Month: April 2023

I admit it: I’m not a fan of drug ads. I think the information provided is often confusing and rarely well-balanced. Plus, there are just so many ads. They show up on TV and streaming programs, on social media, on billboards and the sides of busses, on tote bags, and in public bathrooms. Yes, there’s no refuge — even there — from the billions spent on direct-to-consumer ads in the US.

I’ve often wondered how highly-promoted, expensive new drugs stack up against other available treatments. Now a new study in JAMA Network Open considers exactly that.

Many advertised drugs are no better than older drugs

The study assessed 73 of the most heavily advertised drugs in the US between 2015 and 2021. Each drug had been rated by at least one independent health agency. Researchers tallied how many of these drugs received a high therapeutic value rating, indicating that a drug had at least a moderate advantage compared with previously available treatments.

The results? Only about one in four of these heavily advertised drugs had high therapeutic value. During the six years of the study, pharmaceutical companies spent an estimated $15.9 billion promoting drugs on TV that showed no major advantage over less costly drugs!

Why drug ads are not popular

Only the US and New Zealand allow direct-to-consumer medication marketing. The American Medical Association recommended a ban in 2015. While I’ve often written about reasons to be skeptical, let’s focus here on three potential harms to your wallet and your health.

Drug ads may

• raise already astronomical health care costs by increasing requests for unnecessary treatment and promoting much costlier medicines than older or generic drugs.
• create diseases to be treated. Everyday experiences, such as fatigue or occasional dryness in the eyes, may be framed in drug ads as medical conditions warranting immediate treatment. Yet often, such symptoms are minor, temporary experiences. Another example is “low T” (referring to low blood testosterone). While it’s not a recognized illness on its own, ads for it have likely contributed to increased prescriptions for testosterone-containing medicines.
• promote new drugs before enough is known about long-term safety. The pain reliever rofecoxib (Vioxx) is one example. This anti-inflammatory medicine was supposed to be safer than older medicines. It was withdrawn from the market when evidence emerged that it might increase the risk of heart attack and stroke.

Four questions to ask your doctor if you’re curious about a drug ad

Wondering whether you should be taking an advertised drug? Ask your doctor:

• Do I have a condition for which this drug is recommended?
• Is there any reason to expect this drug will be more helpful than what I’m already taking?
• Is this drug more expensive than my current treatment?
• Do my health conditions or the medications I already take make the drug in the ad a poor choice for me?

The bottom line

The AMA recommended banning drug ads nearly a decade ago. But a drug ad ban seems unlikely, given strong lobbying by the pharmaceutical companies and concerns about violating their freedom of speech.

Still, cigarette commercials were banned in 1971, so it’s not an impossible dream. Meanwhile, my advice is to be skeptical about information in drug ads, and rely on more reliable sources of medical information, including your doctor. Consider contacting the Federal Communications Commission if you have complaints about these ads — a step few Americans seem to take. And try this: mute the TV, fast-forward your podcast, and close pop-ups as soon as drug ads appear.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

At some point in life, everyone experiences denial, a natural response when you’re unable or unwilling to face the facts. Denial is not always a bad thing. But it might be easier to recognize in others than in yourself.

“It’s hard to look at your own life and take a good inventory of what’s going on. It takes a lot of work,” says Jonathan Scholl, a therapist and clinical social worker at Harvard-affiliated McLean Hospital.

Here’s a little insight about denial, how to spot it in yourself and others, and what you might want to do about it.

What is denial?

In psychological terms, denial is a defense mechanism, a skillful tool the mind can employ when things get tough. “I see it as a protective barrier we have that we might or might not be aware of,” Scholl says. “It keeps us safe. It also keeps us from looking at ourselves or addressing something around us and making a change.”

You can be in denial about something you’re not ready to admit or take on, or something that challenges deeply held beliefs.

Common triggers for denial can involve

• abuse (mental, emotional, physical, verbal, sexual, financial, or other types of abuse)
• alcohol in excess or other substance use, or substance use disorder
• lifestyle or family issues
• medical diagnoses
• mental health issues
• politics
• smoking
• unhealthy weight gain.

How does denial help us?

Denial can shield us from difficult emotions. Scholl says that might be helpful in the short term, and provide relief to people who don’t have the bandwidth or ability to face a problem.

For example, maybe someone is unhappy in a relationship, but the thought of being alone is worse than the thought of being together. Or perhaps someone is burned out or overwhelmed, and lacks the energy or emotional capability for accepting what’s happening. “Part of the person feels it’s easier not to think about the situation, and lets it go because it feels like it’s too much to handle right now,” Scholl says.

How can denial hurt us?

In dangerous or unhealthy situations, denial can hurt us.

For example, keeping our eyes shut about the realities of a physical or mental illness can lead to serious health consequences. “We see a lot of teens with depression and substance use disorders, and some parents deny there are problems because they’re afraid of what it means for the child. It comes from a place of worry,” Scholl says. “But denying problems can hurt children and block them from making meaningful change.”

Denial can also hurt when it involves addiction or abuse. Those problems affect everyone in a family, and can lead to unhealthy patterns that get passed down from one generation to the next.

Spotting behavior patterns that suggest denial

People in denial often exhibit certain behaviors. For example, they might

• minimize or justify problems, issues, or unhealthy behaviors
• avoid thinking about problems
• avoid taking responsibility for unhealthy behaviors, or blame them on someone else
• refuse to talk about certain issues, and get defensive when the subjects are brought up.  

Moving from denial toward meaningful change

Dealing with denial means first recognizing that it’s occurring — which can be a challenge for anyone — and then addressing the underlying issue that’s causing it.

If you recognize denial in yourself, Scholl advises that you reach out for help. Talk to someone close to you or get an outside opinion from a therapist, a spiritual counselor, your doctor, or a hotline number, such as the National Domestic Violence Hotline if you’re experiencing intimate partner violence. For addiction problems, make that first call to a substance use disorder hotline or recovery center, or try attending just one meeting of a 12-step program (such as Alcoholics Anonymous). In time, you can learn to face your fears or concerns, and develop a concrete plan to change.

Recognizing denial in others: Tread carefully

If you recognize denial in others and you’d like to point it out, tread very carefully. Seek guidance from experts before taking on a situation that could be dangerous to you or to the other person.

If the situation is not dangerous, be as compassionate as possible. “Have a warm and empathetic conversation in an environment without distractions,” Scholl says. “Express your love and point out what you’re seeing. Talk about how it affects you. And then give it time. You can’t force anyone to change. All you can do is plant a seed.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD