We've got the pills, so you must have a problem

31 , 2007/The Guardian

Direct to consumer drug adverts in America are a proper joy, and especially the TV ones: your
life is in disarray, your restless legs/migraine/cholesterol have taken over, all is panic,
there is no sense any where. Then, when you take the right pill, suddenly the screen
brightens up into a warm yellow, granny's laughing, the kids are laughing, the dog's tail
is wagging, some nauseating child is playing with the hose on the lawn spraying a
rainbow of water into the sunshine and laughing his head off as all your relationships
suddenly become successful again. Life is good.
They even have celebrity endorsements for drugs, on chat shows, conveying important
treatment information on odds ratios and relative risk - if I can slip into 1990s teen slang for a
moment - "not".
It couldn't happen here. But now, excitingly, it looks like it might. The pharmaceutical
industry HAS consistently been knocked back in the EU, and WAS turned away on its last
request to "educate" the public in 2004, but the EU "Pharmaceutical Forum" is reconsidering,
and reports next month.
Like the rest of the advertising industry, pharmaceutical companies look at their nails
innocently when you suggest that adverts might affect behaviour, even though they know that we know - that they'd only spend money on it if it worked. In fact, specific campaigns
have been shown to affect prescribing practice, because modern doctors listen to their
patients' demands, and pharmaceutical consumer advertising is growing twice as fast as
advertising direct to doctors, for one simple reason: history has shown that you are stupid and
easily led, although your education in Bad Science may stand you in good stead.
Doctors are trained to spot bullshit, and this is one area where paternalism, I would argue, is
acceptable. Pharmaceutical companies produce next-level, postgraduate bullshit. Drug reps
brandish literature that is the comedic parallel of the promotional stories you get in the media
for supplement pills, but the tricks are far more complicated: they cherry pick the literature looking only at the positive studies - they use surrogate endpoints - a blood test rather than a
stroke - they use inadequate controls - a lower dose of the competitor's drug. They do all this
far more subtly than the homeopaths, or the fish oil gang, because they are addressing a
critical audience.
The best the public and journalists can offer in the face of big pharma's advanced hustling is a
rather infantile set of conspiracy theories that all drug company research must be "biased"; but
they can't quite explain why, because it's boring and largely impenetrable, and so they only
focus on the few clear examples of corporate fraud, where safety data has been mischievously
withheld.
But the move the drug companies are demanding is far more interesting than the right to
produce straight adverts. They want the opportunity to "educate" the public, directly, building
awareness of disease, and biological treatments, and re-framing our understanding of our
bodies. This is a far more sinister project, and one pursued by all flavours of pill peddler.
The nutritionists and food supplement industry - whom the newspapers continue to picture as
a quaint cottage trade, rather than a multibillion-dollar pill industry - run about telling
everyone they've got food intolerances, or hidden dietary deficiencies, or frightening disease
risks, for which they have the solution, in a pill.
The drug companies, meanwhile, overplay the role of medication in the treatment of mild
depression, and sell new conditions like "restless legs syndrome", or "female sexual
dysfunction", for treatment with pills which they, too, already had in the warehouse.

Pills are seductive and easy, especially for problems with a strong psychological or social
component; but the tragedy is, in the UK, there is nobody advocating against this
disempowering pill mentality: only different groups, some of whom claim to be "alternative",
squabbling over who can sell the most pills.