Dr Robert London

Pharma and Medical Breakthroughs

Clinical Psychiatry News - Volume 35, Issue 9, Page 58 (September 2007)

I had the experience recently of taking a time shuttle back to my youth. I took the look back by reading “Medicine Ave.: The Story of Medical Advertising in America” (Huntington, N.Y.: The Medical Advertising Hall of Fame, 1999).

The book, given to me by a friend and one of the authors—Ron Pantello—highlights many of the major developments and advancements in medications that profoundly improved the health and quality of life of Americans in the 20th century and beyond.

Reading this large, beautifully illustrated book reminded me of my youth, growing up in a medical family. Many of the advertisements presented in the book were ones I had seen years ago.

Looking at those advertisements also reminded me of relationships that my physician father, as well other doctor relatives, had with pharmaceutical representatives.

In those days, pharmaceutical reps were, by and large, pharmacists. As such, they had a lot in common with physicians and appeared to speak and understand the same medical/pharmaceutical/health care language. I remember one man in particular, from a giant company, who became a good family friend.

The book quickly covers the first half of the 20th century, when advertising was understated and directed solely toward the physician to balance the effects of over-the-counter patent medications.

After World War II, when breakthrough medications were developed for the treatment of infectious diseases, hypertension, asthma, diabetes mellitus, cardiac disease, inflammatory illnesses, and severe mental illnesses, the advertising changed, and clear and artfully creative advertisements became the rule.

Decade by decade, the book reviews the medicinal advances through print, creative design, and graphics. While reading and looking through this book, I remembered more and more life experiences—going well beyond the pharmaceutical advertising.

In the 1950s, we saw the emergence of Orinase (tolbutamide), Terramycin (oxytetracycline), Chlor-Trimeton (chlorpheniramine), Cortone (cortisone acetate), and Transderm-Nitro (nitrogylcerin), to name a few life-saving advances.

As we moved into the 1960s, Lasix (furosemide), Polycillin (ampicillin), and Tylenol (acetaminophen) advertisements stood out. Ortho-Novum (norethindrone and ethinyl estradiol) and Motrin (ibuprofen), in addition to advances in antibiotic therapy, dominated the 1970s.

Interestingly, there is a rendering of the early-20th century actor, Rudolph Valentino, who died at age 31 of pneumonia, and the advertisement points out: “Today we could have saved his life for the price of a matinee.”

I had a grandmother and aunt who died prematurely of bacterial infections before I was born, when no treatment existed. I would have liked to have met them.

As the book looks at the 1980s and 1990s, it highlights Tagamet (cimetidine), Procardia (nifedipine), Feldene (piroxicam), and Vasotec (enalapril). In addition, it shows Aricept (donepezil), Biaxin (clarithromycin), and American Cancer Society ads. One ad jumps off the page: “Kick Butt—You Can Live Without Smoking.”

Perhaps not surprisingly, the ads I found most intriguing were those for psychotropic medicines, which started appearing in the 1950s—when tremendous breakthroughs took place in the treatment of mental illnesses.

We saw drugs with antipsychotic actions emerge, such as phenothiazines. One of the more prominent ads was for Thorazine (chlorpromazine)—the first antipsychotic used in America.

We also saw the first antianxiety agent, Miltown (meprobamate), and the antidepressants Tofranil (imipramine) and Elavil (amitriptyline). In the 1960s came Librium (chlordiazepoxide), a benzodiazepine, for anxiety. Psychiatric medicine was revolutionized by the introduction of antipsychotic, antidepressant, and antianxiety medications. It improved even more over the years with atypical antipsychotics and selective serotonin reuptake inhibitors, to name only a few advances.

How easy it is to forget that severe and even moderate mental problems were virtually untreatable before these medications were developed.

We have made enormous changes in mental health care over the last 6 decades, moving away from custodial/institutionalized care and the one mainstay of outpatient care—psychoanalysis—to a much broader-based set of options in effective treatments.

The book reminded me that medicinal advances have altered treatment in ways few other therapies have for the severely and moderately mentally ill.

Thanks to these medications, many of these patients can have a quality of life that before would have been unfathomable.

Unfortunately, the pharmacist-pharmaceutical representative is gone, as are the warm relationships. Also gone are the endless samples that physicians could give to patients in financial need.

In many instances, these scenarios have been replaced by complicated forms and regulations to get gratis medications.

Today's pharmaceutical reps look like movie stars and talk about the half-lives of medications (which usually we don't question so as not to trip them up). Often, they use aggressive techniques to get in the door, as if they were selling used cars.

Despite our frustrations with much of the current crop of pharmaceutical reps, we should not forget that without their products, we as psychiatrists would have far fewer treatment successes and less time for talk therapy. Even though I use cognitive and behavioral therapies successfully for many disorders, the fact remains that many of the psychotic and mood disorders respond well to pharmaceuticals.

Treating patients who have knowledge about these medications because of direct advertising (which started in the 1990s) is not always easy.

But it seems to me that consumers, including patients with mental illnesses, are better off learning about medications and asking intelligent questions of their doctors.

Besides, the 7- to 11-minute visits encouraged in today's managed care environment for general medical issues allow very little time to be folksy or educational. Many hospitals and doctors appear to advertise endlessly about being the best around.

It is my hope that this kind of information will make us all better health care consumers. Perhaps the pharmaceutical industry could continue to revolutionize health care in this country by leading the way in improving care for the severely mentally ill.

The pharmaceutical industry could provide the lead in reopening many state hospitals as residential and therapeutic programs for the chronically mentally ill that use talk therapy/rehabilitation and the long-term consistency of medication management.

Let me know your thoughts about ways in which the pharmaceutical segment of the health care industry could go further in serving patients in a positive manner, and I will try to pass them along to my readers.

PII: S0270-6644(07)70640-9


© 2007 Elsevier Inc. All rights reserved.