March 4, 2008

Essay

By ABIGAIL ZUGER, M.D.

Years ago, a large poster featuring an appealingly sweaty and smiling young man climbing a mountain appeared in my subway station, directly across from my usual waiting spot. Purportedly he had been invigorated by one of the first AIDS drugs marketed directly to the public. He looked magnificent on top of his mountain, a lot better than my AIDS patients �?a lot better than me.

The advertising campaign worked well. Over the months, quite a few patients urgently requested the mountain man’s drug. Then they began to come back complaining of some of the predictable side effects, which were debilitating and particularly tricky to manage. I moved down the platform so I wouldn’t have to look at the mountain man anymore. His smile had become a sneer.

Attractive, healthy-looking models playing sick patients will sell drugs; any magazine or medical journal proves this. So will models playing kindly doctors, their wise faces wrinkled in all the right places. They are all marketing magic pills to turn us into fairy-tale visions of our patients, our doctors, ourselves. Nothing new there: this is advertising.

Real doctors also have considerable personal power when it comes to drug marketing. Study after study shows that when doctors are plied with free pens and elegant restaurant meals, trips to snow-white beaches and turquoise waters, not to mention cash payments for listening to drug testimonials disguised as educational meetings, they will begin to endorse the products of their benefactors.

Until now, these have been the time-honored approaches to selling drugs: bluntly speaking, companies hire an actor, or buy a doctor. And then, Pfizer came up with a third option.

Dr. Robert Jarvik is neither a physician nor an actor, and yet he managed to sell medications for two years and, in so doing, deceived us all. Or so Congress implied as Dr. Jarvik’s performance as a spokesman for the cholesterol-lowering drug Lipitor came under intense public scrutiny last month. Pfizer finally pulled the ads last week.

Of course, Dr. Jarvik is indeed a doctor �?but he lacks the one commodity usually sought by the pharmaceutical companies: he has no medical license and cannot write prescriptions. And he is indeed an actor; he stood before cameras and read from a script. He even had a body double doing his athletic work for him, rowing a scull in the background of his advertisements.

But when it comes to drug ads, we are used to actorly actors, with full heads of hair and such appealing charisma that we want to be near them �?or to become them ourselves. Or conversely, we expect real doctors �?our own doctors, with our own individual best interests at heart, despite that Lipitor pen protruding from their pockets.

And such was the confusion engendered by the hybrid neither-of-the-above Dr. Jarvik that the escalating chorus of disapproval actually, incredibly, argued for the status quo: Dr. Jarvik may design artificial hearts, but if he is not a “real�?cardiologist, with real patients and a real prescription pad, then what qualifies him, the critics asked, to recommend this or any other drug?

In fact, a fully credentialed cardiologist touting Lipitor on television would simply be one more particularly visible iteration of a relationship the public is known to despise: a doctor paid in cash instead of goods for promoting a drug to millions, instead of one at a time.

Surely the best message we can derive from the Jarvik episode is that it may be time to rethink the advertising of prescription drugs. Both doctors and their patients need to be educated about these products, no argument there. But Madison Avenue’s usual embellishments can turn sinister when it comes to medication.

After all, we know that no pair of jeans or bottle of beer will bring us health, wealth, joy and a full head of hair. But when it comes to a pill, we all �?doctors and patients alike �?tend to succumb to wishful thinking.

Perhaps it is the time for all drug advertising to be reformulated according to the premise that a medication is too powerful, serious and subtle a commodity to be promoted by attractive or famous individuals �?doctors or actors �?making implicit or explicit promises while indulging in vigorous exercise and pocketing checks.