of statins reflects Americans' and medical practitioners' impulse to treat a condition quickly with a pill rather than more slowly but more effectively with lifestyle changes. Needless to say, Pharma makes no money on better lifestyle choices. Here is how AlterNet described the success of statins.12

    "Patients loved statins because they could ignore diet and exercise advice and still, apparently, reduce heart attack risks; their body would 'forgive' the bacon cheeseburger. But not all medical voices agreed. Some wondered why the nation spent approximately $20 billion a year on cholesterol-lowering drugs instead of effective, less dangerous and less expensive lifestyle and diet changes."

Another example of an overexposed condition is erectile dysfunction (ED). According to the National Institutes of Health (NIH), approximately 12 percent of men younger than 60 and 30 percent older than 70 suffer from ED. However, the market for the top three ED drugs is over $1 billion annually and expected to reach $3.2 billion by 2022. This means many men are treating a condition that may be well within the range of normal.

The same overdiagnosis and overtreatment can be seen with low testosterone or "low T." Rather than making diet and exercise changes, men are erroneously told they need to treat their testosterone decline with drugs.
Pills for Rare Diseases Are Pharma's Biggest Profit Center

If you have noticed aggressive DTC advertising for drugs that treat rare diseases, you are right. Approximately 1.2 percent of Americans (3.2 million) have schizophrenia, yet drugs that treat the condition have been among Pharma's bestsellers.13 Specialized, highly expensive drugs that treat rare mental disorders, cancers, autoimmune diseases and other specialized ailments "have been growing in leaps and bounds in recent years," says the financial site Motley Fool:14

    "[That] means that volume may not necessarily be driving sales of these therapies higher so much as price hikes. A good example would be Amgen's … anti-inflammatory drug Enbrel, which grew revenue by 14 [percent] in 2016, but actually had units sold of the drug fall by 6 [percent] year-over-year. This means price increases drove its 14 [percent] total growth."

Rheumatoid arthritis (RA), which also afflicts a small number of people, is very aggressively advertised because of the high price tags of the drugs that treat it. As I have often warned, rheumatoid arthritis drugs are among the most dangerous drugs available. Humira, Remicade and similar drugs double your chances of getting a serious infection and triple your risk of some cancers. They also fail miserably in not addressing the underlying foundational reasons why the condition began in the first place.

The drugs are linked to lymphoma, tuberculosis, pneumonia and skin, gastrointestinal, breast and lung tumors. Older patients who take the drug for long periods are at highest risk.

These dangerous drugs are almost always unnecessary for most people taking them. It has been my experience that virtually all rheumatologists are clueless about the root cause of the disease they are treating. Because they don't have a clue about the cause, they have to rely on toxic concoctions that can devastate your health.

Over the past 16 years, however, I've treated more than 3,000 patients safely by using my extensive RA protocol, which does address the underlying conditions, as does my new book "Fat for Fuel," which helps you optimize your mitochondrial function.
Greed Sends Health Care Costs Soaring

In the past few years, the public, health care professionals and Congress itself have been appalled at Pharma's profiteering. Many remember how Martin Shkreli, former Turing Pharmaceuticals CEO, raised the price of the life-saving drug Daraprim, crucial for AIDS patients, from $13.50 a tablet to $750 per tablet, and the similar EpiPen price hikes.

Valeant Pharmaceuticals International Inc. hiked the price of a once-daily form of Wellbutrin, a 30-year-old antidepressant, to $1,400 a month despite the existence of a $30 generic, and refused to lower prices on the millions hospitals pay for its life-saving heart medicines.15

The ruse of patient assistance for expensive drugs is just that: a ruse. Pharma, trying to look like it has a heart, simply shifts the high cost to privately insured patients and still gets its high prices. Taxpayers also pay. A Senate committee found that the hepatitis C drugs Sovaldi and Harvoni cost taxpayers $5 billion in 2014. Of course, there are cheaper drugs, but they are not the ones promoted, reported Pharmacy and Therapeutics:16

    "Another common complaint is that manufacturers often use DTCPA [direct-to-consumer pharmaceutical advertising] to promote expensive 'me-too' or 'copycat' drugs that might not offer any significant benefits over older and cheaper medications.

    For example, two heavily promoted diabetes treatments, rosiglitazone (Avandia, GlaxoSmithKline) and pioglitazone (Actos, Takeda), were found to be no more effective — or safe — than older drugs, even though they were much more expensive.

    In another study, older drugs for the treatment of schizophrenia were found to be equally effective and to cost as much as $600 per month less than olanzapine (Zyprexa, Eli Lilly), quetiapine (Seroquel, AstraZeneca), or risperidone (Risperdal, Janssen)."

Other Ways Pharma Ensures Its High Prices

As mentioned, outrageous conflicts of interest at the FDA allow drugs that once might not have been approved to fly through their approvals and onto Wall Street.17

It is no surprise, then, when rushed-to-market drugs are withdrawn, since an insufficient amount of time was allotted for safety problems to emerge. Patient front groups — a typical "astroturf" strategy, since they are not really grassroots — keep drug prices high. According to AlterNet:18

    "More than 80 percent of patient groups are Pharma-funded ... including the National Hemophilia Foundation, the American Diabetes Association and the National Psoriasis Foundation.

    But the most insidious are the mental health front groups like the National Alliance for Mental Health (NAMI) and Mental Health America. Not only do psychiatric drugs represent four-digit outlays per month per patient, and sometimes much more, patients are kept on them for decades or for life, with few medical attempts to determine if patients still need them or ever needed them.

    Side effects of the drug cocktails are viewed, thanks to Pharma spin, as confirmation of the 'mental illness,' not the side effects they almost always are. The use of such drugs in the elderly, despite their links to death in those with dementia, has become epidemic and is an underreported cause of falls."

To defend its high prices, Pharma has also rolled out PR campaigns targeting lawmakers who want to stop the profiteering. They are designed to show the "value" that drugs that cost five and six figures represent. The prices are always presented as fixed and non-negotiable, but the Senate Finance Committee said last year they do not reflect research and development but are simply an opportunistic and arbitrary "revenue" push.19

The message of the campaigns, showing patients whose lives were saved or lengthened by expensive Pharma medicines, is that questioning Pharma's outrageous drug prices means you're heartless and don't care about these patients' lives. Even as Pharma companies seek to incorporate overseas to duck U.S. taxes, and manufacture almost all their drugs overseas, these campaigns also claim its high-priced medicines help the U.S. economy by creating jobs, like for "sheet metal workers."20
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Disclaimer: The entire contents of this website are based upon the opinions of Dr. Mercola, unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Mercola and his community. Dr. Mercola encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. If you are pregnant, nursing, taking medication, or have a medical condition, consult your health care professional before using products based on this content.

If you want to use an article on your site please click here. This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. If any other use is desired, permission in writing from Dr. Mercola is required.

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