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We Report... You Deride

Saturday, November 29, 2003  
The New Tobacco Ads

I've spent much of the last two days enjoying Bravo's West Wing Marathon (a definite improvement over Detroit-Green Bay or Miami-Dallas). The good news is that I got something out of it.

(My relationship to TWW, by the way, parallels my internist's opinion of E.R.: Enjoyable, but unrealistic. Only three characters in the original cast resemble any White House staff I know, and Leo is the only one still with the show.)

The commercials provided an object lesson in how much you lose when your party loses power. The newly-elected president gets to bring in his cronies. Those guys bring in their cronies. Their hot-button issues become the new administration's agenda. Because these issues get covered (to some degree, at least), you get to measure the costs and benefits of the policies.

But the invisible cost-- the opportunity costs, if you will-- are the ones that really sting. There's a finite amount of column inches and airtime; unless someone with clout pushes a topic, it'll probably go unnoticed. One of the government's job is to raise issues that no one currently worries about-- stuff like East Timor, bovine growth hormone or the DMCA's impact on consumer rights-- to the level of national concerns.

When stuff doesn't get talked about for four years-- or more-- it can go from an issue to a problem to a crisis. Here's an issue-- which is rapidly reaching crisis status-- that the FCC or FDA needs to address. And if different undersecretaries were calling the shots it might be: Television advertising for prescription drugs needs to be banned.

Until 1997, it was illegal to advertise prescription medications without including detailed information on its potential side-effects. Ever wondered why drug ads in magazines always run at least two pages--one of which is filled with fine print? It's the law.

Actually, it wasn't illegal to advertise prescription drugs on TV-- the law just made it impractical. You could run a commercial, but you had to display (or have an announcer read) all the fine print.

In 1997-- after extended prodding from the drug lobby and (probably) more than a little dotcom-inspired idiocy-- Bill Clinton's FDA relaxed limitations. All the ads have to do now is list an 800 number or web address where you can request the information.

So the amount spent on direct-to-consumer (DTC) advertising has risen from $859 million in 1997 to $2.49 billion last year. And that's had exactly the result you might expect.

According to this article (taken from that notoriously-leftist publication, The Wall Street Journal), the most frequently-advertised drugs in 2002 were Vioxx and Celebrex-- two pain medications for arthritis that represent a gigantic boondoggle for consumers.

Vioxx and Celebrex are valuable drugs-- but only if you meet certain criteria. WHich most people don't. Arthritis pain, which is caused by inflammation of the joints, has been treated with drugs that reduce the body's ability to produce an enzyme (cyclooxygenase, aka "COX-1") that causes inflammation.

"COX-1 inhibitors" (the best known is ibuprofen, aka Motrin) are effective, reliable and cheap. But they have one catch. The COX enzyme causes joint paint, but a very similar enzyme protects your stomach lining from inflammation. COX-1 drugs inhibit the production of both enzymes; the longer yiou take them, the greater your chances of ulcers and digestive trouble become.

Unless you're unusually sensitive, it takes months for your lining to erode. So if you only have occasional flareups-- if you only need to take a dose for a week a couple of times a year--COX-1 inhibitors work just fine. And, According to the Christian Science Monitor, a year's supply of ibuprofen costs $24 .

Vioxx or Celebrexx are COX-2 inhibitors-- an improved version that reduces inflammation without affecting yoyur stomach lining. To people who have chronic pain--who need to take medication every single day--"COX-2 inhibitors" are a godsend.

About 6% of the people who suffer from arthritis suffer from chronic pain. A year's supply of Celebrex costs $900-- 3,800% more than the cost of ibuprofen.

Another popular technique is to tout a brand-name drug when a generic is available. Until it became an over-the-counter drug, Prilosec got this sort of push. Glucophage (generic name metfornin) is currently getting it.

Other ads skip merrily along the border between marketing and disingenuousness. Viagra ads suggest that one prescription can give you the sex appeal of a haircut, new suit and workout program combined. Other ads insist that you can eat right and exercise dilligently and still have high cholesterol--but you can eliminate the problem with their product. (Leaving the impression that you can eat bacon at every meal as long as you take their pills, of course.)

The two stories I've linked to were based on insurance company reports of skyrocketing spending on DTC-advertised drugs. We now have a study of 78 physicians and 1,431 adult patients-- half located in the US and half in Canada (which still restricts DTC ads) which documents the impact. U.S. patients requested the 50 most adrvertised drugs by name more than twice as often as Canadians.

Doctors reported that they felt 50% of the requests were inapprorpiate-- that the medication either wouldn't address the patient's complaint, or felt that a cheaper drug (or a generic) would be a better choice. But they didn't feel comfortable telling the patient "No":

"Patients who requested DTCA drugs were nearly 17 times as likely to receive 1 or more new prescriptions as patients who did not request medicines. Nearly 9 of 10 such patients received prescriptions, either for the drug they had requested or an alternative."

So we have higher insurance costs. And increased reliance on medicine, rather than preventikon through diet and exercise. And the possibility of long-term side effects which we don't know yet. And the more often you use a drug, the greater your resistance to it becomes.

In fairness, this started on Bill Clinton's watch. But the Congress was solidly Republic at the time. It's impossible to imagine W's regime opposing the idea. And it hasn't lifted a finger to stop the bleeding-- in facxt, it's arguing that DTC ads are helpful.

And the drug lobby wants to loosen restrictions even further--arguing that, as long as consumers can get information about side-effects on the Internet (only 8% do now), they shouldn't have to hear it in the ads.

DTC ads won't last-- the insurance industry is already enacting programs to discourage use of the drugs, Eventually they'll start lobbying-- but since they're not exactly trustworthy (if it were up to the industry, they'd probably still encourage the use of bleeding and leeches), they'll need a lot of time to get traction.

Actually, this whole mess plays right into one candidate's hands. And-- if my schedule permits-- I'll try to get to that topic this week.

2:45 AM

Thursday, November 27, 2003  
The Only "Mann" Coulter Item You'll Ever See Here

One question about an item in her jihad (emphasis mine):

"In addition to having a number of family deaths among them, the Democrats' other big idea – too nuanced for a bumper sticker – is that many of them have Jewish ancestry. There's Joe Lieberman: Always Jewish. Wesley Clark: Found Out His Father Was Jewish in College. John Kerry: Jewish Since He Began Presidential Fund-Raising. Howard Dean: Married to a Jew. Al Sharpton: Circumcised. Even Hillary Clinton claimed to have unearthed some evidence that she was a Jew – along with the long lost evidence that she was a Yankees fan. And that, boys and girls, is how the Jews survived thousands of years of persecution: by being susceptible to pandering."

And (s)he came by that piece of information how?

(Credit to The Hamster for the lead.)

12:11 AM

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