Over-Medicating America
There is an important study in this month’s issue of the Annals of Family Medicine It concerns something that most health care professional in the United States have been worried about for some time: it is direct-to-consumer advertising of prescription medicines. I rarely watch much television, but out of interest I had one channel on for an hour this morning and saw six advertisements for medicines. It is not widely known that this practice is illegal in most of the rest of the world, with the exception of New Zealand.
The research suggests that this direct-to-consumer television advertising of prescription drugs may be influencing Americans to believe that they are sicker than they really are. This may in turn lead to taking more medication than they actually need.
The study was funded by the National Cancer Institute’s Centers of Excellence in Cancer Communication Research and the Robert Wood Johnson Foundation, and was led by Dominick Frosch from the David Geffen School of Medicine at the University of California, Los Angeles.
The researchers evaluated the educational value of 38 direct-to-consumer television advertisements for prescription drugs and analyzed how they tried to influence viewers. The drugs in question were for treating illnesses ranging insomnia and depression to high cholesterol and high blood pressure.
Their findings suggest that the advertisements had virtually no educational value. Furthermore they failed to describe who is most at risk for which illnesses, what their symptoms might be, and whether non-medicinal alternatives such as lifestyle changes might also be viable options.
According to the figures cited, Americans watch up to 16 hours of television advertising about prescription drugs per week. The scientists watched the advertisements shown during the evening news and prime time periods. They used a coding system that takes into account a number of attributes of each ad. The attributes included the factual claims made about the illness the drug is aimed at, the method used to attract the consumer, and also what is revealed about the behavior and lifestyle of the people in the advertisement.
Although they found that over 80% of the advertisements did make some factual claims and put forward rational arguments for use of the drugs, only 25-26 per cent of them described symptoms and causes of illnesses, the associated risk factors and how common or rare they are.
The scientists also found some common strategies: many of the advertisements portrayed the drugs in terms of people losing control over their lives (58%) and then regaining it (85%) once they took the medication. 78% of the ads also portrayed the medication as engendering social approval, while 58% of them implied that the drug was a medical breakthrough.
The findings also show that nearly all advertisements (95%) used emotional appeal to influence viewers and none of them showed lifestyle and behavior change as viable alternatives, except for 19% of them that showed this as an adjunct to taking the drug. 18% of the advertisements suggested that changes to lifestyle would not be enough to deal with the illness.
The conclusion of the study is that despite the claims that television advertisements play an educational role, they contain limited information about causes and symptoms of their target illnesses, their prevalence and risk factors. They also show people that have “lost control over their social, emotional or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.”
Dr Frosch said that “We’re seeing a dramatization of
health problems that many people used to manage without prescription
drugs,” and that the “ads send the message that you need drugs to
manage these problems and that without medication your life will be
less enjoyable, more painful and maybe even out of control.” He said
that the US should consider banning direct to consumer television
advertising of prescription drugs too. Something that was echoed in the
accompanying editorials.
I have spent a great deal of time weighing the pros and cons of direct-to-patient advertising with health care professionals and people in the pharmaceutical industry in Europe, the United States and Australia and New Zealand. Despite all of our work to empower people, I remain unconvinced that they are ultimately in peoples’ best interests.
Open Access
I have had a number of kind comments about my brief piece concerning the revolution in open access to information.
Few people have yet realized the impact that it will have on our lives.
I am most honored to have just received this note from Peter Suber:
Hi Richard: PLoS is part of a larger movement for open access to
peer-reviewed research literature, and a lot has happened since PLoS
was launched in 2001. For details, see my Timeline [ http://www.earlham.edu/~peters/fos/timeline.htm ], and for daily updates see my blog, Open Access News [ http://www.earlham.edu/~peters/fos/fosblog.html ].
I have had a good look at Peter’s material, and I have also subscribed to his blog, so it will now appear on the left-hand side of this blog under “What I’m reading,” so you can access his writings without having to dart all over the place.
The entire open access movement encompasses a great deal more than just scientific and medical research, and is all precisely aligned with my aim of achieving greater personal empowerment, so that you can take control of your life, your health, your future and the legacy that you leave behind.
Several correspondents have agreed with my point, that the next imperative is to teach people how to use this information.
Checking Data
Following my brief piece on the sun and some of its potentially adverse effects, someone was kind enough to leave this comment:
"Don’t forget that skin cancer is cured by melatonin and vitamin A.
