Ads spur urge for drugs


You’d probably be interested in a drug that’ll keep you peppy even when you’re running on fumes.

How about a drug that can cause depression, anxiety, hallucinations, psychosis, mania and suicidal thoughts? How about chest pain, sores or serious rashes?

You had to sift through the fine print of full-page newspaper ads that ran coast to coast last week to learn that these drugs are one and the same. The ads were for Provigil, which its maker, Cephalon Inc., is pitching to consumers as the solution for something many people might not even realize is a disorder: excessive sleepiness.

Provigil, the ads said, can help “fight the fog.”


This is the latest manifestation of what’s known as direct-to-consumer marketing of a prescription drug, a practice that proponents say helps educate people about possible ailments but that critics say undercuts doctors by having patients all but demand specific medicines -- medicines that can come with a hefty price tag and a bewildering array of side effects.

Direct-to-consumer, or DTC, marketing of prescription drugs is now a mainstay of newspapers, magazines, and TV and radio broadcasts. Some evenings, drug companies seem like the only sponsors of network news programs.

From pills to help men be, well, more manly, to pills that help you sleep at night, DTC campaigns are characterized by their cheerful imagery and frequently ambiguous messages, accompanied by hurried recitations of side effects that can range from diarrhea and stomach cramps to much, much worse.

“Direct-to-consumer advertising has resulted in overprescription of drugs for conditions people weren’t even aware of,” said Ed Mierzwinski, consumer program director for the U.S. Public Interest Research Group. “It has resulted in massive profits for the industry by preying on consumers’ emotions.”


It’s also fundamentally altered the doctor-patient relationship by forcing physicians to respond to people’s demands for heavily touted drugs, rather than taking the initiative in suggesting treatments.

Some doctors I’ve spoken with say they’ll suggest generic equivalents or alternative approaches. But if patients are determined to try a name-brand drug they’ve seen pushed on TV or in the paper, it’s often not worth the trouble trying to talk them out of it.

DTC advertising has turned prescription drugs into just another gotta-have-it consumer product.

The practice has been around since 1997, when the Food and Drug Administration gave its blessing to DTC campaigns. No one knew at the time how quickly such advertising would expand, or how effective it would become.

Spending on DTC advertising more than quadrupled from 1997 to 2005, according to a recent study by the University of Pittsburgh Graduate School of Public Health, with total promotional spending by the pharmaceutical industry rising from $11.4 billion in 1996 to $29.9 billion in 2005.

Drug companies see nothing wrong with this.

“DTC advertising increases people’s awareness of diseases and available treatments,” Pharmaceutical Research and Manufacturers of America, an industry group, says on its website. “Studies show DTC advertising brings patients into their doctor’s office and starts important doctor-patient conversations about health that might otherwise not have happened.”

For example, how many people would have thought to ask about “restless legs syndrome” until pharmaceutical giant GlaxoSmithKline launched a DTC campaign in 2003 to raise awareness of the problem. Two years later, the FDA approved sales of GlaxoSmithKline’s Requip tablets to treat the disorder.


U.S. sales of Requip totaled $455 million last year, according to a regulatory filing.

Cephalon’s Provigil has been around since 1998, originally approved as a treatment for narcolepsy. In 2004, the FDA said Provigil also could be marketed as a treatment for excessive sleepiness associated with obstructive sleep apnea, a breathing disorder that can cause people to wake frequently at night.

Jenifer Antonacci, a Cephalon spokeswoman, said the new DTC campaign is merely intended to raise awareness about excessive sleepiness.

“We’ve decided to take a leadership role in this area,” she said. “Our goal is to help educate consumers about excessive sleepiness and start a dialogue between patients and their physicians.”

While Provigil is being marketed as a remedy for fatigue resulting from sleep apnea, it’s not hard to imagine on-the-go people in today’s 24/7 world seeing the drug as a nifty way to cram a few more hours of wakeful activity into already crowded days.

Why settle for a venti latte at Starbucks when you can get the same kick (and possibly more) from a little pill?

Antonacci described a potential Provigil user as someone who repeatedly finds himself nodding off on the couch while watching TV at night.

“That’s me!” I responded.


“Maybe you have sleep apnea,” Antonacci observed.

And I always thought my excessive sleepiness resulted from getting up most mornings around 5:30 and working real hard during the day and trying to keep pace at night with a 6-year-old boy.

U.S. sales of Provigil totaled $692 million in 2006. In the first half of last year, sales reached $391 million.

This year’s sales will probably be much higher now that Cephalon has launched its “fight the fog” campaign. Last week’s newspaper ads will be followed by a wave of magazine ads.

I asked Antonacci what else could cause excessive sleepiness.

“The No. 1 cause of excessive sleepiness is not getting enough sleep,” she replied.

I’m no doctor, but the remedy for that seems simple enough.


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