A look at the pharmaceutical industry, drug advertising and herbal alternatives.
Consider your choices. People who pay attention to print and broadcast ads could be convinced that a prescription drug exists to cure any ill — even illnesses they didn’t realize they had. The same consumer might conclude that herbal medicines are worthless — or dangerous, if the knitted brow of the television news anchor is any indication: “A new study reveals St. John’s wort is no more effective than a placebo in treating depression.”
Most news anchors missed the revelation in that same study that the prescription drug Zoloft also was no more effective than a placebo. They also didn’t follow up to discover that the study itself is now on trial, its protocol questioned even by one of the scientists who helped initiate it.
Much larger concerns about pharmaceutical medicines growl and huff outside the studio door, but few members of the mainstream media seem able to tear themselves away from the party line (pharmaceutical drugs good, herbs weird) long enough to investigate.
The issue isn’t whether the best choice is synthetic pharmaceuticals or natural herbs — the answer to that question is as individual as the compounds and the illnesses being considered. The issue is why the American public can’t get its hands on enough well-researched, unbiased information to make informed choices.
In 1997, the U.S. Food and Drug Administration (FDA) decided to allow pharmaceutical companies to advertise prescription drugs using their specific names and the conditions they treat. And the rush was on: In 2001, according to The New York Times, drug companies spent $19.1 billion on promotional campaigns, including $2.7 billion — yes, billion — for advertising aimed directly at you and me, not physicians. The article quoted a report from the U.S. General Accounting Office (GAO) stating that spending on consumer-directed advertising rose at a far greater rate than spending on drug research. In the future, we may not have many new treatments for disease, but we can count on lots of new, great-looking television and Internet ads. Stay tuned.
The issue of drug advertising directly aimed at consumers was thrust into the news recently when Merck withdrew its arthritis painkiller Vioxx from the market, citing studies indicating a risk of heart attacks or strokes. Critics noted the role advertising and marketing played in the drug’s being widely prescribed to patients who might have done just as well with ibuprofen or other, less expensive over-the-counter remedies.
Whatever its safety risks, Vioxx was hardly unique as a prescription drug that became a best seller on the strength of advertising directed at consumers. In the seven years since the FDA lifted longstanding restraints against such ads, prescription drug advertising has grown into a $3.8-billion-a-year business. And the FDA says that, despite the controversy accompanying the withdrawal of Vioxx, it has no plans to place new controls on such ads.
The news isn’t all bad: Some of this advertising has paved the way for frank and helpful doctor-patient discussions. Consumers definitely pay attention to these ads; in fact, according to a 1998 study sponsored by Prevention magazine in conjunction with the FDA, an estimated 61 million patients talked with their doctors about a medical condition after seeing a drug advertisement. Unfortunately, ads and news reports rarely provide enough clear information and are sometimes downright deceptive. Investigators for the GAO recently reported that some drug companies have repeatedly disseminated misleading ads for prescription drugs, even after being cited for violations. That leaves only physicians, often already harried and overworked, to answer the questions advertising claims create.
Doctors themselves give this advertising mixed reviews. A recent FDA survey of 500 physicians reported that 40 percent of doctors surveyed said drug companies’ advertising had a positive impact on their patients. But a nearly equal number — 33 percent — disagreed, and said the ads’ effects were negative. Among the criticisms were that the ads sometimes prompt patients to ask for unnecessary prescriptions and that the ads confused the relative risks and benefits of medicines.
And physicians themselves are not immune to pressures from the pharmaceutical industry. A study quoted in the Journal of the American Medical Association (JAMA) said that doctors’ interactions with drug company representatives begin during medical school and continue at a rate of about four times a month. The study concludes that these visits from pharmaceutical representatives increase prescriptions of that company’s medications and non-rational prescribing — meaning the drug prescribed wasn’t necessarily the best suited to treat the condition. The good news: 81 percent of us who asked about conditions we learned of from ads actually did have the condition. The bad news: The drugs we were offered weren’t necessarily the best medicine — just the best advertised medicine.
The landslide of advertising dollars buries the crucial fact that our pantries are full of foods that can help maintain our health — sometimes we don’t need drugs in the first place. When we do fall ill, many safe, relatively inexpensive, natural options exist to treat our conditions. Humans have always had to deal with catarrhs and fevers of unknown origin, ordinary aches and pains, the side effects of overindulgence and the cyclical maladies that accompany being male or female. Throughout hundreds of generations we have used what nature provided to foster our health and to treat our ailments.
