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" Dee Johnson had always been the healthy type -- athletic, energetic, never sick. But at age 38, her legs started to hurt something awful. Over-the-counter pain relievers didn&amp;#039;t help, and while walking and stretching eased the pain, staying still was agony. &amp;quot;It was the weirdest feeling,&amp;quot; says Johnson, an executive assistant at a construction company in Amissville, VA. &amp;quot;The longer I sat, the worse it hurt, clear down to the bottom of my feet.&amp;quot; At night, in bed, the pain only intensified. She couldn&amp;#039;t resist the urge to move her legs and, needless to say, she couldn&amp;#039;t get much sleep. &amp;quot;I was a walking zombie,&amp;quot; Johnson says.  The pain had been going on for months when Johnson happened to catch a TV commercial for the drug Requip, in which a narrator talks about &amp;quot;uncontrollable leg movements.&amp;quot; That sounded just like what she&amp;#039;d been experiencing, so she went to see her general practitioner and told her about the ad. Her doctor wasn&amp;#039;t sure what the problem was, but she had some samples of Requip, and she passed them along. The drug made Johnson feel nauseous, but it also helped ease her symptoms, so her doctor sent her to a specialist, who ran tests to confirm the diagnosis. Johnson had restless legs syndrome (RLS), a rare condition that causes pain in the legs and an irrepressible desire to move them. Johnson&amp;#039;s dialogue with her doctor is an increasingly common scenario, but it would&amp;#039;ve been almost unthinkable just 20 years ago, when doctors called all the shots, and patients knew little about their own medical care. As patients, we want to feel that we&amp;#039;re in the driver&amp;#039;s seat when it comes to our treatment. But on the heels of headlines about drug recalls, in tandem with spiraling health-care costs, we, as consumers, also have a vague sense of unease that it&amp;#039;s the pharmaceutical companies that are in charge -- not us. At the heart of this unease are questions about drug ads and how they&amp;#039;re regulated: What information are we getting, and why? One thing&amp;#039;s for sure -- there&amp;#039;s a lot more pharmaceutical advertising than there used to be: Currently the average American sees about 30 hours of drug commercials a year. Pharmaceutical advertising is one of the fastest-growing sectors in advertising (and makes up a large portion of the ads in REDBOOK); a massive $4.2 billion was spent on direct-to-consumer drug advertising in 2006 (compare that, however, with the $55 billion that drug companies spent on research and development). That $4.2 billion represents a fourfold increase since 1997, when the Food and Drug Administration (FDA), which oversees ads for food products and prescription medications, clarified and relaxed regulations on how and where drug companies can advertise to consumers. As a nation, we have mixed feelings about the proliferation of drug ads. In a 2005 survey, more than half of American consumers said they believe that such advertising should be more strictly regulated. And almost 80 percent of doctors believe that drug commercials encourage patients to ask for medicines they don&amp;#039;t need. Yet in a 2005 poll by the Kaiser Family Foundation, two thirds of consumers surveyed said that drug ads provide useful information at least some of the time. And in cases like Johnson&amp;#039;s, seeing a drug commercial may be the first time a person learns that a health problem he or she is having has a name and a treatment. &amp;quot;[These ads] can motivate patients to seek out information from health-care providers to talk about a disease, and can destigmatize conditions people might be embarrassed about,&amp;quot; says Rebecca Burkholder, director of health policy at the National Consumers League, a nonprofit consumer-advocacy group. &amp;quot;On the other hand, we&amp;#039;re concerned about whether they provide risk information in a balanced way.&amp;quot; Lawmakers are responding to those concerns: Last fall -- in reaction to the 2004 recall of Vioxx, a pain reliever that was shown to have links to heart attacks (risks that hadn&amp;#039;t shown up in clinical trials before the drug was approved) -- Congress passed new legislation with the goal of further protecting consumers. The FDA can now impose fines on ads it deems misleading. This year, the agency will also get an extra $6.2 million (in fees from pharmaceutical companies) to hire 27 more staffers to review all TV ads before they are aired; as of a year ago, there were only five staffers reviewing ads.  These changes will help consumers feel more certain that we know what we&amp;#039;re being sold as far as medical claims go. But in the end, it&amp;#039;s up to you and your doctor to discuss the fine points of your treatment. To help you with that goal, here&amp;#039;s a closer look at what pharmaceutical ads do and don&amp;#039;t tell you, and how to educate yourself so you can be confident about both the drugs and the care that you are getting. ADS CAN EDUCATE -- AND, YES, CAN ALSO CONFUSE Seventy-three percent of physicians reported that their patients asked thoughtful questions because of their exposure to pharmaceutical ads, according to an FDA survey. Among the most helpful ads may be the &amp;quot;disease awareness&amp;quot; commercials that describe a condition without naming a drug, says Matthew Perri III, Ph.D., R.Ph., a professor of pharmacy at the University of Georgia. &amp;quot;When somebody&amp;#039;s sick, they really do tune in to these ads, much more so than the general public,&amp;quot; Perri says. &amp;quot;In that case, these ads can be very informative.