Jarvik karma.

May the phenomenon of metaphysical blow-back that has whisked Dr. (non-practicing-non-rowing) Jarvik out of our lives likewise propel Eli Lilly and Co. and their heart-rending and brilliantly scored Cymbalta TV commercials into deserved oblivion. If traffic on this Website is any measure, people are still captured and intrigued -- haunted, even -- by the quasi-classical music of these antidepressant pitches. All the direct-to-user TV advertising for prescription remedies has so muddied the practice of medicine that formerly important, potent, risk-managed drugs are now sold like Preparation H. All those mumbled voice-over warnings about side effects, including really serious, life threatening ones -- even four hour erections (you don't want to know how they fix that) -- go right past us and we run to our docs asking for them. We take responsibility for our own care, now don't we. So we have only ourselves to blame. And now that studies are saying antidpressants, maybe, work no better than sugar pills against depression, hell, we might as well be swigging Lydia E. Pinkham's. It's at least got an alcoholic side effect to make up for the taste. And has all this made us trust the FDA more? I saw a commercial that used "...and it's FDA approved..." like it was a recommendation. I'd think twice about that. Yes, bring on the karma. This is the way America takes care of problems of misrepresentation and just plain BS. Very Republican. Expose the hype and let the marketplace decide.

Afterthought on Jarvik

I've been rethinking. They say Robert Jarvik's contract to do Lipitor commercials was two years, and the pay: $1.35 million. Consider, please: that's about $650K a year, for quite a few quite complex film camera shoots, on location in many parts of the country -- he was in attendance at that lake, though he didn't row. Plus all the rest of the accompanying folderol involved in being a celebrity spokesman.

It must have been a fairly intense part-time job. For a guy who's running his own company, that's quite a commitment. He must have imagined the exposure would be worth millions more to him in the development of his company, on the worldwide money markets. So, for all this, he put his medical-health reputation -- which even he must have known was not close to that of, say Michael DeBakey -- on the line. However he must have looked at it, he stood to win big, and couldn't lose. Sadly, I suspect he still thinks so.

SLEEP WITHOUT LUNESTA OR AMBIEN.

If you're an insomniac you can go to your doctor and demand a TV pill, or demand sleep counseling. Research shows that, eureka! Simple changes in behavior can put you to sleep better than pills. Read all about it here. And turn off the TV.

DRUG ADS HURT. CONSUMER REPORTS LOOKS AT REQUIP COMMERCIALS.

Yes, they're still hurting, those high pressure TV campaigns for exotic prescription drugs. It's good that so many of you drop in on this site and others to check out the claims. And now we've got company from that most respected non-commercial consumer watchdog, Consumer Reports. On their newly redesigned Website, CR is featuring an analysis of Requip commercials. That's the Glaxo drug promoted for the relief of Restless Legs Syndrome, which I've written about before -- see the Dehype Hall of Fame links in the right column. You should watch the Consumer Reports video analysis and read their report on this drug. Learn how GlaxoSmithKline repurposed a Parkinson's Disease drug for a bigger market -- people who have...or think they have...Restless Legs. Here's the link.

IS ALLI YOUR ALLY?

Have you seen the ads for Alli? They tout it as the only FDA-approved, over-the-counter diet pill -- that is, you don't need a prescription.

With the rollout of this new product, we see a whole new way of talking about side effects -- those pesky problems that may crop up in the course of using a medicine. In the Alli materials, "side effects," which carries a rather negative connotation, is replaced after one use of the words by "treatment effects." There, isn't that much nicer?

The FDA, which may stand for Friendly Drug Approvals, is well accustomed to approving drugs that cause varying levels of trouble for patients. In this case, since Alli works by inhibiting your body's ability to digest fat, the problem can be, oh, just...frequent, oily, difficult to control bowel movements. You can go read the other unpleasant details for yourself here.

For the promised upside -- 50% more weight lost than a low fat diet alone -- and, excuse the expression, the downside, of Alli, you can click right over to drugstore.com and pick up a month's supply (90 caps) for only $59.99.

In fairness, for the desperate and untherapied overweight person, this drug, with its sensible diet advice, is at least a miracle pill that apparently works, as certified by our government, and so may be worth the discomfort.

I can't help wondering how many people will be inspired to eat more healthily by Alli's marketing. And then there's the gnawing suspicion that this is the FDA as retooled and defanged by the Bush years. What have they protected us from lately? Caveat dieter.

