This is the third excerpt from Dennis Miller’s new book The Shocking Truth About Pharmacy: A Pharmacist Reveals All The Disturbing Secrets. The entire e-book is available for download from Amazon for 99 cents.
Here’s what one pharmacist would like to see in drug advertisements even though Big Pharma would oppose it to the bitter end.
In my opinion, drug companies have an ethical responsibility to be completely transparent about the products they market. That is because these products can have side effects which range from the trivial to the deadly.
What Information Do You Need in Drug Advertisements?
In my opinion, drug companies should be held to a much higher ethical standard than other advertisers because, in contrast to most products advertised on TV, drug companies promote products that can adversely affect human health. In my opinion, drug companies have an ethical obligation to fully disclose what is known about non-drug measures that can be utilized to treat or prevent the condition for which their advertised drug is used.
Big Pharma seems to imply in drug advertisements that most medical conditions occur for unknown reasons, or they appear out of the blue, or they are inevitable as we grow older, or they’re genetic and therefore not preventable. Drug advertisements seem to imply that there’s no alternative to pharmaceuticals for the medical condition being discussed in their drug advertisements.
Can You Treat Your Problem Without Medication?
The fact is that much is known about preventing the most common medical conditions in modern societies. Pharma does not want the public to know that most of the prescriptions pharmacists fill are for preventable diseases of modern civilization.
Of course, the drug companies would very strongly oppose any significant discussion of prevention. Such a discussion could lead people to redouble their efforts to change their diet and lifestyle, lose weight, avoid tobacco and alcohol, avoid being sedentary, avoid the synthetic chemicals that are so ubiquitous in modern societies, avoid processed foods, etc. in an effort to prevent those conditions. Clearly the drug companies do not emphasize preventive measures because those measures would mean that people need fewer drugs.
A reasonable person might assume that most people, upon viewing drug advertisements on TV with their long lists of potentially serious adverse effects, would intensify their efforts to explore options for preventing those diseases. But that, of course, would require that people actually understand that so many of the drugs that the drug companies promote on TV are, in fact, for conditions that are very often preventable. Most people are probably unaware of the controversies surrounding the pharmacological treatment of many conditions or that there may be reasonable non-drug alternatives.
How Are Medicines Different from Other Advertised Products?
In my opinion, pharmaceuticals are fundamentally different from most other products advertised on TV. Clearly Big Pharma would like the public to believe that pharmaceuticals are no different from any product that can be ordered from Amazon. Clearly Pharma would like to cut out pharmacists because Pharma views pharmacists as unnecessary middlemen between drug companies and consumers.
Because of a singular focus on profits, we have a model of health care in the USA that is overwhelmingly biased toward the utilization of pharmaceuticals for everything, even for diseases that can be prevented. Imagine a drug advertisement on television for a drug that treats lung cancer (such as Opdivo + Yervoy), but this advertisement does not mention in any way the critically important fact that cigarettes are the leading cause of lung cancer. Would that be a profoundly unethical omission from the advertisement?
Advertising Drugs for Preventable Medical Conditions:
When drug advertisements promote drugs that treat preventable diseases of modern civilization, shouldn’t drug companies have an ethical responsibility to emphasize that fact and perhaps even the broader fact that most prescriptions pharmacists fill are for preventable conditions?
Even though various sources differ slightly, lists of preventable diseases of modern civilization typically include many of the following:
- 1) coronary heart disease
- 2) stroke
- 3) hypertension
- 4) deep vein thrombosis
- 5) pulmonary embolism
- 6) varicose veins
- 7) obesity
- 8) type 2 diabetes
- 9) cholesterol gallstones
- 10) kidney stones
- 11) osteoporosis
- 12) gout
- 13) colon cancer
- 14) rectal cancer
- 15) breast cancer
- 16) prostate cancer
- 17) lung cancer
- 18) endometrial cancer
- 19) ovarian cance
- 20) dental caries (cavities)
- 21) constipation
- 22) appendicitis
- 23) diverticular disease
- 24) hemorrhoids
- 25) Crohn’s disease
- 26) celiac disease
- 27) pernicious anemia
- 28) ulcerative colitis
- 29) multiple sclerosis
- 30) rheumatoid arthritis
- 31) asthma
- 32) cerebrovascular disease
- 33) peripheral vascular disease
- 34) alcoholism
- 35) depression
- 36) Alzheimer’s disease
- 37) arthritis
- 38) atherosclerosis
- 39) chronic liver disease or cirrhosis
- 40) chronic obstructive pulmonary disease
- 41) colitis
- 42) irritable bowel syndrome
- 43) metabolic syndrome
- 44) chronic kidney failure
- 45) polycystic ovarian disease
- 46) vascular dementia
- 47) some types of allergy, and others.
