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Type 2 Diabetes, Largely Preventable, Accounts for Many Pharma Ads

Do you pay attention to the side effects listed in pharma ads? Perhaps the companies should tell us how to prevent type 2 diabetes on TV.
Type 2 Diabetes, Largely Preventable, Accounts for Many Phar...
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This is an excerpt from Dennis Miller’s explosive new book The Shocking Truth About Pharmacy: A Pharmacist Reveals All The Disturbing Secrets. The entire book is available for download from Amazon for 99 cents.

We’re constantly bombarded with TV commercials for potentially dangerous drugs for preventable medical conditions. For example, some of the most heavily advertised drugs on TV are those that treat type 2 diabetes, a largely preventable condition.

Many Pharma Ads List Death as a Side Effect:

Are you alarmed by the common mention of the word “death” in commercials for type 2 diabetes drugs? In what world does it make sense to routinely prescribe drugs that may have fatal side effects when the underlying medical condition is mostly preventable?

Why does our medical system focus so heavily on treating conditions rather than on preventing them? Has the profit motive completely corrupted our medical system at every level?

This article discusses some of the most heavily advertised drugs for type 2 diabetes including Ozempic, Trulicity, Rybelsus, Januvia, Farxiga and Jardiance. A similar criticism applies to the drug treatment of many other preventable diseases of modern civilization which account for the vast majority of the prescriptions that pharmacists fill.

What Are the Side Effects Listed in Pharma Ads for Diabetes Drugs?

Many of the most commonly prescribed and heavily advertised drugs for type 2 diabetes have side effects which include scary conditions like “medullary thyroid cancer,” “multiple endocrine neoplasia syndrome,” “lymphoma,” “pancreatitis,” “ketoacidosis,” and “necrotizing fasciitis.” Some of these side effects can lead to death. Here are summaries of the drugs you’ll find in lots of pharma ads.

[1] GLP-1 agonists for type 2 diabetes: Ozempic, Trulicity, Rybelsus and Victoza

The heavily advertised class of drugs known as GLP-1 agonists includes Ozempic, Trulicity, Rybelsus and Victoza. Surely you’ve seen ads on TV for these drugs if you watch at least a moderate amount of TV and don’t reflexively change the channel when drug ads come on.

Two of the drugs in this class (Ozempic and Trulicity) are among the ten most heavily advertised drugs on TV for 2019 (“Leading Pharmaceutical Brands in the United States in 2019 By National TV Ad Spend”)

Medullary thyroid cancer and multiple endocrine neoplasia syndrome

Not only are these heavily advertised drugs used to treat a largely preventable condition (type 2 diabetes), but the drugs come with a long list of potentially scary side effects.

For example, the TV commercials for Ozempic, Trulicity, Rybelsus and Victoza list “medullary thyroid cancer” and “multiple endocrine neoplasia syndrome” as possible side effects.

All four of these drugs have very similar warnings on their separate websites (ozempic.com, trulicity.com, rybelsus.com, and victoza.com).

For example, the following is from ozempic.com:

Possible thyroid tumors, including cancer. Tell your health care provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Ozempic and medicines that work like Ozempic caused thyroid tumors, including thyroid cancer. It is not known if Ozempic will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.

Do not use Ozempic if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

[2] DPP-4 inhibitors for type 2 diabetes: Januvia, Onglyza

From Januvia.com:

Serious side effects can happen in people who take JANUVIA, including pancreatitis, which may be severe and lead to death.

From Onglyza.com:

Serious side effects can happen in people who take ONGLYZA:

Inflammation of the pancreas (pancreatitis) which may be severe and lead to death.

[3] SGLT-2 inhibitors for type 2 diabetes: Farxiga, Jardiance, and Invokana

From Farxiga.com:

Rare but serious infections that cause severe tissue damage under the skin of the genitals and areas around them have happened with FARXIGA. This infection has happened in women and men and may lead to hospitalization, surgeries and death.

Ketoacidosis occurred in people with type 1 and type 2 diabetes during treatment with FARXIGA. Ketoacidosis is a serious condition which may require hospitalization and may lead to death.

From Jardiance.com:

Ketoacidosis (increased ketones in your blood or urine). Ketoacidosis is a serious condition and may need to be treated in the hospital. Ketoacidosis may lead to death.

Necrotizing fasciitis. A rare but serious bacterial infection that causes damage to the tissue under the skin in the area between and around your anus and genitals (perineum). This bacterial infection has happened in women and men who take JARDIANCE, and may lead to hospitalization, multiple surgeries, and death.

From Invokana.com:

Ketoacidosis (increased ketones in your blood or urine). Ketoacidosis has happened in people who have type 1 or type 2 diabetes, during treatment with INVOKANA. Ketoacidosis has also happened in people with diabetes who were sick or who had surgery during treatment with INVOKANA. Ketoacidosis is a serious condition, which may need to be treated in a hospital. Ketoacidosis may lead to death.