Links: Glaxo, the manufacturer; FDA's Alli label information; drugstore.com's price page

WHAT'S NOT HYPE?

Thinking this blog through again, one of my thoughts is: the problem with living in an info-tainment-gossip tsunami is not how do you tell what's hype; it's how to tell what's not. I'm afraid we must assume all of it is, until proven...what: not guilty? Disingenuous? Every piece of data is produced for somebody's purpose. Not necessarily a bad thing. I've said, I believe marketing and sales, thus hype, don't belong in the practice of health care and medicine, and these fields are now just plain ruled by the pharmaceutical branch of Madison Avenue. And then there's politics. The old political hokum has given way to the marketing-media complex, and I think that's wrong, too. TV news, too, especially the totally sold-out local TV station variety. These have been my focus here on these non-existent pages. Should I continue, or is this a lost cause? Should I be reporting the obvious rottenness, or trying to point to the tiny fraction of communication that's genuine? Which would be a full-time job--finding some, I mean--which I don't want. Any suggestions?

YourTimeForChange?

It's a classic marketing challenge. You've got a good product, but it's just like all the others. You weren't the first into the market, so you don't have brand name recognition. What do you do?

There are lots of prescription drugs for depression. It's one of the miracles of pharmacology. First, there was Prozac. But, of course, there couldn't be just one drug -- all the drug companies had to have one, to get a piece of the depression market. Wyeth wasn't the first on the market. And Lilly, the Prozac company, beat them to the "new-improved" space with Cymbalta, touted to be the first drug that replaces norepinephrine, as well as serotonin. So, now, what does Wyeth do to elbow into this mature market with their me-too Cymbalta-type drug, Effexor XR?

Well, they found a way. See, a particular drug doesn't always work for every patient. Doctors often have to try several with a patient before something clicks. So, Wyeth has just rolled out a TV-Internet campaign, suggesting that if you're taking an antidepressant and still have depression symptoms, it may be "Your time for a change." The TV spots mention no drug. The pitch is to talk to your doctor, and/or go see YourTimeForChange.com. The site doesn't mention a drug name either, just gives you information, offers you a checklist of symptoms, and talking points to use with your doctor. Subtle, no? Wyeth's name is on the TV spots and the site. Nothing illegal here. Oh, they do have another site, or at least a domain name, TheChangeYouDeserve.com, in a Google search ad, which takes you to the Effexor XR site.

You might call this the Ricochet School of Marketing -- finding work-arounds for a heavily regulated advertising marketplace. Wyeth is spending millions to, like, drop a few hints. As a public service? No, folks. Something tells me a depressed person already under a doctor's care would know to go back if she's not feeling better. Remembering that most meds take six or more weeks to kick in, right? And, of course, don't docs who prescribe powerful medicines know to tell you all these things? Ignore drug ads, folks. Things have gotten all out of balance. Focus on getting the most attention from your doctor.

MORE ON MEANINGLESS CYMBALTA MYSTERY.

A dehype reader writes:

I was just discussing what I thought the melody on the Cymbalta ad was with my wife and decide to look it up on the net. I came across your site and would like your opinion. Sounds like portions o"Poor Little Buttercup" from Gilbert and Sullivan's "HMS Pinafore". My wife says it sounds nothing like it, check it out and please give me your opinion. If it is, I would think it could be considered somewhat insensitive.

regards,

Al Fien

And I answer:

Golly, Al. I never thought of "Buttercup." You're right, the first six notes are pretty close, if not identical. Could some ad-music guy be playing a little prank on us? Lilly isn't saying. But, knowing how risk-averse advertisers are, and how closely they scrutinize every detail of a commercial or ad for signs of trouble, I think it's likely what they say about the music is true: that it's "original" music written for the commercial. Still, there's nothing new under the sun, and I'm pretty sure the "composer" was looking for familiar, evocative phrases, and his memory supplied this tune, maybe a snippet of Schumann, maybe a taste of Gilbert. In any case, it's a clever job of pushing our emotional buttons, which, when used to sell a drug directly to people with depression, I believe, is the very definition of insensitivity.

Thanks for writing.

Dave

What's new? If you've arrived at this post by searching for a subject, I invite you to see what I'm up to today. Click here to go to the top of the blog.

