January 08, 2018; Big Pharma’s Big Advertising; That “scientific aura” really moves the merchandise.
Commentary by Ralph Campbell, MD
(OMNS Dec 31, 2017) TV advertising and magazine advertising—sometimes 2 to 3 standard pages for a single drug—is expensive. So why do the drug manufacturers do it? Simple– because it is effective. Advertising experts carefully construct their ads for a specific TV audience or reader. Evening news watchers are subjected to an array of ads aimed at older citizens for the treatment of many health problems, especially the big ones—-heart disease, diabetes, Alzheimer’s and cancer—-problems of this older generation that is most apt to tune in. Sports watchers are subjected to a quite different set of ads. You don’t see ads for the benefits of adequate doses of essential nutrients — because they can’t be patented and in most cases they work better than drugs in treating progressive diseases.[1,2]
Format of the ad
Remarkably, the evening news drug ads all have the same format. A trade name and the generic name are presented, both of which have a clever scientific ring to them. In lay terms, we are told what the drug is expected to do. Then a new, gentler, soothing voice that is many decibels softer chimes in announcing the adverse effects. All through the laundry list of adverse effects, we witness the recipient of the drug exhibiting tremendous enthusiasm for life as he/she partakes in fun things like parties or picnics and the most popular, romping with the family dog. Steven Colbert writing in the Reader’s Digest offered this: “Sometimes I wish I had more health problems, because the people in pharmaceutical ads have more picnics than I do.”
The soothing voice drops even lower and accelerates when it slides over serious adverse effects, such as “occasional death”. Many of these drugs can cause angioedema, a very serious condition that constricts the airway and must be treated promptly with adrenaline. The admonition is: “If trouble breathing, call your doctor immediately or go to an emergency room”. One problem with this: If you live out in the sticks, you might not get a hold of your doctor or get to the emergency room soon enough to prevent death. The drug manufacturers know full well that treatment of autoimmune diseases with drugs may depress a necessary immune response that would encourage a number of serious diseases, so they must include the message “tell your doctor if you have—“. Even though some of the possibilities will be ruled out by tests (Tb, Hepatitis B), others might slip by. What may be puzzling is that the modern doctor has access to all the electronic medical history; so one wonders, why he/she has to be told? Finally there is the exhortation, “Ask your doctor about so and so”, the implication being, I would like your opinion, doctor, but I want this drug.
Benefits of essential nutrients not advertised
Knowledge of the nutritional basis for many progressive diseases in the older generation is not widely understood by doctors as they were not taught this subject in medical school and don’t have the time to keep up with the recent literature. Adequate doses of vitamins, minerals, and other essential nutrients can prevent or reverse many of the diseases mentioned in TV ads, but as they can’t be patented, there is no rationale to produce ads extolling their benefits. The digestive system of older individuals can’t absorb nutrients as well as it once did, so virtually all the older generation needs to consume a larger dose of nutrients from their diet. Rheumatoid arthritis can be successfully treated by natural remedies such as vitamin and mineral supplements and avoiding the food groups that cause flare-ups. 
The use of medical lingo and acronyms appears to be an attempt to gain public trust by placing the patient on par with the physician. For example the term COPD (chronic obstructive pulmonary disease) is currently in wide use, almost a household term. By emphasizing that the acronym “is what doctors call…” puts the TV viewer on par with the doctor. Acronyms for certain test results further the cause. Add blind trust for the overseeing government agencies, such as the Federal Drug Administration (FDA), and many, after believing that they now know all they need to know about a drug or the disorder, surrender their curious, discerning attitude for a complete sell out. Doctor, go ahead. Do what you think is best but please prescribe the best drug.
Here are examples: Immuno-suppression drugs, often used to treat rheumatoid arthritis, are of much concern. Four years ago in this class there was only Humira, (medical name, adalimumab). Names for drugs are selected for their sound byte; being hard to pronounce adds to the scientific color, and “mab” at the end means “monoclonal antibody” (a form of antibody sold as a drug). If used to treat one autoimmune disease (in which the immune system goes a little crazy and begins attacking healthy tissues) it might invite another to flare up. This must be fully explained to the patient. I credit the attempt to tell the TV viewer about its mechanism of action—“a tumor necrosis factor blocker which reduces inflammation.” But the Humira ad may be a winner in listing the most adverse events, the most serious being: “may cause a fast growing type of lymphoma”, “may develop serious (and sometimes fatal) infections”, or “may interfere with normal blood clotting (coagulation)”. After this advice, the ad goes on with “stay away from sick people and avoid activities that may increase your chance of bleeding”. For example, maybe avoid opening child-proof packaging with scissors or knife. This drug may also take the prize for the most “tell your doctor” disorders: chronic infections, Hepatitis B, congestive heart failure, numbness or tingling or Multiple sclerosis, Guillain-Barre syndrome. No vaccinations while on this drug, and don’t use in those under two years of age, or if nursing, since “it isn’t known if it will harm the baby”. I suspect that by FDA rules, these warnings are mandatory. But in abiding by the requirement to post warnings on the container, they’re printed so small that even the keenest of eyes needs a magnifying glass.
