Self-policing often the answer for ethical dilemas

Key Points

Q The world has changed since we went to medical school. Before we get to issues affecting physicians, what do you think of direct-to-consumer advertising for prescription pharmaceuticals? Has it been a benefit or a detriment to health care?

A It's a double-edged sword. It's been an extraordinary benefit insofar as it brings public awareness to disease entities that might otherwise get ignored. I think there's no better example than overactive bladder. Here was a symptom complex that was largely ignored by physicians, and the patients who suffered from those symptoms were very much undertreated. Educating over 40 million Americans that these symptoms are abnormal and that there are effective treatments for OAB has been a great benefit.

Q Do you think the problem was that the maker of Vioxx directed its advertising to consumers, or that doctors didn't use the drug properly?

A It was both. It's unreasonable to expect doctors to be that well versed in all the nuances of these drugs. For example, with Vioxx, the incidence of heart attack in one large-scale study was .4% for Vioxx and .1% for another nonsteroidal anti-inflammatory drug, and even that data was buried in an avalanche of other data that obscured its significance. Such small numbers are hardly on anybody's radar screen, so it is no surprise that Vioxx was prescribed for so many patients without GI risk factors.

Q I'm particularly concerned about two commercials. One is for an erectile dysfunction drug saying that diabetes and hypertension are associated with ED, and this drug can help, implying that the drug can help treat diabetes and hypertension. The other is for a sleep drug that implies that if you can't fall asleep quickly, you should be on this drug and that you can take it indefinitely. Do you think these ads are misleading?