HYPE DOESN'T WORK?

It doesn’t. I give you the recent mid-term election campaign. The Republican mix of quarter-truth slander in a TV ad blizzard. Didn’t work. The Democrats’ snarky attempts at advertising countermeasures and botched insults. Didn’t work. Didn’t even work on either party’s deep-core-base loyalists. All campaign propaganda was simply irrelevant static—always is when the citizenry is awake, alert and taking nourishment.

I give you the O.J. book flap. Didn’t work. There’s probably more to this, that'll emerge over the next few days. For example, how do African-Americans who celebrated O.J.’s acquittal feel about this project’s crash ‘n burn? But, for now, enjoy feeling righteously indignant, if you must.

Hype doesn’t work. We just think it does, because nobody, or too few of us, stand up and slap it down. For instance, hype’s working for Big Pharma because too few of us care to object to drug advertising’s replacement of the practice of medicine.

The illusion of hype’s effectiveness persists because nobody measures how intensely a particular campaign is being ignored. How do you prove a negative? For instance, it took three years for us to slap down the Iraq Affair, because we were ignoring the hype, instead of getting universally pissed off. How about a hype-ignore-ation index? How would we do that? Marketing departments try to measure even such ephemera as “awareness.” Why not ignorance? Surely Google can come up with something. Hype: to paraphrase Samuel Goldwyn, “Don’t even ignore it.”

Wikipedia: hyperbole

LIGHTEN UP, DAVE.

I think I've been taking my mission too seriously. I'm gonna have more fun. Why am I writing this? Because I looked at one of the Google searches you people use to look up information on the Cymbalta TV campaign and its insidious music. Here it is.

When I read what the bloggers are saying about Cymbalta's music, and other commercials, like the Abe Lincoln and beaver spot for Rozerem, I feel a lot better about how gullible people who use the Web are not. Like this one, for example.

I'm getting mostly hits from people looking up these and other pharma commercials. Dr. Jarvik's Lipitor campaign is probably the number two search I see on my hit counter. Keep looking. Keep talking about it. When everybody realizes drug ads don't make drugs work better, maybe they won't sell drugs either.

LUNESTA'S PILL PUSHING. YA SNOOZE, YA LOSE.

It's called the Lunesta 7-Night Challenge. You can get a coupon, on the Web or in magazines, for seven free Lunesta tablets. It's one of the new breed of prescription anti-insomnia drugs. Anybody besides me feel creepy about this? Any physician out there been insulted by a patient handing you a coupon and asking if Lunesta's "right for him." Is it necessary to point out that this turns the practice of medicine on its head? Why is freebie marketing O.K. in the prescription pharmaceutical business? Ask your new Congressman or Senator if shutting this self-diagnosing-self-prescribing promotion game down is right for America.

One of the features of the Lunesta site is a cute animated "fact or fiction" quiz about insomnia causes, remedies and treatments, which confirms that warm milk often works. But, the quiz hastens to add, it isn't a cure, suggesting by pointing this out, without claiming it, that Lunesta could be one. High-quality weasel words. Well, Lunesta, and the rest of the new drugs, aren't cures for insomnia, either, according to the American Insomnia Association.

ALZHEIMER'S; HERE'S ONE YOU WON'T SEE ON HEALTHWATCH.

TV "Healthwatch," "Healthlink" -- and other syndicated short features generally health-clueless local TV anchors read to you every night -- stick with exciting "medical breakthroughs," or the latest liposuction technique. You have to read a newspaper or do your own health "watch" on the Web to get the bad news you need.

Here's a link to a major informational breakthrough-warning you won't see on local TV, published today, and reported here on NYTimes.com. The word is that a class of antipsychotic drugs that have been used to try to control the behavior of Alzheimer's patients mostly don't work, and may make people worse. Here's a key quote from a scientist from a company that makes one of the drugs in question:

“What the study does indicate is that this is a very sensitive population and that any treatment needs to be done with a lot of forethought and constant reevaluation” said Dr. Bruce J. Kinon, a Lilly psychiatrist.

The drugs that are the subject of the new study are not approved for use in the treatment of Alzheimer's, and their use is a practice known as prescribing "off label." I'll have to do some research. I don't understand why this practice is O.K. with the FDA. Or, the AMA, for that manner. But I'm just an ignorant lay person.