As soon as a drug goes generic (when its patent runs out), a new, similar one will take its place. There is often an active advertising campaign attempting to prove the superiority of the new one over its predecessor. The newer immuno-suppressor drug is Xeljanz/Xeljanz XR, used specifically for rheumatoid arthritis. The XR form is a sustained, slow release form of the drug. The same warnings as for Humira, including the possibility of developing lymphoma, are listed, plus a few more–“may develop skin cancer, shingles or liver problems”—and a bad one–“may cause perforation of stomach or intestine, especially if used with aspirin or other NSAI drugs. During treatment avoid receiving a live virus vaccination (not all vaccines)”. The European Medicines Agency (counterpart of our FDA) doesn’t find sufficient evidence of effectiveness of this drug. Are they smarter than we are, or are they just more honest in their research?
The newest kid on the block in this category is Taltz or ixekizumab (can you pronounce that?) Again, the “tell your doctor if you have” list is long: Tb, Chron’s disease, ulcerative colitis, recent infection, allergies, medicines you are taking, if pregnant or plan on getting pregnant. The adverse effects are similar to the other drugs, but in the TV ad for Taltz they do a better job of explaining how it makes one more susceptible to infection: “It may cause neutropenia, a reduction of the white blood cells that fight infection”. They were diligent in finding more adverse effects than Humira but they provide these comforting words: “Your doctor may be able to tell you how to prevent or reduce some of these side effects.” They have calculated the incidence rate for a few of these: Pain and erythema (redness), 10-17%, respiratory problems, 10% or more. But they do not know the incidence rate of the most serious, angioedema. This drug might win the prize for having the most and the worst adverse effects. If one is going to a doctor who is unaware of the conditions listed here, it would be better to switch to a doctor who listens carefully and will take the time to look at the electronic medical record.
Type II diabetes and pre-diabetes can be effectively treated with nutrition and some types of fasting.  Autoimmune type I diabetes may require insulin but can be greatly ameliorated with proper nutrition and exercise. To get the balance right can take some focused effort by doctor and patient. If the diet includes a large proportion of leafy green and colorful vegetables, and adequate doses of all the essential nutrients including vitamins C, D, E, the B vitamins, omega-3 fatty acids, and minerals such as zinc and magnesium along with an adequate amount of beneficial exercise, the conditions that initiate diabetes in individuals with metabolic syndrome can be prevented, even in the absence of drug treatment. But you will probably not see this information in extravagently-produced TV ads.
There are many ads for glucose lowering drugs since so many Americans have been given a diagnosis of Type II diabetes or pre-diabetes. Toujeo is simply a long-acting insulin and may occasionally be used for Type II diabetes but is mostly for the auto-immune, Type I. Since it is designed to lower the blood glucose level, an overdose will produce hypoglycemia. Adverse events include: May cause dehydration (as does diabetes), because glucose in the urine requires water to go with it. They describe the symptoms as feeling weak or dizzy, especially when standing up. May cause infection of bladder and genitals. (Urine with a high glucose concentration promotes the growth of thrush, a fungal infection.) Again, the “tell your doctor if you’ve had” list is extensive: liver or kidney disease, bladder cancer or infection, low blood pressure, heart problems, pancreas problems or if on a low-salt diet or drink alcohol. Barely mentioned is ketoacidosis in which the diet or the body’s glucose metabolism is so out of whack that the body has to metabolize fat in order to supply the brain with enough glucose to maintain life.
Metformin, the most popular blood glucose level lowering drug at that time, had a problem with lactic acidosis, a condition that can lead to muscle wasting. The seriousness of it led the FDA to put a black box warning on it. The normal way glucose metabolism works is to have a by-product of glucose metabolism, lactic acid, processed in the liver to turn it back into pyruvate which can enter the energy producing cycle (Krebs cycle). By Inhibiting this process, there can be profound effects, including muscle wasting. The “black box” warning is no longer present. Buyer beware.
I have saved the worst as the last. Victoza is an injectable glucose lowering drug. The ads make it clear that the drug is not a substitute for insulin, yet they make no attempt to explain just how it works. It, too, claims that with proper diet and exercise, it may work. This weak recommendation is countered with “may cause thyroid problems or cancer or pancreatitis” (prompting a warning to notify the doctor if severe “stomach” ache).
