On Feb 6, David Lazarus, writer of “Consumer Confidential” for the Los Angeles Times, wrote an article on drug advertising, “Ads spur urge for drugs“. The article didn’t break any new ground in its analysis of how drug ads spur people to ask for drugs they may not need, but was a good overview of the issue.
Lazarus focused on a new Direct-to-Consumer ad campaign for Provigil, which originally was approved by the FDA to treat narcolepsy and is now also approved to treat “excessive sleepiness associated with obstructive sleep apnea.” The ads claim that Provigil can “fight the fog.”
Lazarus reports this telling exchange:
Jenifer Antonacci, a Cephalon spokeswoman, said the new DTC campaign is merely intended to raise awareness about excessive sleepiness.
“We’ve decided to take a leadership role in this area,” she said. “Our goal is to help educate consumers about excessive sleepiness and start a dialogue between patients and their physicians.”
While Provigil is being marketed as a remedy for fatigue resulting from sleep apnea, it’s not hard to imagine on-the-go people in today’s 24/7 world seeing the drug as a nifty way to cram a few more hours of wakeful activity into already crowded days.
Why settle for a venti latte at Starbucks when you can get the same kick (and possibly more) from a little pill?
Antonacci described a potential Provigil user as someone who repeatedly finds himself nodding off on the couch while watching TV at night.
“That’s me!” I responded.
“Maybe you have sleep apnea,” Antonacci observed.
So don’t be surprised if a lot of consumers who now ask their doctors about Provigil don’t have obstructive sleep apnea, shift work sleep disorder or narcolepsy, the only three conditions for which using Provigil to treat “excessive sleepiness” is approved. And don’t be surprised if those doctors write a prescription for those patients anyway:
Some doctors I’ve spoken with say they’ll suggest generic equivalents or alternative approaches. But if patients are determined to try a name-brand drug they’ve seen pushed on TV or in the paper, it’s often not worth the trouble trying to talk them out of it.
And studies bear this out. When patients ask their doctors for drugs they’ve seen on TV, doctors will prescribe them in much higher numbers than if the patients didn’t ask for an advertised drug by name. See, for instance, a study published in 2005 in the Journal of the American Medical Association: Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants
It strikes me as highly ironic that two very big markets for prescription drugs, and that feature lots of ads, are (1) drugs to help you fall asleep (Ambien, Ambien CR, Lunesta, Rozerem) and (2) drugs to help you stay awake (Provigil). It suggests that perhaps the problem is not a medical one, but a social one — we as a society just don’t get enough sleep. And no amount of pills will solve that. No matter what drug ads claim.
Or, as Lazarus put it:
I asked Antonacci what else could cause excessive sleepiness.
“The No. 1 cause of excessive sleepiness is not getting enough sleep,” she replied.
I’m no doctor, but the remedy for that seems simple enough.