- The Washington Times - Thursday, May 10, 2001

The Food and Drug Administration, concerned about increased use of prescriptions drugs amid a barrage of advertising, is looking into whether consumers are taking more medications than they really need.

Doctors last year issued 2.9 billion prescriptions totaling $131.9 billion, a 19 percent increase from the previous year, according to a study by the National Institute for Health Care Management.

Increased advertising by pharmaceutical companies is a major factor causing the rise, according to industry observers.

Drug makers spent $13.9 billion on advertising and marketing in 1999, with the largest chunk of that $7.2 billion being spent on free samples handed out to physicians, according to the Pharmaceutical Research and Manufacturers of America, a Washington group whose members are the top 80 drug makers in the nation.

"As we surmised from a couple of years of data, the drugs that are the top sellers the ones that sell the most and drive the increase of prescription drug spending are the drugs that are the most heavily advertised," said Stephen Finley, director of research at the health care institute, a Washington nonprofit research and policy analysis group.

The FDA started researching the connection between advertising and sales late last year to make sure the relationship is good for consumers, an FDA spokeswoman said.

The 50 best-selling drugs during 2000 averaged $75.88 per prescription. That is more than twice the average cost of other drugs, which cost $35.72, according to the institute.

"What you have there is a phenomenon where drugs that come to the scene can be potentially used by 10 million, or 15 million people that have certain conditions," said Mr. Finley. "And if a drug gets acceptance into the market, all of the sudden you see millions of prescriptions written all in the space of a year or two."

Drug makers did not advertise their products until four years ago because the FDA required them to describe drugs thoroughly, which was difficult to accomplish in a creatively effective standard 30-second TV ad or a one-page magazine ad.

But in 1997 the FDA eased its rules, requiring them to only list major side effects. A flood of advertising hit the airwaves.

Drug makers spent $2.5 billion on consumer advertising last year, 40 percent more than in 1999, according to IMS Health Inc., a Pennsylvania health research company.

"In the last four years advertising to consumers from pharmaceuticals has just gone crazy," said Tina Bagapor-O'Harrow, president of D.C. ad agency the Ad Store. "And from the ad agency perspective, it's a whole new venue … a new client."

Drug makers like Merck, Pfizer and Amgen push their products over the airwaves and in print, telling consumers their drugs will make them free of ailments like arthritis (Vioxx, Celebrex), diabetes (Avandia), depression (Prozac, Paxil), high cholesterol (Lipitor, Zocor) and stomach illnesses like ulcers (Prevacid, Prilosec).

Ms. Bagapor-O'Harrow recalled seeing a two-page magazine ad for the popular antidepressant drug Prozac, made by Eli Lilly, that particularly struck her as "insane."

"On the left hand there was like a gray cloud on a black background and the tag line read 'Sad? Under the weather?' " she said. "And on the right side there was a blue sky, a field of happy flowers, and the tag line said, 'It doesn't have to be this way. Ask your doctor about Prozac.'

"As a consumer, I can see the level of advertising to the consumer from pharmaceutical companies is insane," Ms. Bagapor-O'Harrow said. "And there are even drugs now that the ads don't even tell you what they are for … and people are still going to their doctors asking for them."

As promotion increases, so does consumer spending, particularly on the advertised drugs. The sales growth of just 23 of the market's 9,911 prescription medications accounted for half of the $20.8 billion increase on pharmaceutical spending last year.

Although doctors are writing more prescriptions for new drugs, they say it's not caused by the manufacturers' increased marketing.

"As a physician, you always want to choose the correct drug for your patient, not the one that's advertised on television," said Dr. Suresh Malhorta, a gastroenterologist from Alexandria.

He added that patients sometimes come to see him having already heard about a drug, but that he did not believe the drugs advertised were better or worse than the ones that were not.

"We've heard that complaint [about drug marketing], but we've also heard a fair number of doctors say that they see it as a constructive development, because it does mean more patients are educated about their treatment choices," said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America.

Prescription drug use has grown partly because fewer people today pay the full price for medications then a decade ago. In 1998, insured patients paid 27.5 percent of the cost of drugs, while in 1990 they paid 48.3 percent of their cost, according to the National Institute for Health Care Management.

Protected by flat prescription co-payments, consumers have not felt the rising prices of medications that require a doctor's order. But costs have risen as the uninsured have found out because they spend one-fifth of their annual income on such medications.

Prescription drug spending is expected to keep rising, even though the patents on drugs like Prozac and the popular antihistamine Claritin are due to expire this year.

Health care groups predict a 12 to 23 percent per year rise through 2004 as new drugs continue to hit the market, especially later this decade when biotechnology companies are expected to produce even more new treatments.

• Tim Lemke contributed to this story.

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