Bipolar Me

Eight years ago, I wrote a post about how I despise TV commercials for psychiatric drugs. The New York Times has caught up with me. On February 16th (updated on the 17th), they published a story titled “Should Drug Companies Be Advertising to Consumers?” The article concentrated on drugs advertised to seniors, but what they said holds true for psychotropic drugs as well.

The problems of drugs advertised directly to consumers started in 1997, when regulations covering drug ads were loosened. Until then, drugs had been advertised to doctors who were going to be prescribing them. Then, print ads appeared in magazines and journals targeted to prescribers. In addition, drug reps visited doctors’ offices, handing out drug samples and literature, along with tchotchkes decorated with the drugs’ names. The reps also often brought carry-in lunches for the whole office and sometimes wooed particularly influential doctors with golf outings and other gifts and junkets.

That system had its drawbacks, it’s true, but so does the new one. When it was first allowed, drug ads appeared in consumer magazines, often as multi-page fold-outs because so much information about dosages, effects, and side effects had to be included.

Before long, however, the drug companies started to take advantage of television and the internet. And take advantage they did. As the Times reported, last year, “total spending on direct-to-consumer advertising of prescription drugs topped $9 billion.” Only New Zealand and the U.S. permit direct-to-consumer advertising.

The result is that consumers have become drug reps. The TV ads say, “Ask your doctor if Drug X is right for you.” What happens instead is that patients come in to their doctor and say, “I want Drug X.” And if the doctor doesn’t comply, the patient moves on to another doctor who will provide the requested drug. Instead of investing in a flock of drug reps, the pharmaceutical companies are investing in advertising that replaces many reps with many consumers who know much less about the drugs. In effect, the patient has become the drug rep, trying to influence the doctor to use a particular medication.

TV drug ads are sophisticated. Even the psychotropics have songs and slogans and color palettes, just like the ads for other drugs or indeed, soft drinks or cruise lines. Even the much-touted antidepressant Caplyta, which has had some of the slickest, most attention-grabbing ads, uses the song “This Little Light of Mine,” with slightly altered lyrics. Austedo, for tardive dyskenisia, features the slogan “As You Go With Austedo.” Cobenfy ads, for schizophrenia, sing, “Imagine What You Could Be. Cobenfy.”

The commercials do have recitations of the possible side effects, which are accompanied by tiny type on the screen. Often, the side effects seem to contradict what the drug is for: a bone-strengthening pill has a side effect of “unexpected thigh-bone breaks”; depression and bipolar meds have side effects of suicidal thoughts; one for tardive dyskinesia warns of “body stiffness, drooling, trouble moving or walking, trouble keeping your balance, shaking (tremors), or falls.” And there are other warnings: potentially fatal skin rashes (most likely Stevens-Johnson Syndrome), for example, or harm to an unborn baby.

The manufacturers probably count on the consumers not reading the tiny warnings. (The voice-over sometimes says, “These are not all the possible side effects.”) An ad will say, “Weight gain is not often seen,” but the tiny type says how much weight gain in mathematical terms such as “<.27 percent” that can be confusing to a layperson. If you read the type, you can also find that, for example, other side effects are not mentioned in the lists of possible outcomes. (“You should ask your doctor about these and other possible side effects.”) Some of the studies they quote seem to have reported results after only five weeks–not that the public can be expected to know the scientific niceties. I’m aware that I don’t understand them all myself. There may be aspects I’m not catching.

At the end of a psychotropics commercial, the now-stable person/actor/model engages in a variety of pursuits: being outdoors, playing with children or grandchildren, playing guitar, or taking painting lessons. There’s no indication that the meds may not work without an additional drug or drugs, that they may take six weeks or more to begin working, or that they may have no effect at all. In short, the TV commercials build unrealistic expectations for wonder drugs.

Certainly, many people have found that a drug or “cocktail” of drugs has alleviated their symptoms, though not cured the underlying disorder. I’m one of those people. But my information about my medications came from my doctor, not an advertising agency.