Patient, Heal Thyself? : Prescription Drug Ads Have Some Docs Wincing

From Sports Illustrated to the subway, Americans are being bombarded with ads for powerful prescription medicines--a commercial boom that has drug companies smiling but doctors worried.

“Pretty soon they’ll be on milk cartons and hot-air balloons,” said Dr. William Jacott, whose patients have demanded prescriptions by name even before he diagnosed a disease.

Suffering epileptic seizures? Fighting high cholesterol? Afraid your prostate is enlarged?

The questions jump off the pages of newspapers and magazines. The allergy reliever Claritin even advertises in New York subway cars, and hair grower Rogaine is all over TV.

Drug companies say their multimillion-dollar ads make Americans better advocates for their health.

“The decision to prescribe a particular medication is a shared decision between doctor and patient,” said John Montgomery of Parke Davis, which last week advertised its new epilepsy drug, Neurontin, in several major newspapers.

The ads do advise seeing a doctor--after all, the drugs are available only by prescription.

But the American Medical Assn. says there’s a fine line between educating and misleading vulnerable patients.

“The ones I’ve seen are clearly quite commercial and don’t necessarily give the whole story,” said Jacott, an AMA trustee and family physician at the University of Minnesota. Patients “come in and put the pressure on their physicians to prescribe that product.”

Drug companies have always advertised over-the-counter medicines aggressively. But until recently, they marketed more powerful prescription drugs only to physicians. Salespeople dropped off free samples, and ads full of complicated medical data dominated scholarly journals.

“That era is slowly fading,” said Jack Trout, a marketing consultant in Greenwich, Conn. “They’re beginning to feel the docs . . . don’t have time to schmooze. So they feel a need to build an equity with the ultimate user.”

Take Proscar, which shrinks enlarged prostates. Every year 4.5 million men over age 60 are diagnosed with prostate enlargement, which causes urinary problems. Although many never need treatment, they’re reluctant to discuss symptoms. So Merck is blanketing magazines with ads aimed at men who wonder why they “go to the bathroom more than ever now.”

Like other companies, Merck won’t say what it spends advertising Proscar, which earns more than $100 million a year.

But a full-page ad in a national magazine can cost $115,000, so campaigns add up fast, said advertising expert Patricia Stout of the University of Texas at Austin.

Proscar’s success prompted Merck to advertise Mevacor, the world’s leading cholesterol-lowering drug at $1 billion in sales. The ads target 6.5 million Americans who rely on diet and exercise alone to fight high cholesterol, said Merck’s Gary Bruell.

Parke Davis followed Merck’s lead last week, launching trial Neurontin ads in New York, Atlanta, Los Angeles, Chicago and Houston. If sales increase in those cities, the ads will spread.

Neurontin may be an alternative for some of the thousands of epileptics who last month abandoned its competitor Felbatol, which can cause liver damage and fatal anemia. In fact, Parke Davis hired a publicist to push Neurontin when the Felbatol fiasco emerged.

The Neurontin campaign carefully emphasizes that the drug has only a few, minor side effects. But the ads, which went into production before Felbatol’s problems appeared, don’t specifically mention the competitor, Montgomery said.

The AMA’s Jacott said many drug ads, picturing smiling, healthy models, ignore side effects and the fact that drugs are appropriate for only certain patients--or they relegate it to medical jargon in the fine print.

When patients miss the warnings and demand a drug, doctors have to spend a lot of time explaining why they disagree, said Dr. Jehan El-Bayoumi of George Washington University’s medical center.

“It’s very positive if people are more involved in their health care,” she warned, “but there can be a negative consequence to the more commercial packaging of drugs.”