POINT REYES STATION, CALIF. – It is an old saying in the advertising trade that you sell the problem, not the solution. That helps explain why the media today are awash with images of disease. Erectile dysfunction, depression, stress, attention deficit disorder, on and on - you can't escape them and the sense of looming peril that they conjure up.
Politicians sell terror and fear; pharmaceutical companies sell disease. Every state and stage of existence has become a pathology in need of pharmaceutical "intervention," and life itself is a petri dish of biochemical deficiency and need. Shyness is now "social anxiety disorder." A twitchy tendency has become "restless leg syndrome." Three decades ago the head of Merck dreamed aloud of the day when the definition of disease would be so broad that his company could "sell to everyone," like chewing gum.
That day is rapidly approaching, if it's not already here. "We're increasingly turning normal people into patients," said Dr. Lisa M. Schwartz of the Dartmouth Medical School. "The ordinary experiences of life become a diagnosis, which makes healthy people feel like they're sick."
In one sense, the ads have been successful. The Kaiser Family Foundation found that every dollar drug companies spend on ads brings more than four dollars in additional sales. But for most others, the result has been soaring medical insurance costs, toxic side effects, and new tensions between doctors and patients, who increasingly badger doctors for the drugs they've seen on TV.
One study found that 30 percent of Americans have made these demands. A Minnesota doctor complained recently that patients now push him for sleep medications "when maybe they just need to go to bed on a more regular basis."
But perhaps the worst part is that prescription drug ads have immersed us all in a pervasive drug culture that seems to have no boundaries. We are being reduced to helpless "consumers" who have no capacity to deal with challenges other than by taking a pill. Last month Tim Pawlenty, the Republican governor of Minnesota, called for a moratorium on prescription drug ads. It's about time.
For most of the past half century, there were tight restrictions on the general advertising of prescription drugs. These require doctors' guidance for a reason; so why should Madison Avenue get involved? But under heavy pressure from the drug and advertising industries, the government backed down in the late 1990s, and that started the tsunami.
Spending on drug ads for the general public more than tripled between 1996 and 2001. It is now some $4 billion a year, which is more than twice what McDonald's spends on ads. In 1994, the typical American had seven prescriptions a year, which is no small number. By 2004, that was up to 12 a year. Homebuilders are touting medicine cabinets that are "triple-wide."
The industry says this is all about "educating" the consumer. But an ad executive was more candid when he said - boasted, really - that the goal is to "drive patients to their doctors." Reuters Business Insight, a publication for investors, explained that the future of the industry depends on its ability to "create new disease markets." "The coming years," it said, "will bear greater witness to the corporate-sponsored creation of disease."
The Kaiser study found that drug ads increase sales for entire categories of drugs, not just the one in question. The ads really are selling the disease more than a cure.
Advertising is just one way the industry has sought to accomplish this goal. It also funds patient advocacy groups such as Children With Attention Deficit Disorder (CHADD), and doctors who push for expanded definitions of disease, among a host of other things. (When the definition of ADD expanded in the 1980s, the number of kids tagged with this problem increased by 50 percent.)
But advertising is the most pervasive and aggressive way of selling sickness. It also is the hardest to justify. Medicine is supposed to be about science, not huckstering; about healing people, not persuading more of them that they are sick. There are far better ways to inform the public about health issues than to spend billions of dollars a year pushing pills.
This is why more than 200 medical school professors recently called for an end to prescription drug ads, and why close to 40 health and seniors groups have joined them. Even the American Medical Association, many members of which have close ties to the pharmaceutical industry, has urged restrictions. Washington should listen to these doctors. As Governor Pawlenty put it, we need to put "the decisionmaking back where it should be - on an informed basis between the patient and the doctor."