Drug Advertising and Side-Effect Information

Everyone who watches TV has seen ads for "new" drugs with 10 seconds of why it's the best thing since sliced bread, and 20 seconds of side-effects including-but-not-limited-to death, deathiness and death-like symptoms. Kidding.

This should raise several important questions.

First, why do drug companies keep running these obnoxious ads?  Because they keep working (pdf).  Despite their disagreeable qualities, most patients who see the ads ask for a prescription for the drug and most doctors who are asked to prescribe it will do so.  Why?  Most patients are hopeful that something "new" may help them, and most doctors find it faster and easier to say yes than to explain no.

Also, ads should raise the question of how is this drug "new'?  Depends on how you define it.  Drugs advertised on TV are certainly not generics: they are newly developed and approved drugs that will therefore be expensive.  On the other hand, only 10% of them will be new insofar as being the first ever of their kind, or better than already available drugs that do the same thing (congeners).  The other 90% are what is known in the trade as "me-too" drugs.  They are no better than older generically available drugs, and are being sold in hopes of obtaining market share for the drug company that makes them.

Last and not least, I get the most questions on side-effects.  The questions are basically around what are the side effects, and how bad are they.

Listed side effects are not inevitable.  They are simply a list of possible side effects.  WebMD does a great job in discussing what side effects actually are and how they can occur.

Common side-effects may occur in up to 10% of people who take a medication. This also means that 90% of people who take the medication experience no side effects.  Severe side-effects are far less likely to occur, as the FDA does not permit the sale of medications that are seen to frequently cause severe side-effects.

The tricky bit is trying to find out for yourself what side effects actually can happen with a medication, and also how commonly they actually occur.

The problem is that the information provided by pharmacies or in with the medications is largely provided by lawyers, and not by doctors or pharmacists or nurses.  The PI (Product Insert) is principally designed to prevent class action lawsuits by listing every possible reaction to the medication  to prevent you from being able to sue for failure to disclose ("You didn't tell me that could happen.").

It would be helpful if the PI also told you how often the side effect actually happens, whether it's real or theoretical, whether it happens in humans or only in test animals and whether it happens in patients like you, or only in ICU patients with organ transplants receiving the medication in their iv (not kidding).  Problem is, they don't.  The PI is not written to inform you, it is written to protect drug companies.  The much-vaunted PDR (Physician's Desk Reference) is simply a copy of PI's from all medications.

There is no shortage of information from sites such as drugs.com which do a pretty good job of providing useful information in plain English about medications.  However, I've still never seen one that tells you how common the side effects actually are with numbers.  Sorry, but it matters.  You might be okay with a medication where dizziness occurs in 1 in 10,000 people, but not so much if it were occurring in 10% of people.

Sider 2 is useful in getting that information.  Its A-Z listing shows side effects in color-coded columns from most common to least common and allows you at a glance to see if a side effect is common or rare and also percentage of occurrence by the color coding in the sidebar.

Micromedex is the first (or second) most widely used medication database used by doctors and pharmacists.  It's smartphone app is available for only $2.99/year. It does a superb job in easily presenting drug information including actual occurrence rates of side-effects.  However, it is targeted to doctors and pharmacists.  If you want to use it, you'll need a medical dictionary at your side to translate it.  Sorry, we say rhinorrhea and you say runny nose.