Dorothy Guellec

In

the two years since the FDA began an experiment to let the mass media broadcast

the prescription-drug message directly to consumers, the pharmaceutical industry

has shelled out a whopping $1.3 billion per year on consumer ads. That dwarfs

the $763.6 million spent on beer ads, says Competitive Media Reporting. This

figure may or may not be accurate, as we all know from the little, but important

book, "How to Lie with Statistics." (Copyright 1954) Disraeli said

"There are three kinds of lies: lies, damned lies, and statistics". So

common sense has to reign. As of August 2, 2999 there were 34 drugs advertised

to the public on television.

Why

does the world’s best-selling drug, the heartburn medicine Prilosec, cost $3.30

a pill in the United States but only $1.47 in Canada? Why does Claritin cost

almost $2.00 a pill in the United States but only 41 cents in Great Britain? Why

does the United States have the highest drug prices in the world? To begin,

every industrialized country with the exception of the U.S. imposes some form of

price controls on prescription drugs. Additionally the American consumers

literally pay the price to subsidize research and development for the world as

well as the pharmaceutical industry’s substantial profits. Fortune magazine

ranked the pharmaceutical business as the most profitable of all industries in

1998 when measured by returns on equity, sales and assets.

Why

do TV ads seem so convincing? What is it that they do in the 60 or so seconds

that makes people act on this information? Maybe the television commercial is

not about the product at all, but rather the character of the consumer. What the

advertiser needs to know is not what is right about the product but what is

wrong about the buyer. I have heard many well-educated friends and relatives

say, "I saw it on television so it must be right." In 1998 an

estimated 55 million people talked with doctors about prescription medicines

they saw advertised, and doctors wrote prescriptions 84% of the time they were

asked, according to a Prevention magazine study. The television commercial has

"embedded in it certain assumptions about the nature of communication that

run counter to those of other media, especially the printed word." The

commercial is unusually short – an instant, always addressing itself to the

psychological needs of the viewer. It may be considered instant therapy. As Neil

Postman said years ago in "Amusing Ourselves to Death" "The

commercial asks us to believe that all problems are solvable, that they are

solvable fast, through the interventions of technology, techniques and

chemistry." Of course this is preposterous, yet I hear it over and over.

"It must be true otherwise it wouldn’t be on television." I would

rather hear "It certainly is wrong and oversimplified, and that is

precisely why it is on television. The USA is the only industrialized nation

that permits prescription drugs to be advertised directly to consumers through

television commercials and print ads. High U.S. prices are coming under

increasing scrutiny because prescription drug costs are the fastest-growing

segment of health care costs. Since 1993 they have risen at a 12% annual rate.

There seems to be a cure for everything: allergies, ailing hearts, depression,

herpes, high blood pressure, premature hair loss, headache, impotence, and on

and on. The most expensive drugs are advertised, not the generic ones of course.

But doctors face pressure from their HMO companies to prescribe inexpensive or

generic drugs to hold down costs. "I could be de-selected by an HMO or

managed care program. Is that a conflict of interest?" said Dr. Thomas

Kowalski a Milwaukee pediatrician. I think the answer is obvious

According

to Health Affairs a leading policy journal "Advertising prescription drugs

directly to the consumers may be harming the quality of clinical care" and

upsetting the delicate doctor/patient relationship, if there still is one. In

Health Affairs Michael Wilkes, MD and colleagues write that these ads" may

cultivate the belief among the public that there is a pill for every ill and

contribute to medicalization of trivial ailments, leading to an even more

‘overmedicated’ society." This type of advertising rarely mentions

lifestyle changes and nonpharmacologic interventions. TV ads are for the most

expensive pills. The consumer really has no choice if there is one particular

medication available for his or her condition. The cost of running ads adds to

the price, and companies are currently seeking to extend their patents longer to

make sure that generics do not compete.

New

travel spin offs have had success as seniors join groups to travel to Canada and

Mexico. For $99, RxPassport provides a seat on the bus, pays the Canadian

doctor’s fees, helps patients fill out the paperwork for their prescriptions,

and includes a gourmet box lunch on the return trip. The office, set to open in

a month, is ready to deal with up to four busloads of American patients every

day. Dr. Paul Zickler, the managing partner of RxPassport, stresses that the

office is not a clinic. Although a nurse will be present, patients will not

receive exams. Prescription requests must arrive with a letter from the

patient’s primary care physician or specialist before the visit. If the Canadian

doctors find no problems, they will rewrite them, have them filled and give them

to the patients when they arrive. Customs allows only a 30-day supply to cross

the border. The majority of the patients will be seniors "and the

medications that they’re on are primarily high blood pressure pills, diabetic

pills, heart pills."

American

prices for prescription drugs are the highest in the world so it is not

surprising that people will travel across borders. The United States actually

does have a price control system similar to other countries but it applies to

only one customer: the federal government. Pharmaceutical companies are required

by law to sell drugs to the government at the best wholesale price given to

their large U.S. customers. Then, the four biggest federal customers – the

Veterans Administration, Defense Department, Coast Guard and the Public Health

Service/Indian Health Service – get an additional 24% discount. This essentially

gets international prices for the federal government. But these four markets

account for only 1.5% of the U.S. market.

Annie

Ryman, a retired nurse in Bay City, Texas, won’t shop for cheap drugs in Mexico.

"Her doctor told her not to because some of her medicines have very precise

formulations. So she copes with the high cost of prescription drugs by skimping

on medicines. She cuts some pills in half and ends up taking only half the

prescribed dose."

One-third

of the elderly have no prescription-drug coverage, and many of those with

insurance have high deductibles. A great many folks do not even know if they are

in an HMO or not. They are not aware of the caps on prescription coverage that

limits them to $1,000 to $2,000 a year.

On

the program 20/20 (ABC) about statins, used to control cholesterol levels Dr.

Tim Johnson and Barbara Walters advised everyone to take this medication

prophylactically, every day. This makes no sense at all. Even if the plaques

that cause heart attacks are hidden, taking a medication every day, on the off

chance that an attack could be staved off, would not make good medical sense and

would cause wear and tear on the liver. It does make good business sense, and

that is as usual the bottom line in the good old USA.

Dorothy

Guellec [email protected] member Foreign Press Ass’n