Some of these treatments were no more effective than those you and I might concoct off the top of our heads. But many traditional herbal remedies have passed the test of time and deserve to be put on a front shelf in our medicine cabinets. This is not to say that synthetics are never useful, but simply that they aren’t the only game in town. There’s not a lot of gold in them thar’ herbs, since they often can’t be patented, so they’re minimally — if at all — studied, tested and advertised. The media generally ignore them — and only the most motivated consumers ferret out the facts about what ought to be as natural as a walk in the garden.
“The pharmaceutical drug industry spends between $8,000 and $13,000 per year per physician to promote their products,” says James A. Duke, Ph.D., one of the world’s foremost authorities on medicinal plants and author of the best-selling The Green Pharmacy (to order, see Page 58). Recently retired from a 30-year career with the U.S. Department of Agriculture, Duke holds a doctorate in botany and has done extensive fieldwork, which inspired his passionate advocacy of herbal medicines — and an almost equally passionate outrage over the promotion of expensive, often ineffective and sometimes toxic synthetic drugs. For the best of the best herbs, see “Dr. Duke’s Dynamic (Baker’s) Dozen,” Page 27.
The media’s failure to report positively or even from an informed perspective on herbs and supplements is a complicated situation — but worth untangling. At stake is nothing less than our health.
“A hundred times a day the television tells you to ask your doctor if expensive Brand X is ‘right for you,’” Duke says. “At the same time the press loudly lambastes herbal companies for making unproven claims, they’re meekly sleeping through the even greater deficiencies of some of the synthetic drugs.
“How many of us have heard that no herb has been clinically shown to arrest anthrax? True, none have. But how many of us has heard that Cipro (the synthetic prescription antibiotic presumed to work against anthrax) also hasn’t been shown to arrest anthrax? How many have heard that garlic often works with synthetic antibiotics? If I were exposed to anthrax, I’d certainly want to take some garlic (a proven antibacterial) and some echinacea (a proven immune booster) along with my Cipro — if I could even get the Cipro. The garlic and echinacea, I have in my garden and in my pantry.
“How many times do we hear the press tell us that a disease is especially dangerous for people with compromised immune systems? Do we ever hear the corollary, that boosting our immune systems will help us resist these diseases, and that there is an abundance of herbs and foods that can give our bodies that boost? Ninety percent of plant-derived chemicals are cheaper both environmentally and ecologically to extract from whole plants than to synthesize. Which alternative do you think makes more sense?”
The media’s failure to report positively or even from an informed perspective on herbs and supplements is a complicated situation — but worth untangling. At stake is nothing less than our health. William Allen, an independent science writer and a senior fellow at the Institutes for Journalism and Natural Resources, says those drug-company advertising dollars are only part of the picture. “The situation has to do partly with public relations, partly with the record of scientific achievement of pharmaceutical companies,” Allen says, “and partly with the perception of drug companies as mainstream and of herbal companies/advocates as ‘fringe.’ I’m not saying it’s fair; it just is.”
The pharmaceutical industry has a lengthy record of doing and supporting good scientific research on many of its drugs, Allen says. On the other hand, there has been good science debunking some of the herbal advocates’ claims. This contrast lingers in the minds of many journalists and shades their perception on both sides of the issue. Add to this the pharmaceutical industry’s army of public-relations flaks, mountains of press releases and incessant presence in broadcast and print advertising, and the sum is a well-funded, powerful and aggressive force.
“Against this tidal wave,” Allen says, “there are relatively few science writers to cover the pharmaceutical industry for the mass media. This means that the drug industry gets relatively little scrutiny by journalists qualified to probe its dark side — not to mention having the time to do so. Instead, nonscience journalists crank out stories using big drug companies’ press releases about this or that new drug.”
“The unnatural synthetic drugs our genes are just now experiencing are much more likely to accumulate in the environment and to harm the human body than natural compounds our genes have known for 7 million years.” – Dr. James Duke
Drug development and trials are costly affairs: Pharmaceutical companies are highly motivated to get their products on the market as soon as they are able. According to research from the Tufts Center for the Study of Drug Development, taking a drug from discovery to approval for marketing in the United States typically takes 10 to 15 years and costs about $802 million. Unfortunately, the drive to recoup this investment sometimes means that drugs are on the shelves and in our bodies before they’ve been given a good test-drive. Adverse drug reactions are one of the leading causes of death in this country, according to a report in the May 2002 JAMA. Right up there with heart disease and cancer, we’re dying from drug companies’ oopsies.
