So far, I’ve been writing about places far from New Mexico. I’ve linked observations about, or experiences in, those place to life here at home by looking at the differences or similarities emanating from our common humanity. Today I want to write about something to which we have become accustomed in the United States, something that is absent anywhere else in the world. No, not freedom or democracy, or any of the other values of which we are so proud. I’m talking about widespread and corrosive commercial advertising on the part of our pharmaceutical companies.
This advertising can be found on billboards, in print media, on radio and TV. Turn on a television set in Oslo or Harare, Mexico City or Taipei, London or Johannesburg, and you won’t see adds for medications or medical procedures. You won’t be confronted with images of vibrant active young men and women—pictures of health and longevity—while an authoritative voice suggests that this or that drug will keep you virile, eliminate heart problems, improve digestion or offer hope in the event of cancer. In other parts of the world you won’t be subjected to a bombardment of arguments for taking this or that pill or syrup, while a litany of possible side effects moves too quickly for the eye to follow along the bottom of the screen.
You won’t see this type of advertising in other countries because it is against the law. As was true in the United States twenty or thirty years ago, persuasive commercials screaming quick fixes for complicated problems were not only illegal, they would have been considered in poor taste—like personal injury lawyers hawking their wares. Today both categories of advertising have become so common and flagrant they go largely unquestioned by the public.
Doctors have told me they have a much more difficult time these days thinking about the nature of a patient’s problem and deciding on a legitimate course of action, because such a large number of patients have been so influenced by this advertising and its rash promises that they come into the doctor’s office demanding prescriptions for the wonder drugs they are convinced are “right for them.” Often they aren’t satisfied until they can leave with the script in hand. What they have seen on television is worth more to them than their doctor’s individualized assessment of their health.
For that is the hook: “ask your doctor if such and such a medication is right for you.” In this expertly orchestrated context, what does “right” mean? The first problem with advertising prescription and even over-the-counter medication is the extraordinary power wielded by the pharmaceutical companies. As a lobby, there are few more influential. Data for 2009 showed the largest—Johnson & Johnson, Pfizer, Glaxo Smith Kline, AstraZeneca, Merck, Beyer, Eli Lilly and Bristol-Meyers—with total yearly revenue averaging around 50 billion each, change in net income on the positive side in every case but one, and a Fortune 500 ranking for most within the highest one or two hundred.
These companies’ combined power is such that the industry can get away with running the studies on the effects of their own products, without the public wondering what interests those studies promote. They can influence the government agencies charged with drug safety to permit sales long before adequate testing has been conducted. They can privilege their bottom line when it comes to keeping drugs on the market even after independent studies have shown them to be dangerous; if their profit from sales is higher than damage from lawsuits, they will continue to produce and sell the drug. And they can advertise in such a way as to convince millions of consumers that it is in our best interest to ingest a substance that may very well worsen our health—or kill us.
US medical practice includes regular visits from drug company representatives to hospitals and doctors’ offices. Medical personnel are also invited to conferences or forums paid for by the pharmaceuticals. But this contact is not limited to an explanation on the part of the company of what its medications achieve, or the risks that may be involved in taking them over the medium or long term, or when conflicting medicines are taken or conflicting situations exist. Doctors are wined and dined, routinely given expensive gifts and treated to luxurious vacations. Monetary kickbacks are common. For all but the health workers most virtuously resistant to this sort of pressure, prescribing this or that medication is very much in their economic interest.
If the art of advertising had not advanced to such a degree, if its sophistication had not reached such subliminal heights, the average person who doesn’t automatically hit the mute button every time one of these drug commercials appears wouldn’t be so likely to be seduced. The list of possible side effects alone would be enough to stop most of us from going out and buying the latest wonder drug, or insisting that our physician prescribe it. A drug claiming to cure joint pain may cause heart problems. One that helps digestion may set up dependency or cause addiction. Antidepressants may produce “suicidal thoughts or actions.” Why not call “suicidal action” suicide: a drug dangerous enough that it may cause the person taking it to end his or her life?
The growing list of magic pills to treat erectile dysfunction—I call it reptile dysfunction—may cause blindness or an erection lasting longer than four hours. “If you have an erection lasting more than four hours,” the authoritative voice warns, “see your doctor right away.” Surely there are men for whom a four-hour erection doesn’t sound so bad. More importantly, most of these male enhancement drugs are covered by health insurance plans, while birth control pills and other female medications aren’t. The gendered nature of prescription medication coverage, as well as the gendered disequilibrium in many studies, warrants a whole other article.
One thing leads to another. Over the past ten years of this sort of commercial drug advertising, a considerable number of medications have been proven to be dangerous in one way or another. The whole class of statins—Lipitor, Torvast, Crestor, Zocor and others—pushed for years as a safe and effective way of lowering cholesterol, has been found to produce side effects that have made tens of thousands of consumers stop taking them. They may lower cholesterol, but cause liver damage, neurological problems, Type II Diabetes, and muscle distress. And before the crisis with statins there was the crisis with hormone replacement. Many women decided they would rather suffer hot flashes and mood swings than invite an increased risk of cancer.
The United States prides itself in having serious medical safeguards in place. The Centers for Disease Control are supposed to control the sale of new drugs, and the Pure Food and Drug Act regulate their use. Whenever the high cost of US drugs are in the news, we are warned not to buy the same drugs in Canada or elsewhere “because they aren’t safe.” Most of us assume that drugs made and sold in this country have been appropriately tested. Yet this isn’t necessarily so. More and more often lax laws, or cutbacks in the funding that makes enforcing those laws possible, leave us open to unimaginable dangers. The filthy conditions at the New England Compounding Center, recently responsible for widespread contamination, illness and death, is only the latest in a long list of such abuses.
Once we understand how the big drug companies manipulate us through suggestion, coercion, and lies, we may not be so willing to purchase medications that offer more harm than relief. We may begin to be able to read between the lines. We may stop equating that young healthy looking model with how we will look or how much energy we will have if only we take this or that medication. We may even realize that there are no real substitutes for eating clean food and getting regular exercise. I wouldn’t bet on it, though. Once a multi-million dollar many-pronged advertising campaign takes hold, it is hard to extradite ourselves from its persuasive grip.
As terms such as “natural” and “organic” have gained currency in our culture, many people have turned to the so-called natural remedies as alternatives to the pharmaceutical compounds. We tend to believe “natural medicine” is less dangerous. Sometimes it is. But it’s worth keeping in mind that all medication is made from natural substances or synthetic versions of those substances. So-called alternative medications are controlled no better than their pharmaceutical cousins, sometimes not as well. Every chemical or biological compound affects our bodies in positive or negative ways, often both at the same time.
Am I advocating that we stop medicating ourselves? Not entirely. I know many of us need to lower our blood pressure or get rid of a debilitating headache. There are medications that quite literally keep many of us alive. What I deplore and denounce, with every ounce of my reason, is the fact that the pharmaceutical companies are allowed to advertise in US media, and that the US American public is being so powerfully influenced to ignore our own health risks while growing the obscene profits of companies that clearly care more for their bottom line than for our wellbeing.
Responses to “Ask Your Doctor”