by Virginia Suarez [vsuareznin@yahoo.com], a  UNC student in public health.

Controversy around heavy advertising of prescription drugs (often called Direct to Consumer or DTC advertising) has been on the rise recently with an increasing number of questions around effectiveness and safety. Just a few examples of recent scandals and drug recalls include:

• Vioxx linked to serious adverse events including heart risk, stroke and death
• Accutane linked to birth defects and increased risk for heart and liver damage
• Ketek linked to liver damage including liver failure and deaths
• Zelnorm linked to increased heart attacks and strokes
• Lotronex linked to ischemic colitis and multiple deaths

Consumer advertising spending by the drug industry has more than quadrupled in 7 years. According to a Congressional Research Service report, it increased from $791 million in 1996 to $3.2 billion in 2003, for mostly 50 brand name drugs.  Overall health costs have nearly doubled over this same time period.  Getting this spending under control is a key part reducing health costs both in North Carolina and nationally.

The medical profession agrees.  Doctors overall tend to view DTC advertising negatively. Survey results, published in the Archives of Internal Medicine, concluded that a majority of physicians felt that DTC advertisements increase overall drug consumption (61.9%), do not provide enough information on cost (94.9%), lead to patients’ request for specific drugs (80.7%), do not do a good job of informing patients of side effects (54.8%), do not provide sufficient information on alternative treatments (94.9%), increase patient visit times (55.9%), and need better regulation (68.8%).

The FDA also may slowly be waking up to this situation.  Before the pharmaceutical company Merck pulled Vioxx out of the market in September 2004, Dr. David Graham of the FDA reported that an estimated 88,000-140,000 excess cases of serious coronary heart disease probably occurred in the USA with a 44% fatality case rate.

DTC advertising not only increases cost of prescription drugs but more importantly it puts many people at risk of serious adverse events including death.  Banning DTC advertising is a good first step to start getting costs under control and improving the health of patients.

Written by Josh Glasser, Fulbright Scholar

I was in Nghi Son Village today, a small fishing village on the Vietnamese coast. It has a small harbor, but otherwise it is very quiet and even depressed economically. It's village leadership are nice enough, but they have received nowhere near the education that one would typically receive at an American university (even if they went to a Vietnamese university, which some may have).

Nghi Son also has a drug problem, which has caused an increase in HIV, which has caused the village to adopt a needle exchange program.

Now, riddle me this. Our legislature has the "best and the brightest" either serving or on staff. It has plenty more resources than your typical Vietnamese fishing village. It has all the time and experts handy to design and explain the program to the public.

How exactly does the village government in Nghi Son have a better public health policy with regard to needles than the State of North Carolina?