&amp;quot;  Ads for drugs also provide this kind of information, especially about lesser-known conditions. Consider bipolar disorder (BPD), a psychological condition in which people cycle through periods of despair and intense euphoria. BPD can be devastating: Ninety percent of sufferers&amp;#039; marriages end in divorce, and they account for half of all suicide deaths in the United States. Many sufferers don&amp;#039;t seek treatment, but TV ads like the one for the drug Seroquel may help them recognize that their highs are connected to their lows. Without that insight they might not think to mention their hyperactivity to a doctor, and could walk away with a standard antidepressant that might actually exacerbate their symptoms. That&amp;#039;s good news. But when it comes to the bad news (a drug&amp;#039;s potential risks and side effects), commercials generally deliver that information faster -- 30 percent faster, on average -- than information about a drug&amp;#039;s potential benefits, according to an analysis by scholars Kimberly Kaphingst and William DeJong. In order to fulfill FDA requirements, risk information must be presented, but it&amp;#039;s often delivered in &amp;quot;medicalese&amp;quot; that can bewilder consumers. Those familiar rapid-fire TV voice-overs are so overloaded with details, from the banal to the absurd, that they&amp;#039;ve become a running national joke. &amp;quot;These ads can confuse people. Some confuse me, and I&amp;#039;ve been a pharmacist for a long time,&amp;quot; says Perri. Magazine and newspaper ads and websites can likewise overwhelm readers with technical information, but newer print ads present the nuts and bolts much more clearly (often in Q&amp;amp;amp;A format), and at least it&amp;#039;s possible to reread them or show them to a doctor for discussion.  THE BOTTOM LINE: Advertisements can cue you to a condition you may have, but they should be just a catalyst for a conversation with your doctor, which is why drug ads direct you to have that conversation. THE DRUGS WE SEE ADVERTISED MOST ARE OFTEN THE MOST PRICEY Pharmaceutical ad campaigns often support the newest and most expensive drugs -- and these drugs are not always better than the old ones. The heartburn medicine Nexium, for example, was the most advertised drug in 2005, with $224 million spent on consumer ads. It&amp;#039;s a very similar drug to Prilosec, with similar rates of efficacy -- but because it&amp;#039;s newer, it&amp;#039;s still protected by patent law, meaning that no other company can sell a generic competitor for 20 years. With no competition, these patent-protected pills are generally more expensive -- Nexium costs about $160 for 30 days, compared with about $30 for 42 days for Prilosec. Perri points to Singulair, which is approved for both asthma and allergies, as another example: At $115 for 30 pills, it&amp;#039;s much more expensive than other allergy treatments.  THE BOTTOM LINE: Don&amp;#039;t press your doctor to give you the newest drug. Instead, ask which treatment will give you -- with your particular medical history -- the best results.  ADVERTISED DRUGS ARE USUALLY NEW TO THE MARKET -- AND MAY PRESENT RISKS THAT AREN&amp;#039;T YET KNOWN New drugs can have unexpected side effects that aren&amp;#039;t caught in their clinical trails. The arthritis drug Vioxx made a huge splash when it was introduced in 1999, in part because of heavy advertising. But drug trials indicated that older remedies such as naproxen (an anti-inflammatory) combined with a proton pump inhibitor like Nexium or Prilosec (to reduce acid production that can damage the stomach lining) were equally effective for most patients. Vioxx turned out to pose serious heart-health risks, but it took five years for those risks to become fully evident, and in the meantime, millions of people took the drug, exposing themselves to heightened danger of heart attack or stroke.  &amp;quot;When a drug is approved by the FDA, it&amp;#039;s usually based on short-term studies,&amp;quot; says Richard Kravitz, M.D., a professor of medicine of the University of California at Davis. &amp;quot;The advice I received in medical school was: Don&amp;#039;t be the last on your block to start using a treatment, but don&amp;#039;t be the first either.&amp;quot; In part because of the Vioxx scare, the pharmaceutical industry has made some changes. In 2005, Pfizer pledged not to advertise new drugs for the first six months they&amp;#039;re on the market, to allow more time for unknown or longer-term side effects to emerge; Bristol-Myers Squibb committed to wait a year. THE BOTTOM LINE: Ask your doctor if a drug&amp;#039;s side effects are well understood and if there are time-tested alternatives that have been proved to work as well. ADS AREN&amp;#039;T REQUIRED TO GIVE YOU ALL OF THE BAD NEWS Drugs aren&amp;#039;t always the best solution to a health concern, but you wouldn&amp;#039;t know that from watching a commercial. For example, ads for the sleep aid Rozerem proclaim the med&amp;#039;s ability to help you fall asleep, but they say nothing about whether it helps you stay asleep -- and it&amp;#039;s not clear that it does, according to a comparison of drug efficacy by researchers at Oregon Health &amp;amp;amp; Science University. Behavioral therapy, on the other hand, which teaches healthy sleep-inducing habits -- such as not watching TV in bed and resisting naps -- helps 70 percent to 80 percent of those with chronic insomnia fall