Don't Be First On the Block

If you can help it, don't be the first one on your block to try a new drug.


This is not very easy even with widespread availability of proven and safe drugs.


Enter the drug companies, with a vast array of formidable strategies,  to make us hell bent on embracing new drugs all the same.


They also cultivate a nagging feeling in us that we are not nearly as well or functional as we should be.  It follows that their latest medications are just the thing to fix us up.


Perhaps their most successful sales pitch is advertising prescription medicines directly to the public on television.  This is not allowed in many countries,  including Australia, and it is an egregious mistake as the consequences of pill sales are vastly different and more serious than, say, refrigerators.


The ads are like smart bombs hitting their targets at will with amazing accuracy.   Despite dutiful recitations of doomsday side-effects, there is a sunny whimsicality and hopefulness which prevails, making the ads highly seductive and effective.


The companies go after the big fish: depression, erectile dysfunction and hypercholesterolemia.


A typical ad goes something like this.  A young girl goes bounding through a field of high grass, hat lifted by the wind,  much as the drug lifts her depression,  while a narrator earnestly recites a hefty list of misfortunes that could befall the user of this product, with the implied exception of the girl bounding through the tall grass.      


Listen in:  This drug can cause listlessness, constipation or diarrhea.  This ant-depressant has on occasion been associated with suicidal ideation  and insomnia.  Weight can go up or down.  Libido is commonly grounded and erectile dysfunction is certainly possible.  Skin can dry and fatigue is common.  Be sure to discuss these side effects with your physician should they be bothersome.  


Another ad teaches the viewer that folding laundry with your mate can be a major turn on, with the impending ignition of smoldering coals for those who are only ready.  Again, there is a broadcast of numerous disasters that could befall those trying to reach the promised land of hot burning coals.


Nonetheless,  patients, who used to think their sex lives were just fine,  or that they were just somewhat moody, damn the torpedoes, storming clinics and pharmacies, requesting the new product.  


These targeted drugs are, on the other hand,  members of drug categories that are important, relevant and often effective elements in our therapeutic arsenals. 


So what is the problem?


The problem is that we have developed a therapeutic culture, in which we have drugs looking for patients instead of patients looking for drugs.


Instead of normally robust sexual lives, we seek super normal sexuality.


We often mistake sadness for depression, medicalizing something that is part of the human condition and much better dealt with by fortifying our relationships.


Moreover,  it has been convincingly shown that the majority of hotly advertised medications do not offer meaningful benefit over the standards.  


For example,  anti-depressants generally work equally well.   The same is the case for blood pressure pills.  Importantly, the trumpeted drugs are alarmingly more expensive than the standards which are largely generic.  With few exceptions generic drugs should be used compulsively because of their effectiveness and lower cost.  


Drug companies might need more anti-depressants, we do not.   


Moreover, it is wise to be skeptical  about the safety of new drugs.  Many prescription drugs, over the years, despite rigorous scrutiny by the FDA, still bite us with serious side effects  when filtered through the whole of society, sometimes after only a year or so. 


It is especially unwise to switch from  tried and true drugs, which work well, for a new model, believing that a new drug is an advancement over a well seasoned one. 


When patients and I talked about the above issues I finally came to a metaphor that worked well to frame the discussion. It is a military one for taking a beach head with an amphibious assault.  In such an assault most of us would prefer not to be sent in on the first few waves.  The seventeenth, for example,  should prove to be much less gruesome.


The same can be said for new drugs,  and the taking of what amounts to a pharmacological beach head,  where it is likewise prudent to not go out on the first waves, if at all possible.    


This means that time needs to pass before we can wholeheartedly sanction a drug for regular use.  There can be compelling reasons to deploy a new drug but they are not common.


The beach head metaphor resonated quite well with most patients and few were the first on their block to try a new drug.