Reference 1
Reference 2
I am extremely grateful that he wrote, because it gives me the opportunity to illustrate the point about checking the data. The person who wrote was obviously motivated by a desire to help, but he had been given some information that was not correct.
I pulled out both of these papers and discovered that they said something rather different.
The first paper in the Indian Journal of Medical Sciences is quite a good review article about melatonin. There are several reasons for us to be interested in melatonin, and I actually plan to write a brief review about it as soon as I have finished analyzing the literature. There is indeed some experimental work to suggest that melatonin may modulate and in some cases arrest the growth of some malignant cell lines (1. 2. 3.) But we are still a long way from being able to say that melatonin is a viable treatment option for melanoma.
The second paper does not talk about melanoma treatment at all: it is a paper about the possible use of Vitamin A as protection against cancer in sun-damaged skin.
As I mentioned in my piece about the new open access journals, our next task is to help people learn how to interpret the data in all of these papers. I am on the review and editorial boards for several scholarly research journals and it is amazing how often the article summary does not tally with the data in the paper.
And also how often people cite articles that they cannot have read. Within the last 24 hours, the editor of a well-known journal asked me to review a research paper that had been submitted for publication. There was very interesting data in the paper, but the author had made at least one error in his citations. He accidentally claimed that a piece of research had discovered one thing, when the research had actually said something quite different. I happened to know that because I wrote the original paper!
This problem of misinterpreting data keeps coming up, and I’m sure that we may all have missed something at some time. It’s sometimes hard to analyze all the ins-and-outs of a piece of research.
You may have heard about a bit of a scandal over a book on gender differences that was just published. I liked reading the book, but I was worried about some of the references about hormonal effects on behavior. I know this literature very well, and some of the statements and inferences were a bit questionable. Now several experts have been checking some of the citations about gender differences in language that were used by the author. They discovered that some were just plain wrong.
Have you ever heard that one about, “Women talk more than men?” It always sounded pretty silly. And of course, if something sounds silly it probably is. Does it matter? If someone is going to write a popular book, good luck to them: I actually think that scientists have a duty to make their work accessible to the public.
But if they quote a lot of papers to give themselves an air of authority, they really have to make sure that they are not misleading anyone. If some references are wrong, then it’s difficult to be sure which ones we can trust.
We cannot have one set of rules for a book written for professionals and another for the general public. Each must be created with the utmost care, clarity and attention to detail.
My last book and CD series – Healing, Meaning and Purpose – cites over 800 books and websites, all carefully checked by yours truly. I did this just so that people can follow up on what I say. That way my books, articles, papers – even this blog – become portals to a world of ideas and information that you can use to improve your life.
Science and Medicine at Your Fingertips
There is a very important initiative which will likely have far reaching consequences.
A number of organizations are creating a Public Library of Science (PLOS), which is a non profit organization of scientists and physicians who are committed to making the world’s scientific and medical literature a freely available public resource. The impressive Board of Directors includes the Nobel Prize winner Harold E. Varmus, Chairman of the Board, and President & Chief Executive, Memorial Sloan-Kettering Cancer Center in New York; Patrick O. Brown
, Stanford University School of Medicine and the Howard Hughes Medical Institute and Michael Eisen, Lawrence Berkeley National Laboratory University of California at Berkeley.
Some of the journals that are relevant to Health, Integrated Medicine, Meaning and Purpose are in the "journals" section in the side bar on the left.
Let me explain why this is so important. Since the early days of science, most of what has been written has been hard to get at and therefore often open to misunderstanding and misquotation. Books – including textbooks – are full of errors that have been repeated from one to another, in most cases simply because the authors did not bother to check their sources. There’s a good example in popular literature. Book after book has repeated the story of the Hundredth Monkey. According to the story, Japanese scientists in the 1950s discovered that when a hundred monkeys learned a new task, monkeys elsewhere – without any physical means of contact – suddenly and spontaneously learned the same thing. The idea was that once the global monkey mind learned something, then the information was available to monkeys everywhere.
A number of years ago I looked at all the original research papers, copies of which are lodged in the Senate House Library in the University of London. The papers showed that the whole thing was untrue! There is a short piece about the hoax here.
If the papers had all been openly available, this urban legend would never have been able to take root.
