The People's Perspective on Medicine

Drug Advertisements, Scary Side Effects and Cognitive Dissonance

How do pharmacists and the general public react to the reality of potentially very serious adverse effects? Is denial a common coping mechanism?

One of the most remarkable things on television these days is drug advertisements. These commercials usually include long lists of potentially very dangerous side effects, yet the public largely remains enthusiastic about pharmaceuticals. Only the USA and New Zealand allow direct-to-consumer advertisements for prescription drugs.

No other products advertised on TV are accompanied by so many warnings. Those for prescription drugs are far lengthier than those that once accompanied cigarettes when cigarettes were advertised on TV.

Why Don’t Warnings Discourage Drug Use?

Normally, when someone is confronted with scary warnings about a wide range of hazards we encounter in life, the tendency is to shy away from whatever is the subject of that warning. But the opposite seems to occur with drug advertisements on television. These advertisements somehow increase the demand for pharmaceuticals. Although many drugs are essential and some are even life saving, many others do not come anywhere close to fitting that description.

Why does the public seem to ignore the long lists of potentially serious side effects listed in drug advertisements on TV? Our brain is telling us to be cautious, while TV drug advertisements encourage mindless consumption. Pharma marketing promotes hedonistic consumption that is no different from the marketing of any other consumer product.

Do Long Lists of Side Effects Numb Your Brain?

In my opinion, the psychological effect of hearing long lists of scary  side effects in drug advertisements should be to prompt people to do everything in their power to prevent the medical condition targeted by the drug so that people can avoid needing to take that drug.

As a result of one of my commentaries in Drug Topics lamenting the lack of emphasis on prevention in our health care system, one pharmacist sent me an e-mail in which he said that he became a vegetarian in an effort to avoid having to take the drugs that he dispenses all day long.

Other people don’t seem to have that reaction. As a pharmacist, I have heard many people say things like, “Yeah. The side effect occurs in one person in a million so the government (FDA) requires the drug company to list every possible side effect.”

What Does FDA Approval Mean?

FDA approval doesn’t really mean a drug is safe. Perhaps it only means that the drug company has met the narrow legal standard for disclosure. In the real world, the FDA expects physicians to weigh the risks versus benefits of drugs. The FDA in effect passes the buck to physicians. But busy physicians assume that if the FDA approves a drug, then it must be safe. 

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Drug Advertisements Divert Attention from the Importance of Prevention:

One of the most unfortunate effects of the ubiquity of drug advertisements on television is that people conclude that pharmaceuticals are the only reasonable way to address a wide range of ailments and medical problems. In my opinion, drug advertisements should include a substantial section on what is currently known about dietary/nutritional, lifestyle, psychological, and environmental factors in the causation and prevention of that condition.

Most of the prescriptions that pharmacists fill are for what’s known as diseases of modern civilization or diseases of affluence. This includes elevated blood pressure, elevated cholesterol, elevated blood sugar in type 2 diabetes, gout, osteoporosis, asthma, coronary heart disease, cerebrovascular disease, peripheral vascular disease, obesity, cancer, alcoholism, and some types of allergy.

Worldwide Incidence Data:

In addition to prominently listing potential drug side effects, the advertisements should include a substantial section on what is known about the prevention of that condition. They should mention the fact that the incidence of the condition may vary significantly around the world. Moreover, they should discuss the reasons for that variation in incidence when they are known.

Take breast cancer for example.It is a significant source of illness and even mortality in the US.

According to the World Health Organization,

“Incidence rates [for breast cancer] vary greatly worldwide from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 women in Western Europe.”

Wouldn’t it be enlightening if advertisements for drugs that treat breast cancer were required to include such worldwide incidence data? This might prompt the public to demand that priority be given to cancer prevention rather than chemotherapy.

What Does “Safe and Effective” Really Mean?

The FDA declares that the drugs it approves are safe and effective, but many of the potential side effects listed in drug advertisements certainly do not coincide with the layman’s definition of safe. Death is often mentioned as a possible adverse effect of many of the drugs heavily advertised on television. The reality is that FDA approval does NOT mean that a drug is safe by the layman’s understanding of that word.

Cognitive Dissonance:

In psychology, cognitive dissonance is the mental stress or discomfort experienced by an individual who holds two or more contradictory beliefs at the same time. According to Wikipedia, cognitive dissonance theory is founded on the assumption that individuals seek consistency between their expectations and their reality. An individual who experiences inconsistency (dissonance) tends to become psychologically uncomfortable. Since it is impossible for a thinking person to hold two mutually exclusive beliefs simultaneously, they often become anxious. 

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Cognitive dissonance is inevitable in every pharmacist’s life when faced with these contradictions:

  • The contradictions between the glowing picture of drugs painted by direct-to-consumer advertising and the reality of a long list of potential side effects
  • The contradiction between the FDA’s seal of approval and the reality that many side effects don’t even appear until after a drug is on the market
  • The contradiction between the fact that our health care system is based on drugs and the reality that prevention is safer and more effective than pills

Cognitive dissonance often arises when there is conflict between a pharmacist’s positive concept of himself/herself and the reality.  For example, a pharmacist might believe: “The drugs that I dispense are safe and effective.” As a result, this person might fail to recognize that some drugs do more harm than good.

a pharmacist at work behind the counter of a pharmacy, mistake, atenolol shortage, ethical question

How Do Pharmacists Handle this Disconnect?

