Healthy Skepticism Library item: 6340
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: Journal Article
Cassels A.
Cholesterol TV ads clog reality
Common Ground Magazine 2006 Nov 1;
Full text:
Cholesterol TV ads clog reality
By Alan Cassels
Quick, here’s a skill-testing question: What do a rhino on a street corner,
a shark in a swimming pool and a bull about to charge a woman hanging
laundry have in common?
1)They’re a new wave of cutesy ads by Telus. 2)They’re Gary Larson comic
reruns. 3)They’re fear-mongering ads designed to get you running to your
doctor for a cholesterol test.
If you answered 3, it is because you know the name of this column. OK, you
pass. Keep reading.
Let’s be clear: Fear sells. Consumers are constantly bombarded by
fear-mongering messages, and this fear drives us to buy. The marketers of
cholesterol-lowering drugs are not ignorant of this fact. And, they are
clearly benefiting from our fear that a heart attack is about to strike, as
menacingly as the shark lurking in our swimming pool, or the dark shadow
ready to bite off our legs. Cue the Jaws music.
In one ad campaign, Pfizer, which makes Lipitor (atorvastatin), the market
leader in cholesterol-lowering (statin) drugs, ran newspaper ads in France
and Canada showing the tagged toe of a corpse. What would you rather have,
a cholesterol test or a final exam? asks the headline. The key message is
that getting a cholesterol check and then, probably taking drugs to alter
your cholesterol, will prevent a premature death. Even, if you are otherwise
healthy.
Another ad shows a man walking down the street, a rhinoceros lurking around
the corner. The ad says: Living with high cholesterol, you never know what
s around the corner. Yet another ad shows a man floating in a backyard
pool, holding a tall drink, a shark below him. The tagline says it all:
Living with high cholesterol. You could be surprised at what’s lurking
beneath.
But, what is lurking behind these ads? The drug companies, which wear the
camouflage of groups such as the Heart and Stroke Foundation, the Canadian
Lipid Nurse Network and the Canadian Diabetes Association, whose logos
festoon these ads. Big Pharma easily hides its fingerprints they’ve got
the financial bulk to get the organizations they support to do the fear
mongering for them.
What most people won’t learn from such ads is that when scientists have done
meta-analyses (a study of a collection of studies) of the largest statin
drug trials, they inevitably find that the drugs show no difference in
mortality, when compared against placebo. There may be some changes in heart
attack rates, but no changes in overall deaths, which is what the ads are
all implying. We don’t call this disease avoidance, we call it disease
substitution. The drug may prevent a heart attack death but in the process
will cause other kinds of deaths, a sort of zero sum gain that is the
equivalent of taking an expensive placebo.
Let’s be clear: ads featuring a charging rhino, or a shark in your pool,
would likely scare you. And, the strength of the logos, of the impartial
agencies accompanying the ads, would tend to give them some surface
credibility. But not all people are running scared. In fact, a growing
number of people are taking great pains to deconstruct the cholesterol
empire, brick by brick.
Eddie Vos is an engineer who lives in Montreal and he’s a member of the
International Network of Cholesterol Skeptics (www.thincs.org/), a network
of researchers, physicians and scientists around the world who are seriously
questioning the orthodoxy around cholesterol. Members of this network say
that blaming heart disease on the consumption of animal fat, and a person’s
high cholesterol, is simplistic and misguided. They question the
advertising of this disease called high cholesterol, and the
fear-mongering scare ads around cholesterol, when there is so much
uncertainty still.
Eddie Vos criticizes drug companies for indirectly promoting drugs using
direct-to-consumer advertising in a way that does not respect the ethical
criteria of the WHO, namely, being accurate, informative and balanced. He
was so upset by the cholesterol fear-mongering ads that he wrote to federal
Health Minister Tony Clement.
The reply is a masterful stroke of Orwellian self-deception that leaves no
doubt which side Health Canada is on. The health minister wrote:
Help-seeking messages such as the campaign described in your
correspondence, where a health problem such as cholesterol is mentioned, but
no reference to a specific drug product is made, are considered of a
non-promotional nature. The cholesterol prevention help-seeking messages
currently meet the criteria set out in Health Canada’s policy document The
Distinction Between Advertising and Other Activities, and is not considered
advertising and therefore, not subject to the requirements of the Food and
Drug Act.
Let me translate: Health Canada says it’s OK for the drug companies to
mislead and scare Canadians because they aren’t actually advertising a
drug. Statin investors of Canada, rejoice!
If a fear-mongering cholesterol ad drives you into a doctor’s office here in
Canada, and he or she determines that you need a fix for your high
cholesterol, you’re likely to walk out with a free sample of Lipitor. To say
the sales of Lipitor, the top selling drug in the world, are robust is a
gross understatement: Pfizer sells about $14 billion worth every year.
Pfizer also employs award-winning advertising tactics to keep those sales
robust. In April of this year, the prescription access litigation (PAL)
project (www.prescriptionaccess.org/), a group trying to make drugs more
affordable for US consumers, awarded Pfizer’s Lipitor, the 2006 Bitter Pill
Award, alongside Crestor, another heavily pumped statin. The awards
committee noted that the marketing campaigns for Lipitor and Crestor have
created the impression that anyone and everyone with even slightly elevated
cholesterol needs them. This marketing gives short shrift to the much
cheaper but effective generic statins, as well as to lifestyle changes, such
as better diet and more exercise, that should be the first line of treatment
for millions of people who have high cholesterol but no other major risk
factors.
What you don’t get in the ads scaring you to see your doc for a cholesterol
test is any sense of the dangers these kinds of drugs pose. The product
information accompanying all cholesterol-lowering drugs tells us in black
and white that these drugs will increase a person’s chance of developing
muscle pain or rhabdomyolysis, a potentially fatal condition resulting from
muscle breakdown.
Eddie Vos, on his website (www.health-heart.org) points to research that
shows that there was 15 times more damaged muscle fiber in those on statins
than in patients who were not, and this damage is so hidden that common lab
tests cannot detect its existence, yet patients feel the effect.
Criticism of fear-mongering campaigns is not just coming from the fringes.
There are ample critics, even within the world of orthodox medicine. The
Pfizer toe tag ad incensed staff at the World Health Organization. Its
officials wrote to the medical journal, The Lancet, stating that these
disease-mongering ads were unethical because they mislead the public about
cardiovascular risk. They recommended that disease-awareness campaigns be
regulated to prevent the public from being bamboozled.
You see, with the Canadian-style, non-promotional advertising, in the form
of these disease awareness campaigns, the companies don’t even have to talk
about side effects. Beauty, eh? Me, I’m going to relax in the pool, with a
tall drink, and try not to think too much about the sharks, hovering nearby,
ready to turn me into a patient.
Alan Cassels is co-author of Selling Sickness and a drug policy researcher
at the University of Victoria. He is also the founder of Media Doctor Canada
(www.mediadoctor.ca), which evaluates reporting of medical treatments in
Canada’s media.