In fact, 10 percent of all new drugs approved from 1975 to 1999 either acquired new warnings or were withdrawn, according to the JAMA article, which concluded that serious adverse drug reactions commonly emerge only after FDA approval. Consider the drug Baycol, widely prescribed as one of the newest and best defenses against dangerous cholesterol. The parent company, Bayer, removed Baycol from the market in 2002 after it was cited as the cause of more than 30 deaths.
Fortunately, it often isn’t necessary to resort to drugs. Plenty of foods and herbs can help bring cholesterol levels down, such as avocados, beans, carrots, garlic, safflower, sesame and shiitake.
In a dramatic example of this dilemma, hundreds of reports on adverse side effects of the antimalarial drug Lariam are on file, and the Army is investigating whether Lariam played a role in murders at Ft. Bragg involving soldiers who took the drug.
Yet, according to Duke, whole sweet Annie (Artemisia annua) an herb vastly cheaper than the synthetic chemicals in Lariam, contains several antimalarial compounds proven to work against malaria and even drug-resistant bacteria.
In January 2003, the FDA announced that all drugs containing estrogen for menopausal women must include warning labels stating that these drugs may slightly increase the risk of heart attacks, strokes, blood clots and breast cancer. This precaution comes decades after the drugs first hit the market.
The sky-high cost of research also means that many effective but unpatentable herbal medicines never get fully tested so they can be marketed as drugs. Instead they are sold as nutritional supplements, and FDA rules prohibit manufacturers from making health claims about supplements.
If consumers want echinacea to treat a cold, or uva-ursi to treat a bladder infection, they have to embark on their own research projects to discover whether the herb is appropriate for them, if the herbal medicine has contraindications, and how much and how often they should be treating themselves. They can buy the herb, but they won’t find this information on the package.
Newer drugs often are more expensive and not as effective as drugs that have been around for a while, but once the drug companies’ patents on new medicines run out, any company can produce generic versions. So the companies want to establish a beachhead and sell their brands as aggressively as possible before their patents expire. Consumers are admonished to buy, buy, buy medications that may be no more effective but are certainly more expensive than their older cousins.
Many studies have surfaced in the past few years detailing the appearance of drugs of all kinds, including antibiotics, antidepressants and hormones, in our water supplies. Some of these substances have been documented as causes of genetic mutations in small fish and amphibians. The primary methods of water treatment in the United States fail to remove all of these microcontaminants from our drinking water.
The FDA says drug residues in water supplies are at such low levels that they are unlikely to pose risks to human or aquatic life. But little research exists on how much of this microcontamination our bodies can tolerate or what is likely to happen when Substance A mixes with Compound B plus a little fertilizer or pesticide runoff from local fields. Perhaps nothing, perhaps a lot. The point is, no one knows.
“The unnatural synthetic drugs our genes are just now experiencing are much more likely to accumulate in the environment and to harm the human body than natural compounds our genes have known for 7 million years,” Duke says. “Researchers have estimated that up to 80 percent of drugs taken by people and livestock are excreted and then go back into the environment.
“If more and more synthetic drugs are made and sold, isn’t it reasonable to believe that these substances will increasingly show up in our drinking water? I would certainly expect that even low levels of some drugs in our water will have an effect. Fish and frogs’ sex lives today; our lives tomorrow.”
Given medical care’s skyrocketing cost and the fact that cheap, safe and effective herbal alternatives exist for many common ills, maybe insurance companies will lead the way to prevention and more natural treatments. A clash among titans is sure to ensue — Forbes magazine ranks the pharmaceutical industry as the most profitable industry in the country, one that’s not likely to go quietly into the good night.
But this doesn’t mean we are at the mercy of the drug companies and an overly influenced medical profession. We should review reliable research on whatever medicines we consume — whether herbal or synthetic — and we should ask who paid for that research. The Internet makes it possible as never before to do our own research, carefully and with a grain of salt. Quackery and deception abound, and we need to be informed enough to spot it — on either side of the medical divide.
Kathryn Compton is editor in chief of Herbs for Health.
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