Our next task will be to show people without a strong scientific background how to go about reading a paper: it is not as simple as it may seem, but is a learned skill. So almost anybody can be shown how to do it.
This is a terrific step toward greater freedom of information and everyone involved deserves our thanks.
Robert Anton Wilson R.I.P.
The American writer, humorist, philosopher, psychologist and futurologist Robert Anton Wilson finally passed last Thursday. I say "finally" because he has suffered for some time with post-polio syndrome that caused a bad fall last year. Since then he had required continuous medical care.
I never met him, but felt that I got to know him in the thirty some years since I first picked up a copy of The Illuminatus! Trilogy which he co-authored with Robert Shea. Advertised as "a fairy tale for paranoids," it was very funny in parts, using humor to examine American paranoia about conspiracies. Since then I read more than twenty of his books and there is no doubt that some of his ideas influenced not just me, but a generation of people who were interested in thinking outside that famous box.
Even thirty years later, one of his best and most influential books was Cosmic Trigger I: Final Secret of the Illuminati in which he examined everything from The 23 Enigma (the number 23 appears more often in "random" number series than any other and is said to have hundreds of odd correlations, from the number of human chromosome pairs to the Bible), leprechauns, Mr. Spock’s ears, Discordianism, Sufism, Futurology, Zen Buddhism, Dennis and Terence McKenna, the occult practices of Aleister Crowley and G.I. Gurdjieff, the Illuminati and Freemasons, Yoga, and other esoteric or counterculture philosophies. He also advocated Timothy Leary’s eight circuit model of consciousness and neurosomatic/linguistic programming.
"RAW" as he was affectionally known, also introduced millions of people to the idea that consciousness can affect the material world.
Some people found some of his writing difficult, simply because he was always trying to force people to make new associations and to see things differently. And few people would agree with absolutely everything that he said. Because he did not want them to: he wanted to make people think and to develop their intuition.
I shall always be grateful for RAW’s influence, and I hope that he enjoys the next stage of his journey.
Common Misconceptions About "Weight Loss" Supplements
My recent comments about chromium, the penalties handed down over false weight loss claims and my inability to find any support for an apparent claim concerning probiotics and weight gain, have lead to a flurry of questions and helpful responses.
By far the most common has been surprise. Most people assumed that:
- These dietary supplements are regulated and that:
- They are therefore safe and
- They have had to demonstrate that they are effective
In fact all of those three assumptions are wrong.
I have just found a most helpful article that you can download for free.
Last October at the 2006 Annual Scientific Meeting of NAASO – the Obesity Society – the results of a collaborative research program by the University of Connecticut’s Center for Survey Research & Analysis (CSRA) in Stamford, Connecticut and the University of Pennsylvania’s Center for Weight Loss and Eating Disorders in Philadelphia were presented. GlaxoSmithKline (GSK) Consumer Healthcare funded the study.
Findings from this first national survey on the safety and regulation of dietary supplements for weight loss include:
- 65% believing that weight-loss products are tested for safety
- 63% believing that weight-loss products are tested for effectiveness
- 54% believing that weight-loss products are approved by the FDA
- 64% believing that manufacturers are required to include warnings about side effects
- 50% of African Americans and 49% of Hispanics were more likely than Whites of European origin (36%) to believe supplements are safer than OTC or prescription weight-loss drugs
Congressman John Dingell from Michigan has indicated that the new Congress will be re-visiting the issue of the FDA’s regulation of some of these supplements.
That would probably be wise.
Though as a very firm advocate for health freedom, I always worry when new regulations are proposed, simply because they sometimes lead to the baby being ejected with the bath water.
I shall continue to watch this developing story and to let you know how things develop.
Dogs, Diet Pills and Healthy Eating
Pfizer Animal Health announced today that the Food and Drug Administration (FDA) has approved Slentrol(TM) (dirlotapide) for the safe and effective management of canine obesity, making it the first and only veterinary-approved obesity drug for dogs in the United States.
Because of our intense interest in metabolism, we have been tracking the rise in canine obesity since 2001. Wild dogs do not get fat, but under-exercised canines given the wrong food rapidly do. Many owners think that they are too busy to exercise them and many neighborhoods either have no side walks or are simply not safe for a walk. Having just received multiple bags and boxes of food, I can also attest to something else: we often equate food with love – without being aware of the potential adverse health consequences.