A rare but serious bacterial infection that causes damage to the tissue under the skin (necrotizing fasciitis) in the area between and around the anus and genitals (perineum). Necrotizing fasciitis of the perineum has happened in people who take INVOKANA. Necrotizing fasciitis of the perineum may lead to hospitalization, may require multiple surgeries, and may lead to death.

Why Pharma Ads Focus on Risky Drugs:

Do drug companies have an ethical responsibility to explain the significance of utilizing potentially risky drugs for largely preventable medical conditions?

Shouldn’t pharma ads for these drugs be required to explain the significance of taking any of these drugs for type 2 diabetes given their long lists of potentially serious side effects and given the fact that type 2 diabetes is widely acknowledged as a preventable disease of modern civilization?

Do drug companies have a moral duty to carefully explain the significance of “medullary thyroid cancer,” “multiple endocrine neoplasia syndrome” and lymphoma from drugs like Ozempic. Trulicity, Rybelsus, and Victoza?

Do drug companies have a moral duty to carefully explain the significance of ketoacidosis from drugs like Farxiga, Jardiance, and Invokana?

Do drug companies have a moral duty to carefully explain the significance of pancreatitis from drugs like Januvia and Onglyza?

Pharma Ads Use Big Words:

The commercials for Type 2 diabetes drugs often mention that concomitantly taking a drug in the “sulfonylurea” class can lower blood sugar to dangerous levels, but most viewers have no idea what the word “sulfonylurea” means, just as they have no idea about the significance of “ketoacidosis,” “medullary thyroid cancer,” “multiple endocrine neoplasia syndrome,” and “lymphoma.”

What is the purpose of advertising prescription drugs to the public if most viewers have no idea what many of the words mean? Viewers probably assume that the drugs must be great because the FDA would pull them off the market if risks outweigh benefits. In the real world, the FDA allows drug manufacturers to market potentially risky drugs as long as known adverse effects are listed. Thus the FDA has passed the buck to physicians and apparently also to consumers to investigate the risks versus benefits of drugs.

TV commercials Should Describe What’s Known About Preventing the Condition:

In my opinion, the FDA should require that at least half of every drug commercial on TV be devoted to describing what is known about the prevention of the condition. Or maybe each drug commercial should be divided into three parts of equal length:

1. What is the drug is used for?
2. What are the known adverse effects?
3. What is known about preventing the underlying condition?

Pharma ads on TV for drugs for type 2 diabetes seem to suggest that nothing can be done (or no one knows how) to prevent this condition and that treatment with pills is the only option.

The fact is that type 2 diabetes is almost always included in books and articles that discuss preventable diseases of modern civilization. There’s no real disagreement that type 2 diabetes is largely preventable. See, for example:

Prof. Daniel Lieberman: Type 2 diabetes is “mostly avoidable” and “used to be rare”

According to Daniel Lieberman, a professor of human evolutionary biology at Harvard, (The Story of the Human Body: Evolution, Health, and Disease, New York: Pantheon Books, 2013, p. 271

[Type 2 diabetes] is now one of the fastest growing diseases in the world. Between 1975 and 2005, the worldwide incidence of type 2 diabetes increased by more than sevenfold, and the rate keeps accelerating, not just in developed countries but also in developing nations. …

Type 2 diabetes is a distressing disease because of the suffering it causes and a frustrating disease because it is mostly avoidable, used to be rare, and now is considered a nearly inevitable consequence of affluence….

Harvard School of Public Health: 90% of type 2 diabetes cases can be avoided

According to an article titled “Simple Steps to Preventing Diabetes” on the Harvard T.H. Chan School of Public Health website, about 9 in 10 cases of prediabetes and type 2 diabetes can be avoided:

The good news is that prediabetes and type 2 diabetes are largely preventable. About 9 in 10 cases in the U.S. can be avoided by making lifestyle changes. These same changes can also lower the chances of developing heart disease and some cancers. The key to prevention can be boiled down to five words: Stay lean and stay active.

Excess weight is the single most important cause of type 2 diabetes. Being overweight increases the chances of developing type 2 diabetes seven-fold. Being obese makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight.

It is immoral that commercials for type 2 diabetes drugs don’t explain that most cases are preventable

In my opinion, it is immoral for pharma ads for type 2 diabetes drugs to avoid stating that about 9 in 10 cases are preventable. It is as immoral as commercials for lung cancer to avoid stating that most cases of lung cancer are preventable by avoiding cigarettes.

Given the list of potentially serious side effects from drugs for type 2 diabetes, shouldn’t the FDA require that every effort be made to prevent this preventable condition? Shouldn’t the FDA require that the advertisements stress that type 2 diabetes is a largely preventable condition and that the drugs that treat this condition can have potentially very serious side effects?

Why Do Only USA and New Zealand Allow DTC Prescription Drug Advertising?

Viewers should realize how unusual these drug commercials on TV are. Only the USA and New Zealand allow direct-to-consumer advertising of prescription drugs. What does that tell you? It tells me that, in the USA, private profits are more important than public health. Clearly the rest of the world feels that the adverse consequences of pharma ads on TV outweigh any theoretical benefit.