Do we react with hostility and denial toward customers who sometimes question the safety of the drugs we dispense? Or do we confront the reality that FDA approval does not mean a drug is safe? On the one hand, our instincts tell us that human health is primarily the result of basic factors such as eating properly, maintaining a healthy weight, embracing an active lifestyle, avoiding the use of tobacco and alcohol, etc. On the other hand, our health care system is based on the manipulation of molecules and cells with powerful synthetic chemicals called pharmaceuticals. How does one reconcile these opposing views of human health?

Mechanistic vs. Holistic:

  • Why does our health care system have a mechanistic and reductionist focus on molecules and cells, rather than a holistic focus on nutrition and lifestyles?
  • Why is modern medicine fixated on alpha blockers, beta blockers, calcium channel blockers, H2 antagonists, proton pump inhibitors, HMGCoA reductase inhibitors, etc.?
  • Has modern medicine miraculously discovered errors in tens of thousands of years’ worth of human evolution?
  • Why is modern medicine obsessed with attacking and overwhelming delicate biological processes with synthetic chemicals foreign to human evolution?
  • Why is our health care system fixated on chemistry rather than on nutrition and lifestyles?
  • Why are pharmacists in the business of pushing pills rather than changing lifestyles?

This question is especially relevant in light of the fact that major dietary and lifestyle changes can, in general, do more  than medication  to improve health. In order to lessen the inner turmoil caused by the attempt to hold diametrically opposed views simultaneously, pharmacists have to adapt to big contradictions. How do pharmacists reconcile Pharma’s rosy view of drugs with the reality of long lists of potentially serious adverse effects?

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I experienced frightening reactions following first-time use of a widely-prescribed blood pressure drug and a widely-prescribed osteoporosis drug. The blood pressure drug left me with permanent loss of hearing and balance problems. The osteoporosis drug left me with continuous hip pain, a limp, and significant loss of hip mobility and ability to walk.

Before taking these drugs I was very physically active, with normal hearing and ability to enjoy music. I consulted several doctors, none helped me. I know other people who had similar experiences.The only progress I have made has come from diet changes and working with highly qualified athletic trainers for my injured hip. I am angry and frightened that drug companies can harm unsuspecting patients with no consequences.

Very important discussion of this extremely complicated, constantly changing issue. Every body reacts differently to medications. It is essential for patients to recognize and, with their doctors, address any side effects.

Good article! What does one do when you are taking a drug for high blood pressure that you would like to get off of but the warning says don’t stop taking

This article raises many questions about pharmaceuticals, that I have been asking for years, but once again, offers no answers about how to resolve this situation except to become a vegetarian. But that is not always the answer for some hereditary conditions. For example: gout is caused by the body’s inability to process purines. Purines are found in meat, but also in dark, leafy green vegetables like kale, spinach, turnip greens, et . In fact, kale is the food highest on the list of purines! I listen to and read the side effects of any drug advertised or prescribed to me, including OTC remedies. I ask questions of my doctor, and refuse meds, such as statins, which I know have caused me severe problems in the past. But doctors don’t like patients who question their prescriptions. I have had doctors tell me “if only one person has an adverse reaction, the FDA makes them list it but, overall, the benefits outweigh the risks.” For whom, the patient; or the doctors and Big Pharma?

I think the answer is to curtail consumer advertising of all pharmaceuticals, the goal of which is to create an artificial demand for unsafe products. Every drug ad ends with the phrase, “Ask your doctor if [XYZ] is right for you!” This places more pressure on already overworked physicians, who are also being pressured by sales reps, and offered perks or kicbacks, to prescribe specifuc brands.

The goal of Big Pharma is not to cure illness, it’s to make profits to fund costly ads to make more obscene profits. Heakthcare in this country is profit driven, not health driven. Why else do they constantly raise drug prices in this country, even on drugs that have been on the market for years, and cost significantly less in other countries? Hint: it’s not because of research, development, or production costs. I suggest we all write our Congressmen to demand they curb this plague on our healthcare system, immediately! But beware, they will probably feed you the same old benefit/ risk line as Big Pharma because they are too busy counting the money they also receive from (?); you guessed it, Big Pharma! So what’s the answer? Nancy Reagan said it best: “Just Say No!”

We need more articles like this. However, many people feel they don’t have time to keep up with this. They know tidbits of information but not enough to help them.

Truths well spoken! Joe and Terry also published a piece about cognitive dissonance – the opposing messages consumers get when watching drug ads: The speaker speeds up when they get to “the list” and speaks in a monotone voice as if the deluge of side effects is irrelevant. At the same time, the video shows perfect-looking actors (supposedly after taking the Rx), looking trouble-free, enjoying an activity which requires a person to be healthy and feelin’ good!