High blood pressure can be prevented by optimizing the health of blood vessels. The strength and elasticity of arteries is supported to a large extent by collagen, the most common structural protein of the body. However, to maintain collagen in excellent shape, the diet must contain adequate daily doses of vitamin C, which is a necessary co-factor for crosslinking collagen into a strong 3D matrix. Both vitamin C and E have been shown to support artery health and prevent high blood pressure. [1,5-8] Vitamin C is water soluble and so is widely available to arteries, veins and organs through the blood. Vitamin E, an antioxidant synergistic with vitamin C, is fat-soluble so it is distributed in cellular membranes throughout the body. These are helpful in doses ramping up to 3000 mg vitamin C per day in divided doses, and 400-1200 IU vitamin E per day. Magnesium and zinc are also beneficial in preventing high blood pressure. Many people are deficient in these essential minerals.[9,10] Supplements of magnesium are commonly taken at doses of 300-600 mg/day, and zinc is commonly taken at doses of 15-50 mg/day. The chloride form of magnesium is absorbed best, minimizing the laxative effect seen with other forms. Along with supplements of magnesium, vitamin D is often recommended (2000-5000 IU/day) because many people are deficient especially during the winter and spring.[9,11] Many people are deficient in these essential nutrients, and taking supplements over several months can normalize high blood pressure, often dropping it by 20% – 30%.
There are many blood pressure lowering drugs on the market which work in different ways. Currently a popular one is Lisinopril, an ACE (angiotensin converting enzyme) inhibitor. Angiotensin is produced by the kidneys to promote a normal blood pressure (neither too high nor too low), but it sometimes forces blood pressure too high. Thus the perceived need for a drug that calms it down. If the drug does too good a job and blood pressure drops too far, the desired effect becomes an “adverse effect”. Another category is the Beta blockers, that block the chemicals released by the sympathetic nervous system, like the hormones adrenalin and norepinephrine that elevate blood pressure and are released in response to stress. The problem is that the drug can’t block just one of these hormones’ actions. So, Beta blockers are known to produce adverse effects — as with ACE inhibitors, an overdose can produce hypotension. This group of drugs needs to be prescribed by a doctor in close contact with the patient, since the effects of these drugs can vary with individuals. The starting dose should always be low. If it isn’t doing the expected job, increase the dose. Some patients need four times the starting dose; others find the lowest dose works the best. Of course, if it is causing any serious effects, a different drug needs to be considered. But (though most doctors will not tell you) before trying drugs to lower blood pressure, you should try an excellent diet that includes adequate doses of vitamins C, D, and E along with essential minerals such as zinc and magnesium.[1,5-11]
Blood clots are increasingly common in the older generation. They can cause ischemic strokes which are the most common type. Vitamin E is known to lower the risk for clotting by slowing the aggregation of platelets in the blood. Although vitamin E, as well as the anticoagulant drugs, can increase the risk of hemorrhagic stroke, vitamin C lowers the risk of hemorrhagic stroke by helping to maintain artery strength.[5,6,14] Vitamin C can regenerate oxidized vitamin E, so vitamins C and E work synergistically to prevent high blood pressure and both types of stroke. Although doctors may advise avoiding supplements of vitamin E for patients taking an anticoagulant to prevent strokes, it is often preferable to take vitamin E (400-1200 IU/day), but under the doctor’s care reduce the dose of the anticoagulant drug instead. Along with an excellent diet containing lots of colorful vegetables, supplements of vitamin C and E are safer and more effective in preventing strokes than drugs.
Ads for anticoagulants provide a “scientific aura” by promoting their effect on “DVT” and “PE” (acronyms for deep vein thrombosis and pulmonary embolism). But ironically, that aura is countered when the ad calls the drug a “blood thinner” (very much a “lay” term). The only way to “thin the blood” is to take excessive water — which can lead to low sodium (hyponatremia), a serious life-threatening condition.
The very widely used warfarin demands consideration of vitamin K intake that can dampen the effect of the medicine. Testing the prothrombin time (prothrombin is the enzyme that initiates coagulation and depends on vitamin K as a co-factor) allows the doctor to be certain the dose is not too high. But doctors will often give the patient a choice of two different recommendations: 1) Totally eliminate vitamin K from the diet, or 2) Adjust the dose of the warfarin, not the diet. The ads for the newer drug, Xarelto, tell of its superiority over warfarin in that it works with a different mechanism than warfarin to avoid the concern about vitamin K. Ads for both drugs warn that they increase the risk of bleeding. Obviously there are times when slowing coagulation is not a good thing, for example (as mentioned above) opening a child-proof package with a sharp object, slipping on the ice, banging your head hard which may cause bleeding in the brain (cephalhematoma). Also, inhibiting the clumping effect of platelets with a daily aspirin can bring about a similar result, but in many people aspirin taken long term is damaging to the gut. Commonly, both drugs are taken at the same time, which may increase the risk of bleeding.
