Prescription Medications and the Consequences of Inappropriate Promotion

 

Back in the days when physicians were considered “god almighty” (1950s) and I had not yet quite overcome the concept, I performed an unconventional experiment with a patient that confirmed my theory that diet pills were largely ineffective. And I admit at the outset that in retrospect, it was a totally inappropriate method.

 A healthy, but considerably thin young lady consulted me because of her desire to gain some weight, so I had the opportunity to test my theory. I relabeled some recently received “diet pill” samples and presented them to her with a most articulate pitch about how useful they would be for her effort to gain weight. In addition, I gave her some common sense advice about food choices and exercise. She gained the desired weight promptly, despite the supposed maximum effects of the diet pills! This early validation of my skepticism about the latest diets and diet aids has stood me well throughout my career. The patient was pleased that she gained the desired weight without harm, and my experiment had adequately confirmed my skepticism about diet pills, which are primarily amphetamines or “speed.”

Amphetamines are very useful for treatment of narcolepsy, a condition characterized by episodic irresistible sleep with great danger of accidents to the sufferers. I have treated a number of these patients through the years. My patients and I have learned that the use of these drugs sparingly when they are most vitally needed maximizes the benefit in preserving wakefulness and removes the threat of dependence and addiction. Amphetamines are now most widely used for attention deficit disorder.

In the 1950s, Benzedrine inhalers were marketed without prescription for relief of nasal congestion with head colds. Benzedrine was one of several amphetamines on the market. All were quite similar right down to the starting dose of 5 mg. The inhalers contained 60 mg. of Benzedrine. There had been a prejudice that only natural narcotics were fully addicting, which prolonged the over-the-counter marketing of these inhalers.

I began to be concerned about drug samples sent to doctors without request because of toxicity to children and motivations to rob doctors’ mailboxes. Remember that my initial experience with these drugs was gained from samples and I wondered if this form of promotion contributed to my impulsive experiment, recounted above.  I managed to avoid receiving them a year or so before unsolicited sampling was prohibited.

Later on when I was insulating myself from biased information about drugs, I noticed that the journal of one of my professional associations was obviously influenced in its editorial material by the advertisers in its publication. I wrote to the organization citing the evidence from recent issues of its own journal and resigned in protest. Other doctors must also have protested. Within a few months the editor was sacked and the new editor emphasized what was going to happen on his watch rather pointedly, but without any reference to the past.

The foregoing illustrates that a few principled people can influence events. What can you do, dear reader? Write to your congressmen. Explain that it is wasteful to spend (as an industry) over $10,000 per doctor per year on promoting drugs to doctors that only inflate the actual cost of the medicine for patients, when many physicians use appropriate generic drugs anyway. Unfortunately, the pharmaceutical industry successfully lobbied for direct advertising to the public of prescriptions without any congressional hearings. An administrative rule change that went against several generations of ethical precedent achieved the industry’s goal.

Developing new drugs is expensive, but the high cost of drugs is also driven by the costs of unnecessary and confusing promotion. I have even been compelled to waste valuable time trying to explain diplomatically why patients don’t need that constantly advertised “purple pill.” They often don’t even know what it is for.

Penicillin required no advertising. In other words, physicians will seek out and clamor for any great new discovery. Advertising prescription drugs not only is unnecessary, but it’s expensive too (and perhaps subtly subversive). I thank, and apologize to my patient of long ago for helping me to understand this.

 

John A. Frantz, M.D.

December 22, 2003

 

Caps and Gowns

         When I was in school in the 1940s student nurses looked forward to being “capped”.  This meant graduating to the status of registered nurse, and they proudly wore their newly earned white caps with a separate design for each nursing school.  Gradually through the years nurses wear these caps less and less.  As a matter of fact they are now only worn for the graduation ceremony, and the caps rented in the same spirit that college graduates have rented caps and gowns for graduation  for many, many years.

         Originally did medieval professors actually wear their caps and gowns for giving lectures and other academic duties?  And did they also gradually stop wearing them except for ceremonial purposes as I have seen the nurses do?  Odds are this is an example of history repeating itself with slightly different details.

          Judges have continued to wear robes.  In Great Britain they even still wear wigs.  Is this to make them look older and wiser?

John A. Frantz, M.D.

January 15,  2004

 

Communicating with Extraterrestrials

           An item in the 125th Anniversary issue of Science (1 July, 2005) entitled Are We Alone in the Universe? tied up a loose end in my thinking.  It described Congress in 1993 prohibiting NASA from spending public funds “looking for little green men with misshapen heads”.

           Suppose we are, as some of us believe, ex officio top dogs in the entire universe.  Are we thereby obligated to spend vast sums of money too large to obtain privately to send our signals to the riff-raff civilizations unable to transmit galactic signals but only able to listen for us?  This is consistent with similar efforts for a couple of millennia informing our more primitive con-specifics the details of cosmic governance if indeed these details have been “revealed” to us alone.

            When  the religious right  takes over our government,  we can expect  many goofy expenditures such as the above.                                    JAF