The USA is the only major advanced country that does not have a national health insurance system. In my opinion, it is no coincidence that the USA is only one of two nations that allow direct-to-consumer advertising of prescription drugs. In both cases, the USA appears to believe that the population is fair game for exploitation by marketing. Private profits are more important than the health of the population.

The FDA should do the following things:

1) The FDA should require that the first part of each commercial explains what it known about prevention of the condition that the drug treats.

2) The FDA should ban intentionally distracting images like portrayals of happy people having fun on sunny days by a swimming pool with the family pet.

3) The FDA should require that the screen goes black while the list of side effects is displayed in white text.

4) The FDA should require that these advertisements acknowledge that only the USA and New Zealand allow the peculiar phenomenon of direct-to-consumer advertising of prescription drugs.

Of course, none of this will happen because of the immense power of the pharmaceutical industry’s lobbyists.

Pharma Ads Ignore the Vast Medical Literature on Prevention:

In my opinion, the biggest reason why drug commercials on TV should be banned is because they typically completely ignore the vast medical literature regarding what is known about the prevention of the medical condition that the advertised drug treats.

Diverting viewers’ attention from side effects

Clearly the advertising agencies are thinking: What are the best scenes we can depict to divert the attention of viewers away from the side effects? Clearly the presence of many smiling faces and dogs wagging their tails makes viewers want to take the advertised drug. The message is: If you take this drug, you will be as happy and you will have as much fun as the attractive people in the commercials.

Why aren’t viewers alarmed by long lists of side effects?

Why don’t viewers react with more alarm to lists of possible side effects for nearly all the drugs advertised on TV? On the one hand, surely part of each viewer’s brain tells him/her that these drugs have lots of potentially scary side effects. On the other hand, viewers probably discount these side effects because the viewers assume that the FDA has concluded that the drugs are essentially safe. Viewers assume that the FDA would withdraw the drug from the market if it were not basically safe.

The surprisingly common yet illogical belief that side effects occur in just one patient per million

Whenever pharmacists tell customers about potential side effects, these pharmacists often hear many customers respond, “Yeah. The side effect occurs in one person in a million so the FDA requires the drug company to list the side effect.”

A huge number of people seem to think that drug companies are somehow magically capable of developing pharmaceuticals so that each side effect will occur in just one person per million. That is absurd. The occurrence of side effects varies widely among drugs and among the people who take those drugs.

Does anyone know the real world incidence of side effects?

Many critics of the pharmaceutical industry say that no one really knows the true incidence of drug side effects, in large part because no one really wants to know. The FDA doesn’t really want to know because the FDA is pressured by Congress to speed the approval of drugs. The drug companies surely don’t want to know the real world incidence of side effects. Such information would depress drug sales. And the general public doesn’t really want to know this information. Most users of prescription drugs don’t want to hear information that suggests that taking pills as if there’s no tomorrow is a bad idea

Who should protect you from unsafe drugs: Your physician? The FDA? Your pharmacist?

In essence, the public assumes that the FDA is protecting them. But, in fact, the FDA allows lots of drugs on the market that critics say should never have been approved. The FDA expects physicians to weigh the known risks versus the benefits of the drug. But busy physicians, like the general public, assume that if a drug is still on the market, then surely the FDA considers it to be basically safe.

Thus we have a circular game of pass the buck. Each party assumes that the other party is doing its job in keeping unsafe drugs off the market. Each party is expecting the other party to play a much larger role than it does. The end result is that nobody plays the role that the public assumes and expects.

For a large number of reasons, pharmacists are more supportive of pharmaceuticals than the public assumes. Chain drug store corporate management doesn’t want pharmacists to criticize the drugs we dispense. Physicians don’t want pharmacists to criticize the drugs they (physicians) prescribe. Pharmacists don’t have enough staffing that would allow us to have substantive conversations with our customers about the safety of pharmaceuticals. And many pharmacists have swallowed Big Pharma’s Kool-Aid about the safety and effectiveness of the drugs we dispense. In addition, it is quite taxing on a pharmacist’s psyche to simultaneously hold diametrically opposing views about pharmaceuticals: pills are great and pills are risky. So the path of least resistance is for everyone to accept Big Pharma’s rosy narrative.

Drug Marketing in the USA Is Still “the Wild West”:

In my opinion, despite assurances of safety and effectiveness by the FDA, prescription drug regulation in the USA in many ways exists in a time warp resembling the Wild West era of bizarre potions, salves, elixirs and snake oils. Today a patina of science obscures the reality of marketing gone mad. The powers-that-be in the USA clearly have decided that there is no inherent moral dilemma in advertising potentially risky prescription drugs directly to naive TV viewers.

Private profits are more important than public health

In my opinion, private profits are deemed more important in the USA than the health of the people. We are all fair game for Big Pharma’s marketing juggernaut. Exploitation of the public for private gain is what it’s all about.

This is an excerpt from Dennis Miller’s explosive new book The Shocking Truth About Pharmacy: A Pharmacist Reveals All The Disturbing Secrets. The entire book is available for download from Amazon for 99 cents.

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