JIM LEHRER: Finally tonight, an ad for a leading heart drug raises concerns. And Jeffrey Brown has our story.
AD NARRATOR: Dr. Robert Jarvik, inventor of the artificial heart.
JEFFREY BROWN: For the last two years, the pharmaceutical giant Pfizer has been running ads for the cholesterol drug Lipitor that feature Dr. Robert Jarvik, best known for developing an artificial heart 25 years ago.
Lipitor is the top-selling drug in the world and Pfizer’s biggest product, with $12.7 billion in sales last year. But it’s been challenged in recent years by cheaper generic alternatives.
Today, a front page New York Times story brought into the open a number of questions about the Jarvik ad and others in which prescription drugs are advertised directly to consumers.
One issue, Dr. Jarvik’s credentials. He has a medical degree, but is not a cardiologist and not licensed to practice medicine.
Another issue raised is whether the ad is misleading in showing Dr. Jarvik vigorously rowing. In fact, he is not a rower, and a stand-in was used.
A congressional committee, led by Democrat John Dingell, has been investigating the use of celebrity endorsements of prescription medications. In a press release today, Dingell said, quote, “In the ads, Dr. Jarvik seems to be dispensing medical advice, despite the fact that he is not licensed to practice the prescribed medicine.”
In a response to Congressman Dingell’s initial inquiries, Dr. Jarvik said, in part, “I have the training, experience and medical knowledge to understand the conclusions of the extensive clinical trials that have been conducted to study the safety and effectiveness of Lipitor.”
For its part, Pfizer said in a statement that it stands behind its consumer advertising with Lipitor and “our work with Dr. Jarvik to deliver important information on managing heart health.”
Jarvik's credentials under scrutiny
JEFFREY BROWN: And we look at all of this now with Gail Shearer, director of health policy analysis for Consumers Union, a consumer advocacy group, and Peter Pitts, director of the Center for Medicine in the Public Interest, a group that receives funding from the pharmaceutical industry. He previously served as associate commissioner for external affairs at the FDA.
And for the record, we invited Dr. Jarvik and a representative from Pfizer to join us. They declined.
Well, Gail Shearer, Congressman Dingell says Dr. Jarvik seems to be dispensing medical advice. Do you agree?
GAIL SHEARER, Consumers Union: Yes, it does certainly have that impression.
And, actually, we did a survey of consumers, people who have high cholesterol, and we found that they got the impression from this ad that he was a practicing doctor, practicing cardiologist, and that he really -- it gave people the impression that he really was providing medical advice. And we're really troubled by that.
JEFFREY BROWN: What about the issue of his credentials in this case? Does that trouble you, as well?
GAIL SHEARER: Well, it does, because that ad, it turns out, was extremely effective in influencing what consumers thought about what drug they should take.
For example, one out of five people who we surveyed said that if they were taking a generic drug, they would go to their doctor and talk about whether they should take Lipitor. Well, that kind of impact is enormous.
And we want to make sure that consumers, patients are getting full, unbiased information just at a time when the stakes are so high. This country, if we don't figure out how to rein in our drug costs, we're really heading for more of a disaster than we have now.
And so the implications -- the stakes are so high, and it's very troubling.
JEFFREY BROWN: Mr. Pitts, what do you see? Are you troubled?
PETER PITTS, Center for Medicine in the Public Interest: Well, I don't think that the ad is going to cause people to stampede towards the American Rowing Association.
But as Gail said, if it causes people to go visit their doctors and talk about high cholesterol, hyperlipidemia, that's a good thing, because that's one of the highest undiagnosed chronic diseases in this country.
And if we can get people to talk to their doctors and get properly diagnosed for these chronic diseases, such as high cholesterol, that's a good thing, and that's what direct-to-consumer consumer advertising does. It drives people to talk to their doctors.
And research shows pretty much unequivocally that people do not take pills they don't need, doctors don't prescribe medicines that aren't appropriate, and that a better prescribed medicine will get a person healthier. It's going to reduce costs; it's going to make that person's life more productive.
And ultimately, to Gail's point, it's going to reduce our health care costs over the long term. That's what focusing on chronic disease does, and that's what direct-to-consumer advertising does, as well.
Comparison to generic drugs
JEFFREY BROWN: But I think she's saying more than it drives them to a doctor; it drives them to a doctor with a particular product in mind, in this case one that costs more than alternatives.
PETER PITTS: Well, no two drugs are alike. You mentioned earlier that there were lots of generic alternatives to Lipitor, and that's true, but there's no generic for Lipitor.
And it really is the doctor's decision as to which statin, which is what Lipitor is, a drug that lowers cholesterol, which drug is best for their patients. And if that drug is a generic, that's terrific. It costs much less. If the drug is Lipitor, as it is in many cases, which is why it's our country's most prescribed drug, that's an important thing, too.
But a patient who comes in and asks for Lipitor is going to first be examined by their doctor, and the doctor is going to make a professional medical decision as to which drug is most appropriate for that patient. And if the drug that the patient asks for is not appropriate, that drug is not going to be prescribed. And that's pretty much across the board what our research is showing.
