Just What the Patient Ordered

By ANDREW PURVIS

One morning this month, Dr. Michael Buenaflor, a family practitioner in Northampton, Pa., took a call from a patient who wanted a prescription. And not just any prescription. The caller insisted on Nicorette, a drug intended to help people stop smoking. How did he find out about it? From an advertisement. When Buenaflor suggested that the drug might not be appropriate for prolonged use, since the patient had a heart condition and an ulcer, the man hung up and took his "business" elsewhere. Concludes Buenaflor: "The pressure to use these drugs is incredible."

At issue is a new trend in the drug industry: a growing number of prescription medications, from allergy tablets to birth-control pills, are being promoted directly to consumers in newspaper and magazine ads and even a few TV commercials. Drug companies and some physicians say the ads help educate patients and give consumers a chance to become more involved in choosing the medications they want. But many doctors deplore the marketing tactic. Argues Dr. Nancy Dickey of the American Medical Association: "Splashy ads with limited information are no substitute for four years of medical school and many more of professional training."

Until recently, pharmaceutical companies generally contented themselves with a softer sell that refrained from mentioning products by name. Ads simply urged those with ulcers or thinning hair, for example, to see their doctor. But increasing competition has spurred some companies to be more aggressive. Last month Marion Merrell Dow launched a major campaign for the allergy medication Seldane, pitching the drug by name for the first time. Other prescription drugs that have appeared in name-brand ads in the past year include Rogaine, Upjohn's antibaldness medication, and Procardia XL, a heart drug from Pfizer.

The ads are subject to strict Government regulations. If they tout a drug by name for a particular illness, they must include a thicket of fine print listing "contraindications" and "adverse reactions." Such verbosity is impractical on TV, but a few companies have sidestepped the problem by keeping their messages simple enough to be within the rules. Marion Merrell Dow, for example, has run TV ads for Nicorette that avoid mentioning what the drug is for.

The danger from prescription-drug ads is that they can mislead patients into believing they know better than their physician which medicine is best. Says Dr. Israeli Jaffe, a professor at Columbia University: "There's no question that certain physicians are being influenced to issue prescriptions that they would not otherwise write." Many doctors also feel that the cost of nationwide advertising could needlessly inflate the price of treatment.

But drug companies and even some doctors argue that the ads can provide information and encourage otherwise reluctant patients to seek help. Advertising could also help dispel some of the mystery surrounding prescription medication and enable people to take a more active role in their own treatment. Dr. Warren Pearse of the American College of Obstetricians and Gynecologists feels that more ads for oral contraceptives would provide women with a better picture of birth-control alternatives. "The days of keeping patients in the dark have passed," he says.

Congress has noticed the ads, and Michigan Democrat John Dingell is among those considering new restrictions. In the meantime, many doctors have taken a fresh interest in the popular media. Says Buenaflor: "We need to keep an eye on the competition."