See the following sources for a discussion of diseases of modern societies:
1. Norman J. Temple, Ph.D. and Denis P. Burkitt, M.D. (Eds), Western Diseases: Their Dietary Prevention and Reversibility, New Jersey: Humana Press, 1994, pp. 24-25.
2. S. Boyd Eaton, M.D., Marjorie Shostak, and Melvin Konner, M.D., Ph.D., The Paleolithic Prescription, New York: Harper & Row, 1988.
3. Tessa M. Pollard, Western Diseases: An Evolutionary Perspective, Cambridge University Press, 2008
4. Wikipedia: Diseases of affluence
5. Wikipedia: Lifestyle disease
Should Drug Advertisements Describe Preventive Measures?
Shouldn’t drug companies have an ethical duty to discuss in their advertising the critically important fact that these diseases can be prevented? Instead, this discussion is conveniently avoided because it could lead to much less enthusiasm for pharmaceuticals. If people understood that many of the most common diseases in modern society are indeed preventable, would they be so eager to consume pharmaceuticals? Shouldn’t the long lists of potential adverse effects at the end of drug advertisements on TV cause people to increase their efforts to prevent these diseases to avoid needing to take those drugs unless, of course, there is no reasonable alternative?
Consider advertisements for drugs that treat blood pressure, type 2 diabetes, cholesterol, cancer and depression. These are some of the most popular classes of drugs in this country and they account for a large percentage of the prescriptions that pharmacists fill.
[1] Advertisements for drugs that treat blood pressure and type 2 diabetes
Is it ethical for a drug company to advertise a drug that’s used to treat elevated blood pressure or type 2 diabetes and not mention the fact that, for example, The Merck Manual (16th edition, p. 984) says that most cases of hypertension and type 2 diabetes are preventable: “Thus weight reduction will lower the BP [blood pressure] of most hypertensives, often to normal levels, and will allow 75% of type 2 diabetics to discontinue medication.” Ninety percent of diabetics have diagnoses that fall under the heading of type 2.
[2] Advertisements for cholesterol-lowering drugs
Is it ethical for drug companies to advertise cholesterol-lowering drugs without mentioning that dietary and lifestyle factors can be superior to statins? Louisville cardiologist John Mandrola, MD, thinks statins are prescribed too readily and that lifestyle approaches would be more effective. He says cardiologists get inferior results when compared to those seen by physical trainers and nutritionists. In an article titled “Heart Disease and Lifestyle: Why Are Doctors in Denial?” (Medscape, Jan 12, 2015), Dr. Mandrola wrote:
In a randomized controlled trial of primary prevention, no cardiologist would want to be compared against a good physical trainer or nutritionist. We would get trounced. …The study would be terminated early due to obvious superiority of lifestyle coaching over doctoring….It’s the same story at medical meetings: Sessions on drugs and procedures draw the crowds. Late-breaking studies rarely involve the role of exercise or eating well. Exercise, diet, and going to bed on time have no corporate backing.…I believe the collective denial of lifestyle disease is the reason cardiology is in an innovation rut.…This is how I see modern cardiology. Our tricks can no longer overcome eating too much and moving too little.…In fact, a reasonable person could make an argument that our pills and procedures might be making patients sicker.
[3] Advertisements for drugs that treat cancer
Is it ethical for drug companies to advertise drugs that treat breast cancer without mentioning the leading preventable causes of breast cancer? According to the Centers for Disease Control and Prevention (CDC), breast cancer risk factors include:
- Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.
- Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.
- Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.
- Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.
- Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.
Is it ethical for drug companies to advertise drugs that treat cancer without mentioning, for example, that The Merck Manual (17th edition, pp. 2591-2592) essentially states that up to 90% of cancer is preventable:
Environmental or nutritional factors probably account for up to 90% of human cancers. These factors include smoking; diet; and exposure to sunlight, chemicals, and drugs. Genetic, viral, and radiation factors may cause the rest.
Drug Advertisements and the Politics of Cancer:
Do drug companies have an ethical duty to be completely transparent about the politics of cancer and how it drives the push for treatment rather than prevention? One of the experts I admire greatly in the field of cancer prevention is Devra Davis, Ph.D., MPH, formerly the Director of the Center for Environmental Oncology at the University of Pittsburgh Cancer Institute. The field “environmental oncology” sends shivers down the spine of corporate America. Davis explains how vested interests have opposed a shift toward prevention. (Devra Davis, The Secret History of the War on Cancer, NY: Basic Books, 2007, inside front dust jacket):
For much of its history, the cancer war has been fighting the wrong battles, with the wrong weapons, against the wrong enemies. The campaign has targeted the disease and left off the table the things that cause it–tobacco, alcohol, the workplace, and other environmental hazards. Conceived in explicitly military terms, the effort has focused on defeating an enemy by detecting, treating, and curing disease. Overlooked and suppressed was any consideration of how the world in which we live and work affects whether we get cancer. The result is appalling: over 10 million preventable cancer deaths over the past thirty years. This has been no accident.