JEFFREY BROWN: And what about the question of whether it is misleading to, given his credentials, the appearance of giving medical advice, in this case?
PETER PITTS: Well, you know, this ad, I'm sure was cleared through DDMAC, which is the FDA office that basically vets a lot of these ads. And at the end of the day, you know, he is a physician.
And, as Gail said, he's not a practicing physician. He doesn't see patients, but neither did Jonas Salk, who's a medical icon all around the world.
I mean, let's face it: Robert Jarvik is a for real medical hero who actually takes Lipitor for his own condition, so I think he has the credibility both from the medical creds and from personal perspective.
As to the rowing episode, you know, I think that's a lot of people trying to make a lot out of nothing, especially people in Congress.
Weighing doctors' roles
JEFFREY BROWN: Well, let me ask you about the rowing episode first, so we can get that out of the way. Does that one trouble you, as well?
GAIL SHEARER: Well, I think it's good for people to have the full information, so it's troubling, but not troubling the way the other issue is. But I think it's important to keep in mind that these ads -- well, first of all, they're very effective. We know they're effective.
JEFFREY BROWN: The companies do it. They spend a lot of money. They know it's effective, and you've done the studies that suggest they're right.
GAIL SHEARER: We know that consumers pay attention. You see the music and everything. It just has an impression. It has a real effect, but it's important to keep in mind that this is the tip of the iceberg.
Not only is the drug industry spending billions of dollars on ads; they're also giving free samples to doctors. And they're also doing all this detailing to doctors.
So they're going into the doctor's offices. We all see these marketers at our doctor's offices, and they're "educating" the doctor about the drug choices. What we need in this country...
JEFFREY BROWN: Wait a minute. You did a quotation around "educating," meaning...
GAIL SHEARER: Yes, "educating," giving them their company's information about their drug, when what this country needs is full information that's unbiased that goes through all the options, including the generic options.
If a doctor has just had a visit from a Lipitor detail person and the consumer, the patient comes in, and says, "You know, I really think I'd better have Lipitor," well, all those things add up to shift the market toward this high-priced drug, when maybe there's a good chance a generic statin could have been used instead.
JEFFREY BROWN: Do you see that larger issue, Mr. Pitts, moving people through that kind of marketing towards the higher-priced drug?
PETER PITTS: Well, I don't know what Dr. Gail goes to see, but when I go to my physician there's a big sign on his desk that says, "Not seeing reps today." So I'll give my doctor the benefit of the doubt that he's not being swayed inappropriately because of a pen or a coffee cup.
You know, as to the rowing episode, again, people use it to put people on their heels about direct-to-consumer advertising and talking to doctors. I think that if we want our doctors to be better informed and we want them to go to places other than listening to drug reps, I think that's terrific.
But at the end of the day, we have to understand that doctors are busy. They're not having the time they used to, to read journals, and pharmaceutical detailing is one way they're getting information.
I know one of my issues with Consumers Union and Consumers Report is that they try to rank medicines like they rank toasters and vacuum cleaners. You simply can't do that. You have to have a doctor-patient relationship.
And, again, I don't think that doctors are being unfairly swayed to make unprofessional decisions. I think that if we move forward and try to disempower physicians by not allowing them to have the information they need to make qualified choices for their patients, we're doing patients like me and Gail a tremendous disservice.
So we've got to get beyond the propaganda to what's best. And in my opinion, what's best is not getting in the way of a doctor-patient relationship and letting the doctor have as much information from qualified sources as possible.
I think it's important to understand that the information that drug representatives give to physicians are very highly regulated. So the intonation, I think, from Gail is that they're getting kind of propaganda or half-truths or untruths, and that's simply not true.
Debating advertising regulation
JEFFREY BROWN: What is your advice to patients? And what would you like to see done for more regulation, if that's the case?
GAIL SHEARER: Well, first of all, we want more information that's unbiased and that's complete. And Consumer Reports has information on our Web site that does just that, and the government is providing more information.
But there are a few things we'd like to see. We'd like to see Congress pass a law that would put a moratorium on ads for new drugs, drugs that are just on the market, say, three years. It's in those early years when a lot of the problems -- safety problems, side effect problems -- play out.
We want to make sure then that consumers can report when they do have problems with drugs.
And we also want to see the FDA do a better job. You know, these early days, even a short ad campaign, if it's allowed to be out there, can have a tremendous impact on the market. We want the FDA to toughen its enforcement against misleading representations made in ads.
JEFFREY BROWN: Mr. Pitts, time for a quick response to that, on more regulation of ads, especially in early stages.
PETER PITTS: Well, you know, you can't deny people drugs that are on the market. That's called the precautionary principle, not doing anything until you know everything. And that's a slip slide backwards away from really good public health. It's a very bad idea.
JEFFREY BROWN: All right, Peter Pitts and Gail Shearer, thank you both very much.
GAIL SHEARER: Thank you.
PETER PITTS: Thank you.