Watch more TV: pop a pill for every ill

Kids these days know way more than they need to about erectile dysfunction, PAD, dyspepsia, fibromyalgia, osteoporosis, and eyelash lengtheners. They grin when they see the couple with an unexpected "Cialis moment" coming on and they suppress their laughter when they hear about erections lasting for 4 hours!

Most of these ads are so stupid and vague that it seems impossible to understand the purpose. And yet there is plenty of evidence to show that they work! For every dollar spent on direct consumer advertising ( DTCA), the drug companies make $4.20! Which means that for the $ 5 billion (yes, that's billion with b), that they spent in 2007, they made over $21 billion! That's a phenomenal return on investment! (Interestingly, the US and New Zealand are the only two countries in the developed world that allow DTCA).

There is absolutely no doubt that DTCA results in patients making unwarranted requests, while promoting  un-necessary fear of side effects. Needless to say, these ads always promote drugs that are newer, much more expensive and with limited or unknown safety track record.

They all end with the standard line "Ask your doctor if XXX is right for you". The patient promptly makes an appointment to discuss whether the "little blue pill", "the purple pill", or "the one with the butterflies" can be prescribed for them because they heard about it "somewhere". A significant number of times, physicians at least partially fulfill these requests to accommodate patients where they would have otherwise chosen an equally effective but less expensive and safer alternative. Or even a non-pill alternative like healthy life-style, God-forbid!

The fact of the matter is that the average visit with a physician last between 16 and 21 minutes. There is little time left for the physician to address misconceptions induced by DTCA. Physicians cite concerns about patient satisfaction and the therapeutic relationship as reasons to accommodate somewhat unreasonable requests. Doctors often fear that denying  requests could result in declining patient satisfaction.

During the past two decades, there has been an irreversible change in the nature of the doctor–patient relationship. Patients are seeking much more medical information and are actively participating in decisions affecting their health. Intruding into this trend has been the rise of direct-to-consumer promotion, which, in its initial thrust, bypasses primary care doctors and other physicians. Although increased access by patients to accurate, objective information about tests to diagnose and drugs to treat illnesses is an important advance, confusion arises when commercially driven promotional information is represented as educational. And the majority of easily accessible information is motivated by interests other than improving the patients' health.

So, the next time you see an ad for a drug on TV, change the channel! And please don't try using eyelash lengthener on your penis!