Tell your doctor if you see a drug ad on TV

You know, the ones that advise you that you should tell your doctor if you suddenly drop dead. The ones that give every disease an acronym: you don't have a bad cough, you have BC.

So what's going on?

Drugs that pharmaceutical companies market most aggressively to physicians and patients tend to offer less benefit and more harm to most patients, two professors of medicine write. Their report finds a clear pattern of physician-focused marketing tactics that ultimately exposed patients to a worsening benefit-to-harm ratio.

"This is not a random occurrence, but rather a repeating, planned scenario in which drugs, discovered with good science for a specific set of patients, are marketed to a larger population as necessary, beneficial and safer than other alternatives," said co-author Dr. Howard Brody, a professor and director of the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston.

"Marketers are just doing their jobs. However, the reality is that for most new drugs, safety and efficacy are scientifically proven for only a small subset of patients. It's time for physicians to take a stand and not prescribe them so readily."

Brody and co-author Donald W. Light, a professor at the University of Medicine and Dentistry of New Jersey, identify marketing strategies that extend a drug's use beyond the proper evidence base. Among them:

Exaggerated safety and efficacy claims -- as many as 140,000 cases of serious coronary disease in the U.S. might have been caused by rofecoxib, a COX-2 inhibitor, that was broadly marketed as safer and more effective than standard nonsteroidal anti-inflammatory drugs.

"Disease mongering" -- Osteopenia, once considered a non-disease state in patients who had not lost enough bone density to be diagnosed with osteoporosis, has now turned into a disease itself, in hopes of convincing physicians and patients that biphosphonate drug treatment will prevent their "disease" from progressing.

Encouraging unapproved uses -- three of five prescriptions for antipsychotics are for off-label use, even though 75 percent of those prescriptions lack evidence of benefits but expose patients to harm. Recent examples include gabapentin and olanzapine.

"While we looked only at marketing directed toward physicians," Brody said, "direct-to-consumer advertising plays a critical role in driving demand for a drug by patients who fall outside the group that might truly need it, and pressuring physicians to prescribe it more readily."