One more thing. If the treatment of this "sensitive population" should be performed with a lot of "forethought," why do drug companies advertise another class of Alzheimer's drug on TV? There is no cure for Alzheimer's, and the experiments in slowing it down are just getting started. Is a claim like this -- "Aricept may help..." (emphasis mine) -- enough to justify millions in advertising and the resulting pressure on doctors? Or are these companies exploiting family members? Drug advertising and marketing makes my flesh crawl.

INCOMPETENCE OR CONSPIRACY?

As I predicted, the doctors are rising up against the FDA and the Pharmas. Two new studies and articles in prestigious medical journals, as reported here, have called for new legislation to fix the FDA's fractured system -- this key health agency is not protecting our health from unproven prescription medicines, folks. And, as you may recall reading on this blog, the AMA has already declared a kind of muted war on drug marketing and advertising. Write your representative. Better yet, elect a new one. Much of Congress depends on the drug companies' deep pockets for their campaigns, and the Bush administration consistently appoints administrative saboteurs to the bureaucracies, including the FDA. Look it up.

GENES, ANTIDEPRESSANTS, AND THE HARD SELL.

How does your doctor decide which antidepressant to prescribe? Has yours ever ordered a genetic screening before writing a 'script? Mine didn't.

A Korean study just published in the Journal of the American Medical Association found that the condition of particular genes in seriously depressed patients apparently determined which antidepressants were effective in those patients. There was good reason to do this study. According to the study, 30% to 40% of initial depression treatment choices fail. If you want to wade through a little technical language, here's the University of Pennsylvania's MedPage report on the study -- I think it's readable, though it's meant for docs.

So, what'll it be? Cymbalta? Zoloft? Prozac? Celexa? Is your doc deciding based on who's selling her the hardest? Are you pushing for the one whose commercial music captivates you?

We could, I suppose, muscle our legislators to drain the FDA-Pharma multibillion-dollar drug marketing swamp. We could pressure our doctors to wake up and smell the hype, and be a little less quick with the prescription pad. But, in the short run, and the long, for that matter, the enemy is us. Wise up. Just say no to drug ads.

CYMBALTA MUSIC: IS IT SCHUMANN?

The drama continues. I don't have an accurate count of the Internet searchers who've wondered what the music is on the Cymbalta TV commercial, but it's a lot. Several commenters to my posts on the subject have suggested that the theme was heard in "Sophie's Choice," the movie, but until now, nobody has identified an actual piece of classical music by name. This week, an anonymous commenter has suggested it's a rearrangement of Robert Schumann's "Kinderszenen [Scenes from Childhood] Op. 15 No. 1 that was played in "Sophie's Choice" by Nathan while sitting on the piano bench with Sophie." Well, it could be. I went here and listened, and it sure sounds like the "composer" of the TV music created something that sounds very much like Schumann's piano piece. There are other places to listen. Just Google "Schumann" and the title above. Unless there's another very similar piece of music out there, I think we've solved the riddle. Just remember why I started posting about this...music and other attention-getting devices have nothing whatever to do with which medicine is right for you.

LINK: Other dehype posts on Cymbalta.

What's new? If you've arrived at this post by searching for a subject, I invite you to see what I'm up to today. Click here to go to the top of the blog.

DEAL OR NO DEAL? GENERIC DRUG EDITION.

Here's one that slipped by me: the April 25 news that because of a pharma-favorable appeals court ruling, brand name pharmaceutical companies are once again paying off generic drug companies to delay marketing their cheaper products.

Here's a classic case of the mixed motives of our government branches, and how corporations get and use legal workarounds -- the Federal Trade Commission goes after pharmas after courts throw out FTC enforcement of a law passed by Congress to end pharmas' generic-blocking deals, which are workarounds to Food and Drug Administration regulations.

>> Washington Post story
>> Thanks to SeniorJournal.com, where I found the original story.

IMPRESSIONS -- CYMBALTA REVISITED

Marketing and advertising people are mainly interested in the manufacture of impressions. When producing an ad, they concentrate on developing words, images and sounds that further the persuasive goal of the marketing campaign. Nothing in an ad is present by accident.

Cymbalta commercials not only promote the use of this prescription drug, but have successfully introduced a new way of diagnosing and treating depression -- based on the presence of physical pain in persons suffering from serious clinical depression. There is medical literature to support this diagnosis, but I believe this marketing position is based upon Cymbalta's having been approved by the FDA for the treatment of diabetic pain as well as depression. The Lilly marketers clearly have used this dual approval to create the impression that Cymbalta is superior to other anti-depressant drugs. "Depression hurts...."

