In my San Francisco hotel room last week (business not pleasure) I reject the movie channels to watch those which have adverts. Forget Practical Magic and other new releases, I'm glued to the drug adverts.
For a start, the US has a more gloves-off approach. It's legitimate to slag off your competitors by mentioning the side-effects of their drugs (theirs irritates the stomach, for example, while yours wouldn't harm a baby's bottom) as well as claiming that the best doctors and hospitals only use your product.
Although the Food and Drugs Administration bans drug companies from saying their medicines may have benefits beyond their main use, many manufacturers do it anyway. They can't say their product, containing aspirin, can reduce the risk of a repeat heart attack, but they can show a heart monitor graphic at the right moment.
But all this is nothing compared to the fact that drug companies can advertise prescription-only drugs to everyone. In the UK they can only advertise to doctors and the advert (usually showing an attractive woman lying down, whatever the drug) has to be printed with its prescribing information, a long screed in small print that not only details the dose, but also side-effects and warnings. Some doctors comb through medical journals to check claims - one drug company was recently taken to task for claiming its medicine had 'proven benefit' when studies had shown it was probably effective but not quite of proven worth.
In the US, however, drug companies have long been allowed to advertise in any magazine or newspaper as long as they include the prescribing information, whether or not it was intelligible to general readers. The motivation is obviously to get patients to badger their doctors.
Until atwo ago companies were less keen to advertise on TV because of FDA restrictions which said they had to carry the whole prescribing information, or make only vague statements. So an advert for a tablet that improves urine flow in elderly men with enlarged prostates, for example, could only say something like: 'There's some good news if you have a blockage in your prostate.' Pause. 'Ask your doctor.'
Which could be hit and miss, as the doctor may then recommend a competitor's product. Many adverts were even less explicit. One for hayfever medication had a women skipping through a sunny field with the voiceover: 'At last a clear day is here. Ask your doctor.' Women with everything from acne to gynaecological complaints did just that.
But the FDA has changed its policy. Companies must now give a balanced account of benefits and risks, and provide easy access (a free phone number or Internet address) to more detailed information. The drug that alluded to a clear day had its advert promptly updated. The named drug could, it said, offer 24-hour relief from allergy. The FDA promptly censured it for unbalanced information. It's hard to get the balance right.
Consumer groups are generally in favour of the right to advertise in this way. They say the adverts are educational, as doctors don't always know what's available. Patient demand certainly contributed to the success of Prozac and Viagra, both heavily promoted. Indeed, consumer snitching about Prozac to the authorities instigated an investigation into Health Maintenance Organisations in California.
Basically HMOs offer a prepaid service, in which there's a fixed sum of money to cover the needs of their patients. They aim to keep costs down while maintaining quality, so theoretically would limit patients to the cheapest 'effective' treatments.
In California the HMOs are being accused by consumers of refusing to prescribe certain drugs, among them Prozac. Consumers are in no doubt that Prozac is worth keeping on any hospital list of prescribable drugs - because they've seen the adverts. And therefore it will probably be cheaper and more effective to just let them have it.