According to 2002 data from the American Veterinary Medical Association 40 percent of dogs – around 17 million – are considered overweight (5 percent to 20 percent over ideal weight) or obese (20 percent or more over ideal weight).
Depending on the species, our canine friends get many of the same problems that we associate with overweight in humans: arthritis, heart disease, respiratory conditions and some cancers. Obesity can also worsen the signs associated with pre-existing diseases such as osteoarthritis. In addition, obesity can affect a dog’s quality of life by making exercise and play more difficult or even impossible.
The medicine is, quite rightly, designed to be used with a diet and exercise plan.
This new medicine does appear to be a real advance, and its mode of action very interesting. Indeed I am at this moment looking at a dog who might benefit!
But I also notice that a number of news outlets have reproduced the Pfizer press release verbatim, and presented it as a news item.
What Pfizer said is 100% accurate, but when the media reporduce something without comment I worry that this is an example of “fake news.“
It is interesting to me that this story was released two days after the release of a report from researchers at the University of Alberta Hospital that has just been published in the Lancet.
Their conclusion? That we need better data on the long-term effects of anti-obesity drugs before more widespread use of the therapies. We need to know not just if a medicine leads to weight loss, but whether it leads to clinical benefit. We saw this with the recent tragedy with the medicine torcetrapib. This was a medicine designed to increase levels of HDL-( “good”) cholesterol. Indeed it does, but more people taking it died in a clinical trial, which was then stopped.
I am often asked, “Wouldn’t it be great if we could do anything that we wanted and then to take a pill to cancel out the effects?”
The answer to that one is surely a big, “No!”
Fortunately such a solution – which would destroy personal responsibility – seems to be years in the future.
If ever.
We MUST take responsibility for the things that we do.
To do anything less is to accept the fantasy that we are no more than machines at the mercy of our brain cells.
We are all far more than that.
And deep down we all know it.
Probiotics: Caveat Emptor Part 2
After I posted about the new data on the apparent importance of intestinal microorganisms and weight management, I received some very helpful comments and emails.
If you look at the "comments" section of the post, you will see this:
"www.Probiotic-Lab.com is manufacturing and distributing Bacteroidetes as a natural bacteria supplement for weight loss."
Posted by an "R.Russell"
Now I have previously reported on a conference in London at which a number of experts expressed concern about some probiotics available in the United Kingdom. So on your behalf, I not only posted the following response, but also emailed the company. First, because there is nothing on their website about marketing probiotics for weight loss and second because it is important to have these questions answered whether they are marketing probiotics for weight loss or for skin care.
This is what I wrote on the blog and also in my email to the company:
On behalf of my many readers may I ask www.Probiotic-Lab.com two questions?
1. In my posting I referred to a short piece that I wrote about a conference in London, at which some of the speakers warned that some products on the market did not contain the active ingredients claimed on the label. How do you guarantee the activity of your preparations?2. Though I am very familiar with the use of probiotics – I first used them in, I think, 1982 – I am intrigued that you are already distributing Bacteroidetes as a natural bacteria supplement for weight loss. What evidence do you have that they are effective? I could not find anything on your website or from a search of the literature. If you have some data to share I would love to analyze it, and if it’s of good quality I will go ahead and write about it, both here and in my articles.
Kind regards,
RP
I wanted to give them time to respond because of the holidays.
But as of today – seventeen days later – there has still been no response to my communications.
I also checked the scientific references on the front page of Probiotic Lab’s website. The first does not have anything to do with weight or skin infections, but actually refers to a study of ear infections. The second reference is problematic: it refers to the "American Medical Journal." But sadly I am not familiar with a journal of that name. I have looked at a range of American Medical Journals in case the journal name or date is wrong. But again I can find nothing.
I shall be delighted if someone can help.
I also looked to see if there is any published peer-reviewed literature on the use of probiotics and either weight management or skin disease, and again I have not been able to find anything.
So you can draw your own conclusions.
Should any data come to light I shall report it. Or if the company responds, I shall post what they say.
Wacky Warnings
The BBC just alerted me to the winner of the "wackiest warning" award for 2006.
First prize went to a washing machine that came complete with a warning not to put anyone inside….
An engine manufacturer who warned "Never use a lit match or open flame to check fuel level" won second prize.
