Direct marketing advertisements really place physicians in a tough position.
A new pharmaceutical is presented to the viewing audience and touted as a successful treatment for arthritis, sexual dysfunction, bladder problems, chronic obstructive pulmonary disease or dementia. I notice that the advertisements tend to cluster on stations with older demographic viewerships.
Thanks a lot for that, by the way. Just in case those of us who like those channels forgot to remember that we are getting older all the time, we have to be endlessly reminded by the advertisements.
Invariably, these promotional slots feature vibrant and happy elders, looking content as the engage in fishing, golfing, ballroom dancing or walks on the beach. Then the announcer describes a long list of side effects caused by the medication. At the end, a voice intones that you should “ask your physician” if you are considering the drug. As if there were another way! The drugs typically require a physician’s prescription.
How do I clarify a message generated on Madison Avenue that I had nothing to do with formulating? It doesn’t help, by the way, that I often cannot keep the advertisements straight in my own head. For example, the ballroom dancing couples could, theoretically, be used for erectile dysfunction, Alzheimer’s disease or bladder dysfunction, although the point is to hawk an anti-inflammatory pain-killer that facilitates the tango.
So let’s talk about pain-killers.
They all have side effects. End of story. The only problem is clarifying the precise risk profile of individual agents, so far as that is possible.
Stated differently, taking an 81 milligram children’s aspirin reduces the risk of heart attack, particularly in men over the age of 40 years. We know that from large population studies, including a famous one involving physicians as patients.
On the other hand, even such a small dose of aspirin can precipitate a life-threatening gastrointestinal hemorrhage or central nervous system stroke caused by bleeding. Aspirin, however, also decreases the risk of stroke caused by blood clots. A higher dose of aspirin may even decrease the risk of colon cancer.
Indeed, the same protective effect may occur with other aspirin-like agents, but these nonsteroidal anti-inflammatories (NSAIDs) may also paradoxically increase the risk of heart attack.
So what is my point? You, and your doctor, must work together to select prescription drugs that combine reasonable likelihoods of helping you with acceptable risks of side effects. That requires individualization of treatment to specific patient needs, a process that should be tempered by clinical judgment.
For example, a 50 year-old man with a high risk of heart attack might do well to take low-dose aspirin, whereas a 30-year-old woman with few risk factors for coronary disease would probably be best served to avoid unnecessary toxicity from a similar treatment protocol. That is called the practice of medicine.
In truth, there may be a democratizing effect of involving patients in pharmaceutical selection processes, and commercials can serve a useful function in educating the public about their treatment options.
I guess I should make peace with the direct marketing of pharmaceutical products. After all, we will all be walking down that long beach for decades to come.
Dr. Scott T. Anderson is clinical professor at the University of California, Davis Medical School. This column is informational and does not constitute medical advice. Reach him at [email protected]