Coming to You Direct
Public service ads-- or just a sales pitch?
Market forces. Hollow words, says Elliot Valenstein, professor of psychology and neuroscience at the University of Michigan and author of Blaming the Brain. "[Drug companies] can anticipate criticism very well. But at the same time, their marketing will assume there are many more people out there" whom they will attract. Indeed, the track records of other "lifestyle drugs" show that many are used to achieve modest goals such as shedding a few pounds or becoming more productive at work. "When Prozac came on the market, it was just approved for severe depression," says Sidney Wolfe, director of the Health Research Group of Public Citizen, a consumer advocacy group. "But it was used for all kinds of depression." Just as Prozac be came a $3 billion-a-year seller thanks in part to those users, Paxil will bolster its sales by targeting the merely meek, predicts Valenstein. "Shyness can't be marketed be cause most people recognize it as a normal variation on personality," he says. "But 'social phobia' sounds like a disease. I'm sure a lot of thought was given to pushing that particular terminology."
The coalition's brochure is careful to highlight the tag line "It's not just shyness," and the campaign's literature never directly mentions Paxil. But some of the symptoms de scribed are familiar to virtually anyone who has faced pressure: blushing, sweating, dry mouth, pounding heart. And SSRIs are praised as vital to the recovery process. In the campaign's video, a sufferer gives testimony to the healing role of her medication: "I wouldn't have been able to concentrate on therapy and the coping skills" without the drug's ability to "take the edge off." Valenstein says that since Paxil is the only FDA-approved SSRI for the disorder, it will become the prescription of choice for general practitioners, who pre scribe the majority of antidepressants.
Alec Pollard, director of the anxiety disorders center at the St. Louis Behavioral Medicine Institute, says the cynicism surrounding Paxil clouds its positive effects, which can be remarkable. "I can't say to you that people won't be given Paxil that don't need it," says Pollard. "But we wouldn't want to judge a treatment based on the fact that some times it will be inappropriately applied. That's inevitable. That's why particularly primary-care physicians need to be educated on proper use."
But Wolfe is concerned that the direct-to-consumer marketing approach will drive some patients to demand the medication without proper evaluation. "People are going to ask for it, and they're going to get it," he says. In the realm of managed care, doctors may be only too willing to acquiesce to those demands. "It is possible to give people careful diagnosis," says Erik Parens, an associate at the Hastings Center, a bioethics think tank. "But diagnosis takes time, and it costs money. Therefore, it is cheaper to give people the drug they ask for."
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