This country is now in the midst of the largest and most expensive propaganda campaign in history. It started in the late 1980s and early 1990s when the pharmaceutical industry and medical profession realized that 30-40% of consumers had visited so-called "alternative" health care practitioners. This prompted a New England Journal of Medicine study to determine why this was happening and the results were reprinted in Oriental Medicine, Vol. 3, No. 2, in the fall of 1994.

This study found that Americans believed medicine was relatively ineffective in treating 10 very common problems you see every day in your office, including back and digestive problems, headaches, and allergies. People are willing to pay out of their own pocket for relief because they were not willing to accept the ineffective "sick care" that was covered by their health insurance provider.

These findings of public opinion prompted the pharmaceutical industry to seek alternative marketing strategies. They decided they would no longer market indirectly to the public through individual medical doctors. Rather, they would have to pave the way to market directly to consumers instead of offering incentives such as paid vacations and merchandise directly to physicians.

The problem, of course, was the Food and Drug Administration (FDA) which regulated their advertising. At the time, the FDA required all side effects to be listed in or on any form of prescription drug advertising, similar to what is listed in the Physicians' Desk Reference. Listing all side effects was certainly unacceptable to the pharmaceutical industry for several reasons.

Not only was it impractical and costly to list all this information, but also the public would not react favorably to a drug advertisement listing numerous side effects.

The solution was revolutionary – change the FDA's regulations through legislation. Create new rules that required advertising to list only the major health risks or side effects involved with an advertised prescription drug. The Pharmaceutical Research and Manufacturers of America, the drug industry's trade association, spearheaded a drive to lobby Congress to change or, in their terms, to "modernize" the FDA. The regulated wanted control over the regulator.

It took three years of lobbying effort and untold millions of dollars to convince Congress but by 1997, with the desired legislation in effect, the pharmaceutical industry began to advertise drugs on television, radio, and in magazines.

In the past five years, advertising drugs directly to consumers has become a megabuck industry. For example, drug company spending on direct-to-consumer advertising (DTC) increased by 39% in 2000 and is expected to continue increasing.[1] Obviously, drug sales increased dramatically because of the increase in advertising, with the largest increases coming from sale of those drugs most heavily advertised.

In spite of this, DTC is considered to be the primary cause for escalating drug prices which have risen three-to-four times faster than prices of other health care expenditures such as hospital and physician costs.[2] Other countries, such as Canada, that control drug prices now benefit from Americans buying their prescriptions across the border. The drug companies tell Americans the higher costs are because of research while at the same time producing TV ads that do not sell drugs but extol the heroic efforts of their researchers.

DTC advertising of drugs has become a major problem for physicians.[3] One doctor said that he "spends two-thirds of the time talking [with patients] about the ads and why they shouldn't pay any attention. That takes away from the time that I have to talk to them about potential preventions."[1] Clearly, DTC advertising has a growing portion of the American public believing that there is a drug for every unpleasant symptom they experience.[4]

The only way you can hope to compete against this propaganda blitz is by getting results on an individual basis, particularly where pharmaceuticals have failed. This seems to happen quite often since most drugs are used without a clear objective means of determining that they are needed.

Richard Kravitz, M.D., director of the University of California-Davis for Health Services Research in Primary Care, says, "Most ads fail to provide information about how a drug works, its success rate, how long it must be taken, alternative treatments or helpful lifestyle changes."[1]

You can compete for revenue and recognition in today's health care marketplace but you will need a scientifically sound and legally defensible methodology that does not parrot the pharmaceutical-pathological model.

I will continue with this discussion next time. In the meantime, I invite your questions or comments.

1. Sean Martin, "Like a Rocket: 'Direct-to-Consumer' Drug Ad Spending," WebMD Health web article, April 4, 2001.

2. "Consumer drug advertising changing face of medicine," Reuters Health, June 15, 2000.

3. Merrill Matthews, "Who's Afraid of Pharmaceutical Advertising?" Institute for Policy Innovation, May 17, 2001.

4. Daniel DeNoon, "Are Drug Companies Making Us Sick?: Human Experiences Become (Treatable) Medical Conditions," WebMD Health, April 12, 2002. Article 46 – July 2002.