Tuesday, October 6, 2009
When exactly did urinary incontinence become known as "overactive bladder"? What about impotence, commonly referred to as "erectile dysfunction"? By coining those terms, today's drug advertisers may be blurring the line between what's normal for your body and what are serious conditions that require treatment.
Some experts say this change stems from consumers having a better understanding of the causes and extent of diseases. But others say the trend is disease mongering: an attempt to widen the market, increasing the number of new tests and treatments by giving fancy new names to old medical problems.
The advertising "increases the use of drugs among people who really need them, but it also increases prescriptions among people in that gray zone," says Richard Kravitz, a professor of internal medicine at the University of California at Davis, who has written about the effect of ads on doctors and patients.
Consumer Reports reviewed drugs that have been heavily marketed lately for three conditions. For each condition, drugs can be a boon when symptoms are serious -- or a bad choice when they're oversold to people who don't really need to take them.Gotta Go
Urinary incontinence, the uncontrollable release of urine, can have a devastating effect on a person's life and can lead to skin infections. However, it is far rarer than less-severe urinary problems, including an urgent or frequent need to urinate.
"Pharmaceutical companies saw that those [lesser] symptoms were common," says Leroy Nyberg Jr., director of urology programs at the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda. "So they developed drugs to treat them, made up a term -- overactive bladder disorder -- advertised it, and people said, 'Hey, I got OAB!' "
Although frequent and urgent urination are more common than incontinence, some evidence shows that even those problems aren't as widespread as some studies suggest. And the drugs used to treat an overactive bladder are only moderately effective and can cause troubling side effects, notably blurred vision and mental confusion.
Bottom line: Before you resort to drugs for an urgent or frequent need to urinate, your doctor should rule out other possible causes. And you should try some simple self-help measures, such as cutting back on caffeinated and alcoholic beverages, especially in the evening, and practicing bladder training (urinating at regular intervals whether you have to or not) and Kegel exercises (tensing and relaxing your pelvic muscles).Viva Performance Anxiety
A funny thing happened in the five years after Pfizer launched sildenafil (Viagra), the first oral drug marketed for erectile dysfunction: Men ages 18 to 45 became its fastest-growing group of customers, even though impotence is relatively uncommon until age 65 or so.
"Occasional inability to achieve an erection is normal," Nyberg says. "Erectile dysfunction means that you cannot get or keep an erection, or most of the time you cannot."
Bottom line: Men who are frequently unable to achieve an erection should be examined for diabetes and cardiovascular disease, because ED is often an early sign of those conditions. In fact, addressing coronary risk factors -- reducing blood pressure, cholesterol levels and weight; stopping smoking; exercising more; treating diabetes -- may help correct ED. The next step is to consider changing or adjusting the dosage of medicines that can interfere with erections, such as those prescribed for depression, heartburn, high blood pressure and pain.Truly Blue?
Antidepressants are the third most commonly prescribed class of drugs, after cholesterol-lowering medications and narcotic pain relievers. But a large portion of those who are prescribed antidepressants have only marginal symptoms. Direct-to-consumer advertising may be at least partly responsible for that, along with doctors prescribing such drugs for problems that can be treated with lifestyle changes or less-expensive options instead.
For example, after the drugmaker Eli Lilly lost protection on its patent for fluoxetine (Prozac), it just renamed the drug Sarafem. The company then colored the pills pink and received FDA approval to market it for "premenstrual dysphoric disorder," which includes depression symptoms, irritability and tension before menstration. Though a small minority of women suffer from severe premenstrual symptoms, a vast majority don't need treatment, and those who do might fare just as well with generic fluoxetine, which costs about $20 a month vs. roughly $200 for Sarafem.
Bottom line: Mild depression is normal, especially in the wake of stressful events. Such feelings usually are resolved on their own or with the help of counseling, exercise or meditation.
You're more likely to need medication, often paired with therapy, if your low mood lasts for more than a few weeks or causes appetite changes, loss of interest in activities, physical symptoms or thoughts of suicide. In such cases, Consumer Reports recommends starting with low doses of the generic versions of antidepressants, including bupropion, citalopram, fluoxetine, paroxetine and sertraline.
Copyright 2009. Consumers Union of United States Inc.
For further guidance, go to ConsumerReportsHealth.org. More-detailed information -- including CR's ratings of prescription drugs, conditions, treatments, doctors, hospitals and healthy-living products -- is available to subscribers to that site.