Add a little research to your consideration of whether you ask your doctor about Cymbalta, or, if you're a physician, whether you prescribe this drug over an alternative treatment. Here's a starter link for you. This Google search raises several questions in its first page of results. It's also obvious that the association of pain with depression is not a universal diagnosis. Of course, the Cymbalta ads don't say it is. It's only one impression the commercials create.

The most powerful impression created by the Cymbalta TV campaign is musical. The Cymbalta music generates hundreds of Web searches every time the commercials air. Cymbalta is one of the most widely prescribed antidepressants. What impression do you have about the intelligence of doctors, and their patients?

Update: We may have the answer to the what's-that-music mystery. See here.

Update 08/11/06: Government scientists think they've found an "instant cure" for depression. Here's my post.

WEASEL WORDS, PROSTATE HEALTH DIVISION.

If you watch TV, you must experience symptoms of some sort at least once a day--you're exposed to so many pharmaceutical commercials, it's unavoidable. (We're working on a pill for that.)

This is a tutorial in Weasel Words-Spotting. Weasel Words are voiced messages in TV commercials that, to the casual TV watcher, sound utterly logical, but are, in fact, nonsense. Weasel Word production is a skill ad copywriters learn early and often: the meticulous crafting of persuasive doubletalk, when the product you must sell has no competitive advantage. I speak from experience.

My example today: the Avodart TV commercial. Here's a link. Go watch it, and look for the real information on the Avodart Web site. Avodart is a prescription prostate-shrinking drug. Here's the commercial's suspect passage--as close as I care to get to verbatim:

"...most prostate medicines just treat symptoms. Avodart actually shrinks your prostate, and improves your symptoms...."

While you're watching that cute animated prostate gland shrink before your very eyes, you're not listening closely to the narration. It kinda weasels right by. How do you suppose prostate medicines "treat" symptoms caused by an aging, growing prostate? Gotta shrink the thing, folks. Like Saw Palmetto does for many men; it's an over-the-counter herbal supplement with a good reputation and a much lower price than prescription medications. Do your own Web search and see what's out there (Google).

If, after this dehype tutorial, you become an enlightened consumer, you'll listen closely to TV drug advertising claims in the future. You'll be able to spot the well-crafted nonsense right away. Don't "ask your doctor if Avodart is right for you." Ask your doctor, first, to do a prostate exam, including a PSA test, to catch the possibility of cancer of the prostate.

There's no law against Weasel Words, but when used in prescription drug advertising they cost you, Medicare, and your insurance company a lot of money. Marketing has infected medicine and healthcare with its particular variety of corruption. The remedy is attention, a free resource. Caveat emptor. And just say no to drug ads.

Robert Jarvik pitches LIpitor on TV?

UPDATE: 2/26/08: Yesterday, 2/25/08, Pfizer announced it was cancelling the two-year multimillion dollar advertising campaign featuring Robert Jarvik. Thanks for all your interest in my posts on this subject over the last two years. To get a fine wrapup of this story, go to Time.com.

What ever happened to Dr. Robert Jarvik, inventor of the Jarvik 7 artificial heart? I'd have gone years more without knowing, if it hadn't been for the new Lipitor commercials.

Dr. Jarvik appears in the new one--rowing a kayak over pristine waters, perhaps in Alaska. He also presents the commercial's message on the dangers of high cholesterol, and recommends, of course, that you ask your doctor if Lipitor is right for you. [CORRECTION: Not a "kayak," a rowing scull. Thanks to J. Sprouse for the catch. See Comments. DN]

Why did Pfizer choose Jarvik as Lipitor spokesperson (Hmm, Pfizer again)? Other than the obvious cardiac connection, there's no sign. He's known for last-chance heart technology. Lipitor is supposed to help keep heart disease from getting that far.

So, are Jarvik's pals at Pfizer giving him a profile-raising at a time when his company, headquartered in that noted mecca of medical research, Manhattan, nears the public investment entry level? Is Pfizer interested in buying his company? Was putting him on TV Pfizer's president's wife's idea? Stranger things have happened. What have you heard? Feel free to comment, and let's keep our eyes on this one.