April 18, 2019
3 Good Reasons Your Doctor Didn\

3 Good Reasons Your Doctor Didn't Prescribe the Drug You Asked About

by Keng Lam, MD  

The United States is one of only two countries in the world (the other is New Zealand) that allow direct-to-consumer, or DTC, drug advertising. On almost every commercial break on television, I see at least one ad telling viewers to “ask your doctor about [X drug].” Pharmaceutical companies spend a massive sum of money—more than $6 billion a year—promoting their products to consumers via TV, print advertisements, and digital media (which include website ads, social media, and online videos).

The top 10 advertised drugs alone accounted for a total of more than $2.4 billion of spending in 2017, according to a report by Kaiser Health News. If you’re curious, those drugs were—in descending order of spending—Humira (adalimumab), Lyrica (pregabalin), Xeljanz (Tofacitinib), Eliquis (apixaban), Keytruda (pembrolizumab), Taltz (ixekizumab), Chantix (varenicline), Trulicity (Dulaglutide), Cosentyx (secukinumab), and Entresto (sacubitril/valsartan).

Of course, we also hear about new—and often very expensive—drugs from other sources, like online patient groups, friends or relatives, and the news. But that doesn’t mean the drug you heard about from any source is the one you should or will get, even if you do “ask your doctor” about it. Here are three good reasons why.

1. It isn’t the best first-line or even second-line treatment for you

Diabetes medications provide a perfect example. As rates of type 2 diabetes and prediabetes continue to climb in the U.S., the media has become saturated with ads for diabetes drugs, including Januvia (sitagliptin), Jardiance (empagliflozin), Victoza (liraglutide), and as mentioned above, Trulicity. But none of these is a preferred initial therapy for diabetes. If dietary changes, weight loss, and exercise alone haven’t been enough to lower blood sugar to recommended levels, the older generic drug metformin is the preferred initial medication. One of the newer drugs may be prescribed as an add-on if metformin alone isn’t sufficient, but none is a first-line treatment.

2. Newer drugs aren’t always better—or safer

For a drug to be approved by the FDA, the manufacturer needs to demonstrate that it is safe and effective for its intended medical use. However, that does not mean it needs to be safer or more effective than what is already on the market. Older drugs aren’t just less expensive in most cases (in part because their patents have expired, meaning they’re available in identical but less-costly generic versions), but they have a longer record, so we have a better understanding of their safety profile. That’s important to remember, since it’s not unusual for the FDA or drug manufacturers to release additional warnings about certain drugs after they reach the market and are used by millions of people—or even to withdraw a drug because of serious safety risks that emerge after approval. One example you may remember is the widely advertised painkiller Vioxx (rofecoxib), which was removed from the market in 2004 after it was found to increase the risk of cardiovascular disease.

Related: New Drugs Not Always the Best Drugs

3. It’s not approved for your specific medical condition

The FDA approval of the first marijuana-derived drug, Epidiolex (cannabidiol), in June 2018 was a huge and important development that received a lot of media coverage. The drug, which contains the cannabis compound cannabidiol, or CBD, is approved for treating certain debilitating epileptic seizures, mainly in children. So I wasn’t surprised when the mother of a child I was treating in the hospital for a seizure disorder asked if I could prescribe it. The problem was that Epidiolex so far is approved only for two specific rare forms of seizures called Lennox-Gastaut syndrome and Dravet syndrome, neither of which this child had. So I had to explain, to the mother’s disappointment, that I could not prescribe this drug, however promising, to her child.

Bottom line: Newer drugs aren’t always better. The most advertised drugs are often the most expensive. And pharmaceutical companies are banking on your not knowing either of those facts so that they can convince you to ask your doctor about their products. Even with a promising new medication like the CBD drug Epidiolex, you may have to wait for studies to be done in people with your specific condition before they’re appropriate for your doctor to prescribe.