Squeezing Docs, Hiking Insurance, Hooking Patients

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http://www.counterpunch.org/rosenberg04182011.html

April 18, 2011

14 Years of Direct-to-Consumer Advertising

Squeezing Docs, Hiking Insurance,

Hooking Patients

By

MARTHA ROSENBERG

Can

anyone remember life before Ask Your Doctor ads on TV?

All you knew about prescription drugs were creepy ads in a

JAMA at the doctor's office with a lot of fine print. Even if

you knew the name of a drug, you'd never ask your doctor for

it because that would be self-diagnosing and cheeky for a

patient.

Flash forward to the late 1990s when direct-to-consumer (DTC)

drug advertising, drug Web sites and online drug sales came on

board, and self-diagnosing and demanding pills has become

medicine-as-usual for the doctor/patient encounter.

The DTC/Web perfect storm didn't just sell drugs like

Claritin, Prozac and the Purple Pill, it sold the diseases to

go with them like seasonal allergies, GERD and depression. It

sold risk of diseases like heart events for which you'd take a

statin like Lipitor, osteoporosis for which you'd take a bone

drug like Boniva and asthma attacks for which you'd use a

second asthma drug like Advair. Of course, by the very

definition of prevention, you didn't know if the drugs were

working but you weren't paying out of pocket anyway so what

the hay…

Thanks to DTC advertising, people started taking seizure drugs

like Topamax and Lyrica for everyday pain or headaches and

antipsychotics-- hello? -- for everyday blues or mood

problems. They started taking monoclonal antibodies made from

genetically engineered hamster cells like Humira that invite

cancer, superinfections and TB when they didn't have to. And

FDA mandated risk disclosures -- brain bleeds, sudden death,

difficulty breathing, stomach bleeding, liver failure, kidney

failure, muscle breakdown, fainting, hallucinations --

perversely increased drug sales either because people like the

identity in having a disease, chemically experimenting on

themselves and/or taking a dare or because ad frequency itself

sells regardless of the message.

Soon anxiety graduated to depression which graduated to

bipolar disorder. Children got schizophrenia and depression

like adults and adults got ADHD like kids. And it didn't stop

there. If the depression you or your kid had didn't go away --

maybe because it wasn't depression in the first place but a

thing called "life" -- you needed to add a drug like Abilify

or Seroquel on to the original drug(s) because your depression

was "treatment resistant."

Of course if people were paying for the drugs out of their

pocket and you told them to add a drug that costs almost $500

a month because the first one isn't working, they would say

the only thing "treatment resistant" is your sales pitch -- go

find another sucker. But if third party payers get stuck with

the bill, no one seems to mind pharma's double-(and

triple)-its-money plan -- or even notice it.

In fact psychiatric drug cocktails of eight, ten and twelve

drugs are now common medical practice for "treatment

resistant" depression and PTSD (often paid by government

entitlement health plans) even though the drugs have never

been tested when taken together. Unless you count the patients

taking them now!

Pharma also adds an urgency pitch to the sell in case you

think you can wait to take you or your child's treatment

resistant drug cocktail until symptoms worsen. Depression is

now a "progressive" disease say pharma-paid doctors after

being known for decades as a self-limiting disease. (The one

good thing you could say about depression; it would go away.)

And don't think kids will outgrow mood problems either, says

pharma. That erratic behavior is no doubt early mental illness

that will become Worse if you'd don't treat it in the bud.

Even mothers of one-year-olds with the sniffles are told

serious asthma is just around the corner if they don't treat

their toddler now.

Pharma is also having a field day with sleep because everyone

is in the demographic. In fact comedian Rock riffs about

hearing a DTC ad that asks, "Do you fall asleep at night and

wake up in the morning?" and recognizing himself. "Yeah, I got

THAT," he says."

Not falling asleep soon enough of course is the disease of

insomnia which can have "strains" like "middle-of-the-night"

and "terminal" insomnia. But it also sets you up for -- what's

the pharma euphemism -- wakefulness problems the next day. And

once you're using a wakefulness aid like Adderall or Nuvigil,

what do you bet you'll have sleep problems?

Because of pharma-paid doctors, PR firms and industry

subsidized medical journals and Web sites like WebMD, pharma

is able to create new diseases (osteopenia, the "risk" of

osteoporosis), perimenopause and Low T), "humanize" others by

giving them nicknames (ED, RA, RLS, Hep C) and elevate others

to public health problems like HPV/venereal warts. (It doesn't

hurt that Gerberding, MD, former CDC head resurfaced as

head of Merck vaccines after she left the government.)

But a more insidious sell are pharma subsidized "patient

groups" that lobby FDA and state agencies about expensive

drugs, often psychiatric. While these "patients" -- often

flown by pharma to testify at FDA hearings -- pretend they

can't get needed drugs like terminal cancer patients, the

issue is seldom availability but money: either they want a new

use covered by insurers or don't want an older, cheaper drug

substituted.

The same patients appear on Web site testimonials and phony

grassroots PSAs (public service messages) about the epidemic

of depression or childhood mental illness. How can you tell

they're not real patients but pharma plants? The Web sites and

PSAs look exactly like direct-to-consumer ads.

Martha Rosenberg's first book,

tentatively titled Born

with a Fritos Deficiency: How Flaks, Quacks and Hacks Pimp

the Public Health, will

be published by Amherst, New York-based Prometheus Books next

year.