One drug manufacturer wants us to "celebrate" relief from arthritis pain by taking its prescription drug. Its primary rival asks, "What's it like to look forward to the first few steps of the day?"

    One company will help us stop burping and moaning, declaring, "For people with acid reflux disease, it's time to check your tummy out of the heartburn hotel." One of its competitors pushes purple pills upon us with a shattering question--"Did you know acid reflux could wear away the lining of your esophagus?"

    Have high cholesterol? Four companies tell us we can live better by taking their prescription drugs. Depressed, tired, anxious? There's hope in pills. Forgetful? Repeating questions? Having trouble finding words? One company says it may not be "normal aging," but the onset of Alzheimer's Disease. Fortunately, there's hope in a 5 or 10 mg. a day dose.

    In full-page color ads in national magazines and 30-second network TV commercials, combined with direct market flyers, and some newspaper and radio advertising, pharmaceutical manufacturers are spending about $2 billion a year in Direct-to- Consumer Advertising (DTCA), up from about $55 million a decade ago.

    About one-third "of all patients have asked their physicians for information on drugs they have seen in a DTCA ad," according a 1997 study by the American Pharmaceutical Association. An independent Prevention Magazine survey in May 1998 determined that DTCA "allows people to be more involved with their health," and that such advertising "is an extremely effective means [not only] of promoting both the public health and prescription medicines [but] may play a very real role in enhancing the public health."

    The FDA, which in the early 1980s had asked for a voluntary moratorium of drug advertising to assess its effects, then lifted the moratorium in 1985 following extensive studies, now supports advertising to consumers. FDA Commissioner Jane Haney, in November 2000, noted that "DTCA prescription drug promotion offers public health benefits that may outweigh the potential costs," and points out that such advertisements remind [consumers] to get their medicines refilled and help them adhere to their regimens; advertisements also promote patients to ask their physicians about new medical conditions."

    Opposition to DTCA has been heavy from physicians and some consumer organizations. The Committee on Bioethical Issues of the Medical Society of the State of New York claimed in October 1999 that direct drug advertising "provides no real benefit to patients," proposed that advertising to the public should be limited only to non-prescription drugs, and urged the FDA to reduce or eliminate DTCA. The New Jersey delegation to the recently-concluded annual meeting of the American Medical Association proposed a complete ban. In vigorous discussion, the AMA reaffirmed its 11-point position about what drug manufacturers should and should not include in ads to consumers, recommended that drug advertising include the disclaimer, "Your physician may recommend other appropriate treatments," but did not endorse an outright ban. Part of its reluctance may have been because the FDA and numerous media organizations have pointed out that a governmental ban treads upon First Amendment protections of freedom of speech.

    For millennia, kings and the clergy had tried to keep the masses illiterate, believing mankind was incapable of rational thought. They believed the masses would misinterpret literature and the Scriptures; this, they believed, would not only bring about a chaos of the understanding of God's will, but also an erosion of the power of the state and clergy. It was an extension of this "divine right" of absolute rule that led the Royal College of Physicians in 1555 to declare, "No physician [shall] teach people about medicines or even tell them the names of medicines." The fear was that the people, not trained in medicine and incapable of rational thought, would be harmed by knowledge that only physicians were allowed to possess. That fear continued for more than four centuries.

    Prior to 1984, American pharmaceutical companies advertised almost solely to health care professionals who acted as "learned intermediaries" between pharmaceutical companies and the public. But, with a rising consumer demand for information about their own heath care, and seeing a probable increase in income if consumers learned about certain medicines, the manufacturers decided the public could act as "learned intermediaries" to the medical profession. Last year, health care professionals issued 2.9 billion prescriptions totaling about $131.9 billion, up about 19 percent from 1999, according to the National Institute for Health Care Management. Another 15-25 percent increase is expected by 2004. But, the industry claims the cost of prescription drugs would be even higher if there were fewer ads and, thus, less volume.

    Nevertheless, about half of all physicians argue that not only does DTCA undermine their authority, it is deceptive. They are right. The purpose of advertising isn't to educate anyone, but to manipulate them to buy something. Physicians who feel "compelled" to write prescriptions because they are "pushed" by patients who tear ads out of magazines can simply refuse to write the prescription, then explain reasons to the patient why that drug may not be appropriate or another drug more suitable. Society still gives power to the health care provider, not the consumer.

    But, if advertising is such an evil, why doesn't the medical profession reject all ads? Although pharmaceutical manufacturers may spend $2 billion a year on DTCA they also spend about $12 billion a year on campaigns directed to health care professionals. The medical societies don't object to receiving advertising in their myriad journals, nor do they object to the $7.2 billion a year spent on the industry's delivery of free samples. What they object to is that in a newer era in which consumers are better informed about health care issues, the physician may lose that "learned intermediary" power that was once inherent in medical care.

    Physicians need not fear the consumer; they will still evaluate and possibly be misled by drug advertising just as they are now influenced, and often misled, by ads for cars, forthcoming movies, and suntan lotions, The solution to better health care is not the absence of information, but more.

Copyright 2001 Walter M. Brasch