Alas, most people are visual learners… Jo and Terry suggested that we close our eyes during Rx commercials and just LISTEN!

I have noticed that the people shown in the TV drug ads, do not look like sick people. They all seem to be attractive, well-dressed, and having a wonderful time. They are always depicted as doing great, fun activities and are so happy! Who would not want to identify with these folks? Makes your own life look boring by comparison, even if you are healthy! This is emotional manipulation at the worst level!
Thanks for the great article.

As a medicine avoider I salute your candor, however I believe there are some instances where pharmaceuticals are essential, for example for stopping infections. But in continuance with your theme, I agree that antibiotics are overused. In conclusion, personally I have experienced the evils of unannounced I’ll effects of pharmaceuticals and have found much more palatable natural solutions. The readers would be well advised to read , “The China Study” by T. Colin Campbell, PhD and Thomas M. Campbell II, MD.

Personally, I avoid pharmaceuticals as much as I can. Currently I am on one prescription med, and plan on staying that way. If I could find a holistic approach, I wouldn’t be on any meds at all. I don’t find any disconect between what is advertised on tv and the side effects. If anything, it’s made me that much more deterimined to stay away from medications if possible.

Part of the reason people might be oblivious to TV drug warnings is the mute button people use on commercials, so all they see is the happy pictures!

Many among my family and friends are so over-medicated, taking 15 to 23 different prescriptions and trusting their doctors who prescribe them. They are now weakened, in my opinion, by those very drugs.

Paying attention to how you body reacts to drugs so important!! Adding another prescription to counter-act reaction is sad !!

My friend’s father who is showing signs of dementia won’t connect that to his statin drugs. Sad.

The more this kind of information about drug side effects is publicized, the better. I have had serious side effects from Ambien and Simvastatin and have reverse effects with pain meds. Needless to say, I am off these drugs. As a result, I have begun intermittent fasting. I average 18 hours between meals and am careful to include fruit, vegetables, fiber and protein, very little sugar or white flour. After five weeks my LDL cholesterol had dropped 75 points, HDL rose 30, triglycerides down. I am careful to eat well-balanced meals.

Now 3 months after beginning this way of eating I am sleeping better than I have in years, feel energetic, never have cravings and am never hungry. I have lost 14 pounds. My doctor is thrilled, and so am I. I just love this way of eating! By the way, I am 81.

“‘Incidence rates [for breast cancer] vary greatly worldwide from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 women in Western Europe.’

Wouldn’t it be enlightening if advertisements for drugs that treat breast cancer were required to include such worldwide incidence data? This might prompt the public to demand that priority be given to cancer prevention rather than chemotherapy.”

Bogus argument! Breast cancer occurs late in life. It is likely that average lifespan in Eastern Africa is short–that women die of other causes before they are old enough to have breast cancer.

As economic conditions continue to improve over time in Eastern Africa, the breast cancer mortality will continue to increase and weak thinkers will blame it on “adoption of Western lifestyles and diets.”

Funny thing about Darwinian evolution: survival of the fittest only applies to conditions that occur before people can reproduce and raise offspring to an age where they can fend for themselves. Any conditions that typically occur after that age do not get bred out of society–such as adult onset diabetes, cancer, heart disease, hypertension, glaucoma, hypercholesterolemia.

There’s only one (unlikely) scenario in which these conditions could ever be minimized or eliminated: if people chose spouses based on the health of the prospective spouse’s parents. This is just beginning to happen, e.g., women with BRCA1 and BRCA2 choosing to adopt–but it is not likely to be adopted for other conditions.

An interesting experiment is to close your eyes during the prescription drug commercial and just listen to the side effects. The cheerful mesmerizing story portrayed in the commercial distracts you from the sobering warnings about side effects.

The capacity for self deception is truly infinite. You can see it in every arena, not just about pharmaceuticals. People WILL believe whatever is expedient or best supports their biases facts and data be damned.

AMEN! I hate these ads. Our family is into prevention of health problems via diet, exercise, and other lifestyle choices. I particularly love the proposal that pharmacists be involved in prevention. They would need the training, of course, but what a great idea. (Doctors too, right?)

A most excellent article. Since I seldom watch TV, happily I miss all these great ads. When they start throwing them into the mix during football or hockey games, I am going to avoid those too. I also notice in several supposedly “health” oriented magazines, there are usually many ads for drugs. Any drug is the last thing I want. Not even Tylenol.

I hope to live long enough to see drug commercials be taken off the air. I can dream, but as long as these insane ads continue to influence how one lives, we will keep seeing deaths increase caused by western medicine’s stance of treating diseases that the system created. We live in crazy world.

This article hit the nail squarely on the head. Why do we Americns demand a pill to fix things that lifestyle changes such as exercise and diet could take care of? And the answer is: It’s easier to take a pill than go to the gym and buy fruits and vegetables. We are a lazy society.

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