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Archive for Wednesday, July 11, 2001

Prescription drug dilemma

July 11, 2001

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— Think of this as old news. After all, the demographic has matured along with Dan, Tom and Peter. Advertisers now target an audience that has aged from Pop-Tarts to Vioxx, from the yellow submarine to the little purple pill.

Yet sometimes even a senior media has its moment. Consider health-care coverage. Nightly news reports on the patients' bill of rights have been interrupted by words from a sponsor about heartburn and Nexium. Background pieces on rising health-care costs have been punctuated by pitches about aches, pains and Celebrex.

The juxtaposition of stories about the health-care crisis with ads pushing prescription drugs to the public has begun to seem as contradictory as stories about the energy crisis flanked by ads for SUVs.

Over the past few years, there has been an insidious increase in the number of ads for prescription drugs. At times, the old political message, "Write to Your Congressman," is all but obliterated by the new ad slogan, "Ask your doctor."

The fastest growing medical expense is not from lawsuits, no matter what the debate is in Washington. It's from prescription drugs.

In 2000, the cost of prescription drugs went up by 17.4 percent. That's way more than the 7.3 percent increase in payments to doctors or the 6.4 percent increase to hospitals.

Much of that increase is good drugs and good news. But some of it is also the result of $2.5 billion spent in direct-to-consumer ads. It's for ads telling patients to "talk to their doctors" or better yet, talk their doctors into prescribing more expensive drugs than they may need.

Does that make your arthritis kick up? Try Celebrex, the star of 30-second scenes that make it look like an Alice-in-Wonderland drug swallow me and you'll be playing baseball with your grandchildren. Celebrex costs $900 a year compared with about $30 for ibuprofen.

Of course, Celebrex was meant for the small percentage of patients who get stomach problems with the old drugs. But "ask your doctor" and you may well receive the designer drug. Especially if your health insurance will cover it.

Pharmaceutical companies tell us that the cost is connected to research and development. No cost, no cure. But major drug companies, as a Families USA report shows, spend more on marketing, advertising and administering than on R&D. Indeed some of what they call research Let's color that pill purple! is what we call marketing.

The same drug companies will also mysteriously push a new "improved" drug just as their old drug loses its patent. Sometimes the only thing really "new" is the price tag.

In the not-so-good old days, all prescription drugs were professional secrets. Today, even Larry Levitt, a skeptic conducting research on direct-to-consumer ads for the Kaiser Family Foundation, says, "some ads do serve a public purpose." There may be, he adds, people out there who don't know there's a drug treatment for, say, cholesterol.

But there's a difference between encouraging self-knowledge and encouraging self-diagnosis. And there's a difference between controlling information and controlling price.

When this current debate over the patients' bill of rights ends if it ever ends we'll move on to a much harder debate about prescription drugs for seniors. Many, many older Americans need that coverage.

But the drug ads raise the question: How do we have coverage without control? Do we cover some prescription drugs but not others? Do we cover them all and break the bank? And if the price of the pill includes the cost of advertising it, will we end up subsidizing the very ads that drive costs up?

This is enough to give you "frequent, persistent heartburn" that could "wear away the lining of your esophagus." But, talk to your doctor? This spring several proposals to limit ads were presented to the AMA by frustrated doctors but none passed. The FDA is waiting for approval to begin its own survey. But it was the FDA that loosened the rules in the first place.

Every one of these prescription drug ads seems to end quickly with a speed-reading list of side effects that include every possibility short of certain death. The only side effect they don't list is the economic one.

Depressed yet? Well maybe the Zoloft ad has a point: "When you know more about what's wrong, you can help make it right."




Ellen Goodman is a columnist for The Boston Globe.

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