It is easy to assume once we’re taking a drug that we would have been sicker, or dead, if we weren’t taking it. But in some cases, we would have been fine—or better off.
Many of the prescription drugs Americans struggle to pay for don’t work very well, and if we were better informed, we might not consider them worth the risk of side effects. Buried among the mediocre drugs are a few that do add years of life or alleviate significant suffering. Clarifying which ones really are lifesavers—such as insulin, drugs for HIV and hepatitis C—would help get those drugs to the people who need them, and help spare everyone from unnecessary medication.
Medical costs, especially drug costs, have rightly taken centre stage in political debates as prices continue to rise and surveys indicate that cost deters many people from filling prescriptions. The problem has needlessly spread: The number of prescriptions being written has tripled in the last 15 years, but this has not been matched by a tripling of the number of miracle cures and magic bullets.
How are we consumers to know which drugs we really need? Drug companies skew statistics and market heavily to make their products sound much safer and more effective than they really are. Philosopher Jacob Stegenga argues in “Medical Nihilism” that we’re all assuming medicine has much more power to heal than it actually does. Which makes sense: Many products that are heavily advertised are overrated. The drug industry spends approximately $30 billion a year on marketing.
Ad campaigns can “raise public awareness” of problems that were essentially invented to sell drugs. Consider the blockbuster eye drop Restasis, which has very little effect on anyone’s eyes. Ad campaigns scared people into thinking they had “dry eye syndrome” and risked permanent damage without treatment. Another popular campaign convinced healthy men to take testosterone by raising awareness of “Low-T of aging,” though the risks of taking the drug are likely to outweigh benefits for those without certain health conditions.
Some of that $30 billion marketing money goes to influencing physicians. Many receive generous speaking fees, are taken on junkets, or are named “influencers” and treated to fancy dinners and luxurious hotels. Psychologists who study conflicts of interest have shown how this has an insidious effect: Doctors think they are not being influenced by their industry benefactors, but they do prescribe more of those companies’ drugs.
The press can also boost marketing by parroting statistics put out by industry press releases, some of which are true but misleading. In “Doctoring Data,” physician Malcolm Kendrick shows how a study can be spun to suggest a drug will save 50,000 lives, but the same data can be read to say that of 200 people taking the drug, 199 will get no benefit and the other one will live only several months longer.
The more impressive number of “saved” lives is derived from assuming that millions of people will take the drug and that a couple of extra months counts as a saved life. Such calculations often fail to note that giving drugs to that many people often causes more harm, through side effects, than good.
Drug ads often reveal a laundry list of side effects, but there’s little or no information on which are rare and which are common. Sometimes, as with the diabetes drug rosiglitazone, life-threatening side effects don’t show up until the drug is on the market and being prescribed to thousands of people.
“Medical Nihilism” author Stegenga proposes that the FDA raise the bar on drug approval, because so many are unlikely to work. But there’s merit in a drug even if it helps only a few people. A better solution might be to charge FDA with giving consumers information that will tell us which drugs are necessary, which are long shots and which we can skip. Then leave the choices to us. This might function the same way nutrition labelling works on packaged food.
The fact that medicine is overrated doesn’t mean it isn’t wonderful. Surely people are better off with vaccines, anaesthesia, antibiotics and the like. Medicine simply can’t live up to the hype that it has a pill to cure or prevent most illnesses. It is easy to assume once we’re taking a drug that we would have been sicker, or dead, if we weren’t taking it. But in some cases, we would have been fine—or better off.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners