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.