Warnings not to dry wet mobile phones in microwave ovens and not to iron lottery tickets tied for third place.
Honorable mentions went to a telephone directory that advised: "Please do not use this directory while operating a moving vehicle".
The awards were made by the Michigan Lawsuit Abuse Watch who say that the tendency of Americans to sue companies has gone too far, encouraging absurd warning labels on products. Their website also has a list of just a few "loony lawsuits," some of which are mind boggling. One of my "favorites" was a prison inmate who sued because he thought that prison food was causing flatulence and a couple who claimed that dust from a neighbor’s house was "trespassing" on their home. These cases have been settled.
Given the level of frivolous lawsuits, the manufacturers of the products are unrepentant. One spokesperson said that the height of the washing machine would be just about right for a small child to climb inside. Who would not be able to read the warning label anyway. Mind you, we always check to make sure that none of our clowder of cats is lurking in the laundry before we switch on the washing machine.
All this reminded me of the annual Darwin Awards for people whose extreme lack of judgment may lead them to be removed form the gene pool.
Well this does not have much to do with our main themes of Health, Integrated Medicine, Meaning and Purpose. Or does it?
Actually it does. And not just because humor is an essential part of healthy living. It is because many people feel that there is a disconnect in our legal system: a disconnect between justice and legality. Whether dealing with the health of the body or the health of the legal system, if those two are not in harmony, we can expect for there to be problems.
We all want people to have legal protection and the right of redress, but I sometimes worry. Two cases in point. In the first a lawyer told me that he would take any case against a doctor because, as he told me, "Who cares? Nobody gets hurt and if I can get some money out the insurance company nobody loses." I know that his was an extreme minority opinion, but it worried me on several levels. I have seen what legal action can do to the most innocent of people. This individual told me that he was not interested in the consequences of his actions!
The second happened on a long flight. I was sitting next to a defense attorney who was defending someone who had admitted to a string of horrible crimes. He recognized my name, told me about a neurological defense that he was working on and asked me what I thought? I said that it was impossible to comment without seeing the records, doing interviews and so on. "But doesn’t it sound like a good defense?" he persisted.
"Well on the face of it he does not have any features of that illness," I replied.
He told me that another neurologist has already said that and that he was going to ignore his report.
I found this intriguing. I asked him whether he was interested in the truth of whether or not his client had the illness. He said, "Of course not, it’s my job to clear him."
And although that is, of course, his duty, all of this leads me to ask myself about common sense. And this is what the wacky warnings, the frivolous lawsuits and the letter of the law as opposed to its spirit have in common. And what all three have in common with Integrated Medicine.
Don’t they all need a really good dose of common sense to thrive?
“Common sense, to most people, is nothing more than their own opinions.”
–William Hazlitt (English Writer and Essayist, 1778-1830)
“Common sense is not so common.”
–Voltaire (a.k.a. François-Marie Arouet, French Writer and Philosopher, 1694-1778)
“As a rule, only very learned and clever men deny what is obviously true. Common men have less brains, but more sense.”
–W.T. Stace (English Philosopher, Former Mayor of Colombo and, from 1932-1955, Professor at Princeton University, 1886-1967)
The Price of False Weight Loss Claims
It has just been reported that this afternoon the United States Federal Trade Commission has recovered more than $25 million ro settle allegations of deceptive marketing for four products:
- Xenadrine EFX
- CortiSlim
- TrimSpa
- One-A-Day WeightSmart
This is not a surprise. For anyone with any knowledge of human metabolism some of the claims made in television and print advertisements were really far-fetched.
The fines may sound large, but are probably just a drop in the bucket for the companies.
This legal action is all about false claims, but there is another worry, and that is that some of the alleged weight-loss products may also have side effects. Two months ago I mentioned that there are currently investigations underway of at least two people who appeared to have developed manic symptoms while on Cortislim. It remains to be seen if there is a causal relationship.
Pretty much ANYTHING will help you lose weight in the short term. But if these products really worked and were safe, then why on earth wouldn’t doctors and nurses be using them themselves and prescribing them to their patients?
Sad to say weight loss does not come in a bottle: I only wish that it did!
Stick with the principles of gradually modifying your diet, exercise and be aware of the psychological traps that can sabotage healthy living. And please don’t waste your money on quick fixes that cannot possibly work.
If it seems too good to be true, then it probably is.
