A culture under the influence of drug ads


It’s amazing what an hour of aimless channel surfing can turn up these days.

After some freewheeling with the remote one night recently, I managed to catch not only half a dozen low-budget makeover shows but also three ads for FDA-approved pharmaceuticals: one for depression, another for premenstrual dysphoric disorder, and a third for inadequate eyelash syndrome — sorry, “eyelash hypotrichosis.” Prescription treatment for “longer, thicker, and darker lashes”? Fellow Americans, have we lost our minds?

In the ad, actress Brooke Shields coyly advises women that any eyelid skin darkening that occurs — a potential side effect of the prescription liquid — “may be reversible” but “close doctor supervision” could still be necessary. Oh, and did I mention that the proposed treatment can take 16 weeks? Imagine the doctors’ billable hours.

How does the pharmaceutical industry have the nerve to tap an already lucrative cosmetics market while keeping a straight face medically? And what exactly was Shields thinking as she read copy that, to my male ears at least, made the product sound downright scary: “There is potential for increased brown iris pigmentation, which is likely to be permanent … for hair growth to occur in areas where [the] solution comes in repeated contact with skin surfaces. If you develop or experience any eye problems or have eye surgery, consult your doctor immediately.”

Shields has also made a “video diary” — you can find it online — to “chronicle her lash journey.” It sounds like an epic voyage. “I thought I would be a good candidate” for the prescription treatment, she confides, “simply because over the years I’ve just been ripping off my false eyelashes while on Broadway.”

We do not go to American TV to seek signs of deep thought. The studios that gave us “Baywatch,” “Toddlers & Tiaras,” and “Skating With Celebrities” can’t be accused of setting our expectations too high. Still, at least we know what we’re getting with such shows. Direct-to-consumer pharmaceutical advertising, legal only in the United States and New Zealand, is — or should be — another matter. After all, it concerns public health.

We should recall that we did just fine when these ads were limited to professional journals and health-care providers. That constraint reduced the risk of self-diagnosis — and spared us the barrage of vanity treatments that now beset us.

In 1997, however, the Food and Drug Administration — encouraged by the Clinton administration — relaxed its rules on this issue. The pharmaceutical industry was given a green light to bypass providers and market its wares directly to consumers.

To gauge the effect of that change, just follow the money. The year before the ruling, drug companies spent $595 million on direct to consumer advertising, according to the Food and Drug Law Journal. Within a year of the change, that spending rose to $844 million. By 2000, it shot up to $2.24 billion. And an August 2007 New England Journal of Medicine article put the total for all drug-related marketing in 2005 at $29.9 billion, with $4.1 billion spent annually on direct to consumer advertising. That’s more than $11 million a day.

If Congress is serious about lowering health-care costs, including for vastly expensive (price-controlled) pharmaceuticals, it can start by reversing the 1997 FDA ruling and banning direct to consumer advertising. That is because such costs are always passed on to providers, and then to patients, in the form of higher prices, co-payments, and premiums. Even when insurance providers decline coverage for treatments such as “eyelash hypotrichosis,” as mine does, they — and eventually consumers — end up subsidizing the treatments because the drug makers inflate prices on regimens that are covered. Above all, there are so many more urgent needs in pharmaceutical research, including dealing with the H1N1 virus and the spiraling rates of HIV infection.

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