Compared to these drugs, vitamin E used as an anti-coagulant (often taken as described above with vitamin C, vitamin D, magnesium, and zinc) has an excellent safety record. Adequate nutrition can prevent and reverse many progressive diseases without the use of drug treatment. Supplements of essential nutrients can help, when used in adequate doses and with knowledge about possible contra-indications. In many cases vitamin and mineral supplements are safer and more effective than drugs.[16,17] They cost less but you won’t find them advertised like drugs on TV.
To learn more:
Angell M. THE TRUTH ABOUT THE DRUG COMPANIES. NY: Random House, 2004. Reviewed at http://www.doctoryourself.com/news/v5n8.html
Also: Angell M. Is academic medicine for sale? N Engl J Med. 2000 May 18;342(20):1516-8.
Rigged Trials: Drug Studies Favor The Manufacturer http://www.orthomolecular.org/resources/omns/v04n20.shtml
1. Case HS. (2017) Orthomolecular Nutrition for Everyone: Megavitamins and Your Best Health Ever. Basic Health Pub. ISBN-13: 978-1681626574
2. Smith RG., Penberthy T. (2015) Vitamin Cure for Arthritis. Basic Health Pub. ISBN-13: 978-1591203124
3. Scientist Reveals Which Natural Treatments for Rheumatoid Arthritis may boost your health. http://www.rheumatoid-arthritis-decisions.com
4. Brighthope I. Vitamin cure for diabetes. (2012) Basic Health Pub ISBN-13: 978-1591202905
5. Shargorodsky M., Debby O., Matas Z., et al. Effect of Long-Term Treatment with Antioxidants (Vitamin C, Vitamin E, Coenzyme Q10 and Selenium) on Arterial Compliance, Humoral Factors and Inflammatory Markers in Patients with Multiple Cardiovascular Risk Factors. Nutr Metab (Lond) 2010, 7:55. https://www.ncbi.nlm.nih.gov/pubmed/20604917
6. Kurl S., Tuomainen TP., Laukkanen JA., et al. Plasma Vitamin C Modifies the Association between Hypertension and Risk of Stroke. Stroke 2002, 33:1568-1573. https://www.ncbi.nlm.nih.gov/pubmed/12052992
7. Levy TE. Stop America’s #1 Killer: Reversible Vitamin Deficiency Found to be Origin of All Coronary Heart Disease. Henderson, NV: LivOn Books, 2006.
8. Hickey S., Saul AW. Vitamin C: The Real Story, the Remarkable and Controversial Healing Factor. (2015) Basic Health Pub ISBN-13: 978-1591202233.
9. Dean C. The Magnesium Miracle (2017) Ballantine Books, ISBN-13: 978-0399594441.
10. Sardi W. The Hidden Mineral Deficiency that Induces Hypertension. http://knowledgeofhealth.com/the-hidden-mineral-deficiency-that-induces-hypertension
11. Grant WB. The Top 18 Vitamin D Papers in 2015-2016. http://orthomolecular.org/resources/omns/v13n08.shtml
12. Centers for Disease Control and Prevention. (CDC), Types of Stroke. https://www.cdc.gov/stroke/types_of_stroke.htm
13. Steiner M. Vitamin E, a modifier of platelet function: rationale and use in cardiovascular and cerebrovascular disease. Nutr Rev. (1999) Oct;57:306-309. https://www.ncbi.nlm.nih.gov/pubmed/10575906
14. Schürks M., et al. Effects of Vitamin E on Stroke Subtypes: Meta-Analysis of Randomised Controlled Trials. BMJ 341(Nov 4, 2010):c5702. https://www.ncbi.nlm.nih.gov/pubmed/21051774
15. Saul AW. (2011) Vitamin E Attacked Again Of Course. Because It Works. http://orthomolecular.org/resources/omns/v07n11.shtml
16. Hoffer A., Saul AW Orthomolecular Medicine for Everyone: Megavitamin Therapeutics for Families and Physicians. Basic Health Pub (2008) ISBN-13: 978-1591202264
17. Saul AW. (Ed), Orthomolecular Treatment of Chronic Disease: 65 Experts on Therapeutic and Preventive Nutrition. Basic Health Pub (2014) ISBN-13: 978-1591203704
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