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Monday, January 11, 2016

Is the Cure Worse Than the Disease?

     Unless you're from the United States or New Zealand you won't understand this post. Only these two countries allow pharmaceutical companies to advertise their medications directly to consumers via television and magazine ads, etc. 
     I am always amused, or is it concerned, about ads appearing on television for prescription medications where we are told, “Ask your doctor if (insert medication) is right for you.” Personally, I have always let the doctor decide if a product is right for me. One doctor told me he never prescribes any new medicine for at least a year after it comes out because he wants to be sure it works and there are no hidden problems with it. Guess he does not totally trust the drug companies.
    What concerns me is the ads for most of these medications usually have a mind-numbing list of side effects. Of course, during studies if even one person reports fire shooting out of their nostrils a side effect it has to be reported, but often this list of side effects sounds worse than the disease. 
     We keep seeing more and more of these ads. The amount of money spent by drug companies on advertising more than tripled between 1997 and 2005 since restrictions governing drug ads were relaxed by the U.S. Food and Drug Administration. Wonder why the FDA did that?! 
     It has worked out well for the drug companies. Spending on prescription drugs has grown faster than any other type of health-care spending in the United States. Of course, doctors cooperate. It's money for them. In many cases if a doctor won't give a patient what they want the patient simply takes their business elsewhere. And, hospitals, physician groups, etc. measure a doctor's value by how much money they bring in. The truth is you could be a crappy doctor, but if you keep the money coming in, nobody cares. 
     Naturally, when a doctor prescribes a medication, you want to be able to make an informed decision and understand the specific risks and benefits and advertising certainly helps. The problem is these ads are designed to tout the medicine's benefits in a vague, general and emotionally driven way and the risks are downplayed. These ads prompt patients to ask their doctor for what they, the patient, thinks might be best. The ads are often misleading as to what the benefit of the drug is. When a patient comes in asking for something they saw on television, and many doctors will probably go along with the requests rather than argue with their patients. 
     Remember a drug called Vioxx? It was a pain medication that was heavily marketed but later pulled when it became apparent the drug increased the risk of heart attack in some people. They never showed that little side effect in the ads. What you see in these ads are people being happy and doing all kinds of fun stuff they couldn't do before taking the advertised drug. 
     Anyway, what grabbed by attention last night was the ad for Chantix, a drug to help people quit smoking. But, it could have been any number of other drugs. The ad shows a guy who tells us that he really loves being a non-smoker. Of course who can blame him? But, I had to wonder, did he dodge a bullet when it comes to the side effects?
     Common side effects of this medication include puking and nausea which may persist for several months, sleep disturbances, irritability, stomach pain, indigestion, constipation, a lot of farting, headaches, weakness, tiredness, unusual dreams, insomnia, dry mouth and/or a crappy taste in your mouth. In some patients it caused psychiatric symptoms such as behavioral changes, agitation and a depressed mood. Oh, by the way, some patients experienced suicidal behavior. Almost makes you think smoking would be safer.
     And, despite all the risk factors, the big question is, does it work? Well, according to a 2008 FDA video clip, the probability is in the neighborhood of 1 in 11 of being able to quit for one year if Chantix is used all by itself. 
     Even with this product success will require education, counseling and support. To be fair though, if accompanied by weekly counseling and support sessions, the chances do improve to 1 in 5 or even 1 in 4. Obviously, the counseling sessions have a LOT to do with the success rate. 
     The makers of Chantix put the success rate at a 44 percent chance after 12 weeks, but you know what? What happened was, in 12 weeks about 4 out of 10 people tested managed to go without a cigarette, but 12 weeks also just happened to be the length of their clinical trials and treatment period. 
     The truth is, this product substitutes a drug which satisfies the desire for nicotine for the nicotine itself. Also, the FDA website has a lot of information on this drug including the warning that Chantix can change the way people react to alcohol. Some patients experienced decreased tolerance to alcohol, including increased drunkenness, unusual or aggressive behavior, or they had no memory of things that happened. Also, there have been accounts of seizures in patients though these have been rare. 
     Here's a link to an interesting ad from back in the days before Claritin became an over the counter medicine. At the time, the ad could not even specify what condition the drug treated.
     Like I said, this post just happens to be mainly about Chantix, but it could have been about any product on Vaughn's Summaries - Drug manufacturers seek to minimize and trivialize the adverse side effects of the drugs they produce. To present a balanced picture, this page HIGHLIGHTS these adverse side effects. In each case, THE OFFICIAL INFORMATION IS "QUOTED VERBATIM" (fair use) from the drug companies' websites and TV commercials.

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