Modern Drug Marketing: An Unsustainable Model

Cymbalta.  Abilify.  Lunesta, Chantix and that drug for "when the time might be right."  As a consumer and especially as a psychologist, it unsettles me when I see television ads exhorting potential clients to ask a doctor about a specific drug.  Even if I do not believe general practitioners or specialists know best, I do not believe consumers should ask for specific drugs.  To me, without any science behind my opinion, that seems like patients are being turned into marketing agents for pharmaceutical companies.  The next observation is based solely on my television viewing habits: it seems the number of diseases treatable by drugs, even if used off-label, has grown.

According to an article published in the American Journal of Public Health, my unscientific beliefs may really have a scientific basis.  Howard Brody, MD, PhD and his colleague, Donald W. Light, PhD identified several trends and cite examples supporting the idea that physicians are pressured to prescribe drugs to a larger population than they were originally intended to treat.  As an experimental psychologist, it especially disturbed me to read that 60% of prescriptions for antipsychotics - not trivial drugs with potentially severe and permanent side effect - are for off-label use.  Meaning, they are being prescribed for conditions they were not originally meant to treat.  The article claims that in 75% of those cases, there was not strong evidence of a positive effect to warrant exposing patients to harm.

The authors do cite drug demand being driven by marketing towards consumers as a factor.  They also cite "disease-mongering", or reducing the threshold for an existing condition to being diagnosed as a disease as a contributing factor as well.  They call the process "the inverse benefit law."  According to Brody and Light, the way to look at the "law" is that the more heavily a drug is marketed, the greater chance of harm to the patient rather than good occurs.

As thrilled as I was to discover I was not merely paranoid, I had to look up the inverse benefit law.  There is dissenting opinion.  Not dissenting, exactly, but more complications.  Naturally, in the form of how regulatory bodies handle the entire process.  Specifically, the dynamic between marketing and the benefit-to-harm ratio may also be affected by a combination of regulation of the pharmaceutical companies and the difference in knowledge about drugs between the manufacturers on one hand and the doctors and their patients on the other.

This implies that the effect of the "inverse benefit law" is modified by a combination of regulation designed to prevent abusive marketing and exaggerated claims about product efficacy and safety with increased public awareness of the problem in the first place.  This is a classic modern model of a public health approach to solving health problems, for better or worse.

If there really is a health problem associated with fabrication of disease states, convincing both the public and physicians to use drugs in unsafe ways, then it constitutes a menace to the public health.  Personally, I am quite aware of the financial and scientific difficulties with drug development, clinical trials and getting drugs approved for use and sale.  I know a large number of people involved in drug development, and I truly believe not a one of them sets out to create a drug that will be misused or do more harm than good.  To me, it is another example of a process that has become so complex with tension created at so many points it may be impossible to ever control.

Image provided by a U.S. Army soldier or employee.