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    What I've learned from DTC advertising


    David Stanley, RPh
    The idea came to me while I was waiting for my weekly Andy Rooney fix. I had long ago decided that I can't just tune into the last segment of 60 Minutes to catch the ruminations of the cranky old grandfather I never had. That would be cheating, like reading Drug Topics solely for "JP at Large." No. CBS goes to a lot of trouble to present in-depth features covering stories of great importance to our world. The least I could do is watch their efforts. Besides, it helps build the Andy anticipation.

    As I watch the show, I get an education — from the commercials, aka direct-to-consumer (DTC) ads. Between segments, I'm reminded about the classic symptoms of rhabdomyolysis that can be a side effect of atorvastatin (Lipitor); that the definition of COPD includes both chronic bronchitis and emphysema, which Pfizer and Boehringer Ingelheim think makes it a perfect match for tiotropium bromide (Spiriva Handihaler); that ibandronate (Boniva), according to Roche and GlaxoSmithKline, not only stops but can help reverse the effects of osteoporosis. And I am reminded that zoledronic acid (Reclast) exists.

    Working as I do in retail, I had forgotten about zoledronic acid, the once-a-year bisphosphonate given by IV injection in the physician's office. With that rekindled memory, the idea hit me.

    60 Minutes could start a program whereby pharmacists get continuing education credits for watching the commercials. You may think I'm kidding, but some of them are more useful to my professional development than the articles I wade through in order to renew my license. Of course, those commercials aren't meant for us, or physicians, or anyone else dedicated to one of the healing professions.

    Those commercials are aimed at members of the general public, so they can be persuaded to have a positive brand image of a chemical (one that stays in your body for a year, affecting the bone tissue in your jaw) in the same way they have a positive brand image of their favorite peanut butter. Novartis was wise to refrain from advising people to "ask your pharmacist" about zoledronic acid. Any customers of mine who do will be told that in my professional opinion, it is a terrible idea.

    ?The question isn't whether DTC advertising in the United States — the only country other than New Zealand that allows it — has gone too far. That was settled when the FDA required Bayer to run a $20 million advertising campaign to correct earlier claims made to the public about the utility of the oral contraceptive drospirenone/ethinyl estradiol (Yaz) for premenstrual syndrome and acne. Commercials that came too late for the young teenage girl I used to see regularly at my store's condom rack, who managed to convince her mother and her physician that this drug was just the thing she needed for her complexion.

    Her mom still phones in for her daughter's "acne medicine" when the Yaz is due. That girl is 13 years old, and herpes is forever. And herpes isn't the worst of what could happen. I didn't see them, but I'd be willing to bet the original commercials didn't mention asking your pharmacist about whether Yaz could be the right choice for your complexion.

    It also isn't a question of whether DTC advertising of prescription drugs adds to the financial burden we Americans bear, almost alone, to acquire them. I remember, not so long ago, being told that prescriptions in this country were so expensive because of the massive amount of money that went into their research and development. I remember believing it. That was before 2008, when Gagnon and Lexchin, two researchers at York University in Toronto showed that the pharmaceutical industry spends almost twice as much money on promotion as on research and development. Four billion dollars' worth of DTC promotion money goes toward messages urging consumers to "ask your doctor." Remember that the next time you try to explain to one of your customers why their prescription costs so much.

    The key question is, why do we let DTC advertising continue? Why do we let Bristol-Myers Squibb/Otsuka present pictures of shiny, happy people taking aripiprazole (Abilify) while glossing over risks like weight gain and diabetes, which are mentioned in the official prescribing information ( http://www.abilify.com/pdf/pi.aspx)? I don't have an answer, which tells me the practice should stop. I have a feeling Andy Rooney would agree.

    David Stanley is a practicing community pharmacist in California. He can be reached at
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    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]