(Vanity) A Merck-y Decision, or, Is Pfizer Wiser?

grey_whiskers ^ | 2-10-2007 | grey_whiskers

[grey_whiskers]

Lately, I have been seeing a lot of advertisements for medicines on TV. These ads have a number of features in common. First, they have an individual (carefully selected to match the target market for the drug) or a group of people (also in the target market) engaged in a stereotypical happy or active pursuit. One of the group usually is singled out, as suffering from some condition or other. Then the voice over recommends medicine X, available only by prescription. The trade name is given, then a scientific, medical-sounding name, which is in fact NOT the scientific name. (*) Following a list of how this medicine will revolutionize *your* life (“it washes, it sweeps, it even does windows”) comes a long list of lawyer-mandated warnings, contraindications, and side effects. And here’s the fun part. The advertisement will always end with the cheerful admonition to “talk with your doctor to see if medicine X is right for you”.

Why is this so much fun? Let’s look at a partial list of the aforementioned lawyer warnings, side effects, and possible drug interactions for a popular cholesterol-lowering drug:

• Do not take without first talking to your doctor if you have liver disease.
• Before taking, tell your doctor if you
drink alcoholic beverages
have a chronic muscular disease
require major surgery
have a blood disorder
• Do NOT take if you are or may become pregnant
• Do NOT take without talking with your doctor if you are nursing
• Do not change the amount of grapefruit in your diet if taking this drug
• Stop taking the drug and seek emergency medical attention or contact your doctor immediately if you have any of the following symptoms:
an allergic reaction (difficulty breathing; closing of the throat;
swelling of the lips, tongue, or face; or hives);
decreased urine or rust-colored urine; blurred vision;
• Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness, especially if accompanied by a fever or flulike symptoms or yellowing of the skin or eyes, abdominal pain, unexplained fatigue, dark colored urine or pale colored stools. These may be early symptoms of muscle or liver problems.
• Do not take this drug without first talking to your doctor if you are taking any of the following medicines:
cyclosporine
gemfibrozil, clofibrate, or fenofibrate
niacin
erythromycin or clarithromycin
cholestyramine or colestipol
hormonal birth control
antifungal medications such asitraconazole, fluconazole, or ketoconazole

So in practical terms, what do all of these disclaimers mean? Let’s say you are a woman in her mid- to late-thirties who has high cholesterol. You have a husband or a live-in boyfriend. First red flag! You cannot take this medicine if you are or “may become” pregnant [third bullet point]. Oh, OK, that’s no problem. Just go on the pill, right? WRONG! You cannot take this medication of you are taking “hormonal birth control” [last bullet point]. So your hubby either has to get a vasectomy, or you can get your tubes tied, or use a condom (what if you still *want* another child)?

There are other pitfalls. Let us say you have dandruff, or you have those toenail infections—both of these ailments seem to be very popular with the TV-advertisements crowd. Guess what? This pill hay help your cholesterol, but your nickname at work is going to be “Mr. Flakes” when your dandruff returns (ketoconazole, and other antifungals are on the forbidden list).

Let’s take another case. Let us say you’re a typical middle-aged guy, and your doctor tells you that you have high cholesterol. Just take this pill, and everything is hunky-dory, right? Mmm-hmm. The second bullet point rules out alcoholic beverages. OK, so maybe drinking less Bud Light will help your beer gut, but there goes half the fun in life during football games on TV. Or, let us say you are trying to be conscientious, and changing your diet to help things along. Eating grapefruit is a good idea, right? Not on this drug.

And of course, I haven’t mentioned the other warnings—liver abnormalities, major surgery, antibiotics such as cyclosporine, or other medicines such as gemfibrozil or erythromycin; and the risk of severe liver or muscular side effects. Keep an eye out for them!

So what is the point? That pharmaceutical companies are evil, that we would be better off without them? Not at all. My question is, with all of the detailed list of warnings, contraindications, and drug and lifestyle interactions, how in the world do they expect a lay person to be competent about taking this drug. “Talk to your doctor to see if our pill is right for you.” That’s good; if the doctor has time, AND he has a list of all of your prescriptions, then he might check up on any drug interactions; but what if you go to more than one specialist for more than one ailment? And is the doctor necessarily going to remember about the over-the-counter dandruff shampoo, or your love of Light Beer, or the grapefruit?

Should we all get a master’s degree in pharmacology in order to keep up with our own prescriptions? Or is there some better way?

“Caveat Emptor” has never been more true—and never more necessary.

(*) For example, the “medical-sounding” name for one compound is “tamsulosin hydrochloride” but the actual chemical name is (-)-(R)-5-[2-[[2-(o-Ethoxyphenoxy) ethyl]amino]propyl]-2-methoxybenzenesulfonamide, monohydrochloride.

[grey_whiskers]

Cheers!

[freespirited]

Don't blame the drug companies. The reason the ads have to include all that stuff is the gummint (FDA).

[grey_whiskers]

Don't blame the drug companies. The reason the ads have to include all that stuff is the gummint (FDA).

I understand completely; my point is that most laypeople are not competent to understand the risks and side effects of many of the prescription drugs.

Full Disclosure: I think that the reason most folks have this mentality is a combination of auto repairs, and simple over the counter remedies, such as aspirin...these leave the impression that a simple adjustment or minor fix will "make everything all right again."

The truth is the human metabolism is an incredibly intricate, interwoven machine. Sometimes the parts come from the factory with a flaw; sometimes parts wear out; sometimes a lifetime of abuse of one structure or system throws something else out of whack. And since so many enzymes, proteins, genes, intermediary chemicals have multiple purposes, it can get pretty tricky trying to coax things back into balance.

And promoting the idea that "pop a pill, your problem goes away" sets up everyone involved for disappointment, failure, and lawsuits.

Cheers!

[neverdem]

The Grapefruit-Drug Interaction Debate: Role of Statins

antibiotics such as cyclosporine...

Cyclosporine is an immunosuppressant. Otherwise BTTT

[grey_whiskers]

Cyclosporine is an immunosuppressant. Otherwise BTTT

Just d@mn. Now I'll have to start fact-checking again...

Cheers!

[Revolting cat!]

Thanks for the ping to this 5 year old thread. I should be dead by now!

[grey_whiskers]

I wrote that before I knew there was a market on FR for bird cage liner...

Thanks for the compliment.

...oh, and Merry Christmas.

Cheers!