and stay asleep. Drugs don&amp;#039;t work on every patient either, but ads aren&amp;#039;t required to publicize success rates. Ads for the toenail fungus drug Lamisil, for instance, don&amp;#039;t reveal that it eliminates the fungus completely in only 38 percent of people who take it. And for some people, a drug&amp;#039;s side effects are worse than the original symptoms: Dee Johnson, the woman with RLS, eventually quit taking Requip because she found the nausea unbearable; she now takes three different drugs to keep her symptoms in check. Of course, all ads offer the promise of an improved life. Your laundry detergent won&amp;#039;t make you happier or more organized, though you might get that impression from commercials. But the stakes are higher with drug advertising: &amp;quot;Drug companies aren&amp;#039;t selling shampoo or frozen dinners,&amp;quot; says Burkholder. &amp;quot;It&amp;#039;s crucial that these ads present risk-and-benefit information in a balanced way.&amp;quot; THE BOTTOM LINE: Before you take a drug, ask your doctor about its efficacy rate and known side effects, as well as whether there are lifestyle changes that may work for your condition. OBSESSING ABOUT YOUR HEALTH CAN MAKE YOU FEEL WORSE  Being concerned about your health is normal, says Gordon Asmundson, Ph.D., a professor of psychology at the University of Regina in Saskatchewan, Canada. But as many as one in five of us are likely to worry way too much about it, and health anxiety tends to feed upon itself, setting off a spiral of intensifying fear and illness. Anxiety is characterized by physiological arousal -- quicker breathing, faster heart rate, tenser muscles -- that can in turn make minor pain seem more intense, magnify odd sensations, and lead us to interpret minor problems as signs of serious disease.  Likewise, commercials that emphasize rare but serious complications of common ailments can amp up existing anxiety. In one survey, 68 percent of physicians reported that ads like these trigger noticeable anxiety in their patients; 12 percent reported that their patients experienced &amp;quot;a great deal&amp;quot; of anxiety. &amp;quot;I quite often see people with conditions like chronic pain who are crippled more by their worry than by the condition itself,&amp;quot; says Asmundson. THE BOTTOM LINE: Any health concern can be exacerbated by anxiety. If your health stress is unmanageable, talk to your doctor about strategies for managing it, such as meditation. DISCUSSING DRUGS WITH YOUR DOCTOR IS ALWAYS A GOOD IDEA Research has shown that mentioning a drug in the doctor&amp;#039;s office can do a patient good. In one of his studies on patient-doctor interactions, Kravitz asked trained actors to visit a general practitioner and describe symptoms of major depression. Of the &amp;quot;patients&amp;quot; who asked for a drug, including those who asked for a particular drug by name, 90 percent got high-quality initial care: an appointment for follow-up, refer-ral to a mental-health specialist, or a prescription. But only 56 percent of the actor-patients who did not mention a drug got any one of these treatments. Kravitz&amp;#039;s conclusion: &amp;quot;It suggests that informed, motivated, and involved patients can dramatically improve the quality of their own care,&amp;quot; he wrote. THE BOTTOM LINE: If you learn about a drug from an ad, and that helps you explain your condition to your doctor or helps you feel less embarrassed, mention it -- but when it comes to deciding whether you need that prescription, your doctor should be the one to make the final call. WHAT ADS TELL YOU -- AND WHAT THEY DON&amp;#039;T The FDA regulates standards on prescription-drug advertising: As with other kinds of advertising, drug ads cannot be false or misleading and must present a &amp;quot;fair balance&amp;quot; of risks and benefits. Because of legislation passed last fall, the FDA can levy fines of as much as $250,000 for ads that violate the rules and can request that an ad be pulled. But the agency can&amp;#039;t force a company to retract a misleading ad. Still, drug companies usually comply: From 2004 to 2005, the FDA identified 19 ads that broke the rules. By the time the FDA responded, more than half were no longer in use. The rest were removed. Here&amp;#039;s what an ad must tell you -- and what it can leave out. Ads Must:  Describe a drug&amp;#039;s benefits without overpromising. The makers of the herpes drug Zovirax, for example, were asked by the FDA to change language on their website suggesting that the ointment could prevent the disease from spreading. There&amp;#039;s not enough clinical evidence to suggest this, according to the FDA.  Explain who should not take the drug. List all potential side effects (for print ads) and include a toll-free number and website for reporting bad drug reactions. TV and radio ads must include a &amp;quot;clear, conspicuous&amp;quot; statement about a drug&amp;#039;s major side effects.  Ads Don&amp;#039;t Have To:  Discuss specific clinical trials in which the drug didn&amp;#039;t do very well, as long as the ad accurately reflects the overall success rate of the drug in the majority of trials. Describe exactly how well a drug works, as long as it improves the problem. Some drugs improve symptoms only slightly, but ads don&amp;#039;t have to give those specifics. Explain that many people may not need a drug to get relief from their condition, or mention other treatments that may be cheaper or better.  "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.redbookmag.com/body/health-fitness/advice/a2654/pill-for-that/>