The official cancer effort was directed by leaders of industries that generated a host of cancer-causing materials and products. Their economic interest lay in making the disease less deadly but never in preventing it altogether. The Secret History of the War on Cancer shows, decade by decade, how this leadership acted to downplay research on prevention, and kept research on environmental causes from gaining widespread circulation or benefiting the general public—and how this suppression of knowledge continues today.
…this is the story of a major public health effort diverted and distorted for private gain, at a cost of millions of lives.
[4] Advertisements for drugs that treat depression
During the last several decades, American psychiatry has seen a huge shift in how it views psychological problems. The pendulum has swung from blaming one’s cold mother to blaming one’s defective brain chemistry. Do the drug companies have an ethical duty to be completely transparent about the deep divide between psychiatrists and psychologists regarding the fundamental causes of depression? Whereas psychiatrists typically prefer an explanation of depression based on a theoretical brain chemical imbalance (mainly serotonin), psychologists typically prefer to blame things like family dynamics, abusive relationships, and psychological scars that remain from childhood.
In my opinion, drug companies have an ethical duty to explain the seismic shift among mental health professionals in the last several decades away from psychoanalysis and toward a mechanistic and reductionist theory of brain chemistry. In this new model of mental illness, pills have largely replaced psychoanalysis.
I think that everyone who takes antidepressant drugs would benefit tremendously from reading a book titled Blaming the Brain: The Truth About Drugs and Mental Health by Elliot S. Valenstein, Ph.D., a Professor Emeritus of Psychology and Neuroscience at the University of Michigan (New York: The Free Press, 1998). See, for example, the following from pages 1 and 2:
American psychiatry is said to have changed from blaming the mother to blaming the brain. It was not so very long ago that the cause of mental disorders was thought to be rooted in early experiences within the family, but now it is widely believed by most authorities and the public alike that the cause is a chemical imbalance in the brain. Today, schizophrenia is commonly claimed to be caused by an excess of the neurotransmitter dopamine and depression by a deficiency of serotonin, while anxiety and other mental disorders are attributed to other neurotransmitter abnormalities. Brain chemistry is believed to be not only the cause of mental disorders, but also the explanation of the normal variations in personality and behavior. How did these radical changes occur within the span of a few decades and does the evidence really support these new theories? Whose interests are served by promoting drug treatment and biochemical explanations and how are these interests advanced? What are the long-range implications of the biochemical theory of mental disorders and the growing reliance on drugs to treat all psychological and behavioral problems? This book attempts to answer these questions and to provide a long-overdue examination of the assumptions fundamental to current biochemical theories.
From about 1945 through 1960, most people had very different ideas about the cause of mental disorders. Although orthodox psychoanalytic therapy was practiced by only a small percentage of mental health professionals, psychoanalytic explanations of the causes of different mental disorders and the best way to treat them dominated the field. In 1950, it was rare that someone not committed to psychoanalytic theory would head a major psychiatry department. Psychotherapists in private practice often spent years trying to discover the repressed causes of their patients’ mental disorders. The value of this approach and the theory underlying it is now widely questioned, if not totally rejected, by most mental health professionals. Today, the disturbed thoughts and behavior of mental patients are believed to be caused by a biochemically defective brain, and symptoms are not “analyzed,” but used mainly as a means of arriving at the diagnosis that will determine the appropriate medication to prescribe. Almost all current chairmen and the majority of the staffs of psychiatry departments are committed to a biochemical approach to mental illness.
How radically our ideas have changed is indicated by the fact that most psychiatric residents no longer receive any instruction in intensive psychotherapy, and many complete their training without meeting regularly with a single patient in psychotherapy sessions. During the 1950s, any research on schizophrenia was considered unethical if it included a control group given drugs without complementary psychotherapy. By 1970, however, the situation had reversed, and it was considered unethical to have a group that received only psychotherapy and no drugs.
Given the huge body of knowledge about the causes and prevention of so many diseases of modern societies, is it ethical for drug companies to completely ignore any discussion of this information and promote pharmaceuticals as the only solution?
This is the third excerpt from Dennis Miller’s new book The Shocking Truth About Pharmacy: A Pharmacist Reveals All The Disturbing Secrets. The entire e-book is available for download from Amazon for 99 cents.
