10-03-14 Column

The only ones I can pronounce are the ones I have heard on TV ads for. The others just seem like a collection of random letters.

Then come the multiple paragraphs - sometimes pages - of small print that include warnings and restrictions and possible side effects. I wonder if much thought has been given to the fact that the biggest consumers of most drugs are older folks who are as likely to suffer from poor eyesight as overactive bladders or age spots.

I decided I needed to do some Internet research to learn more about prescription drug advertising. According to the "ProCon.org" website, a nonprofit organization that studies controversial issues, the $300 billion-a-year U.S. pharmaceutical industry spent $3.1 billion in 2012 on advertising prescription drugs directly to consumers. Since 1962, these ads have been regulated by the Food and Drug Administration to ensure they're not false or misleading.

The website says proponents of direct-to-consumer ads say they "inform patients about diseases and possible treatments, encourage people to seek medical advice, help remove stigma associated with certain medical conditions, and provide needed revenue to fund costly research and development of new drugs." Opponents contend that such ads "misinform patients, promote drugs before long-term safety issues can be known, stigmatize normal conditions and bodily functions such as wrinkles and low testosterone, waste medical appointment time, and lead to our society's overuse of prescription drugs."

To find out how drugs get their weird names, I turned to two main sources: an April 2013 article on the "Popular Science" website and a 2012 online article on the American Chemical Society website. What I learned was that drugs have three names: molecular, generic and brand. The International Union of Pure and Applied Chemistry gives names to the molecules - the actual chemical arrangement of atoms. Generic names must meet standards set by the World Health Organization's International Nonproprietary Names and the U.S. Adopted Names Council. Brand names must meet Food and Drug Administration requirements.

The generic names the Adopted Names Council creates are made up of "stems" that describe a drug's purpose. An example given was Nexium's generic name, esomeprazole. The "prazole" ending indicates it's a type of anti-ulcer medication. A drug ending in a "vir" is an anti-viral medication. The council tries to avoid words that are difficult to pronounce in foreign languages or that may have other meanings abroad.

Putting these together, N-acetyl-p-aminophenol is the molecular name of the generic drug acetaminophen that virtually everyone knows by its brand name Tylenol.

OK, what about all that fine print about possible side effects - serious infections, immune system problems, perforation in the stomach or intestines, diarrhea, headache, constipation, muscle aches, sore throat, heart attacks, strokes, rash, dehydration ...and even death? I am well aware from personal experience that what cures one problem might lead to future problems in another area. When I had an autoimmune disease that left me unable to walk, talk, eat or breathe on my own, I was mighty happy that massive doses of various versions of the prednisone steroid put me back on my feet again. But they also contributed to bone density loss with increased likelihood of bone fractures as I get older.

People who have problems with blood clots forming are often prescribed a drug such as aspirin or Warfarin. But it automatically makes them more susceptible to injuries that involve bleeding.

Drug companies are required to make those side effects - regardless of their probability - known to the public. Still, it's more than just a bit disconcerting to read. This year, the Food and Drug Administration is studying whether those mind-boggling lists can be shortened. The FDA said it's concerned that the list "is often too long and may reduce consumer comprehension and sensitivity to dangers."

Medicine is complicated, even when items we don't consider to be drugs are involved. Those of us "of a certain age" can recall when we were all being regularly bombarded to reduce our sodium intake. It made sense. Reduced salt in the diet meant lower blood pressure. But long-term studies revealed that while the number of people who had strokes from burst vessels declined, an equal increase in the number with strokes from clots occurred! So if saving lives was the criterian, reducing sodium intake had no net positive effect.

So should advertising push medication before the long-term effects are known? Or should we wait, knowing that many who may have benefitted from a good medication will have suffered needlessly? I don't have an answer and am glad I don't have to decide. But with all the goofy hard-to-pronounce names and pages of fine print, maybe they should be required to include one more warning - "Caution, reading this ad may cause brain over-load."

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Earlier columns from 2014 may be found at: 2014 Index.
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