3 Good Reasons Your Doctor Didn’t Prescribe the Drug You Asked For?>

3 Good Reasons Your Doctor Didn’t Prescribe the Drug You Asked For

by Keng Lam, MD  

If you watch TV, it’s unlikely that you have escaped seeing ads telling you to “ask your doctor” about such drugs as Humira, Lyrica, Xeljanz, Eliquis, or Taltz. The U.S. is one of only two countries in the world (the other is New Zealand) that allow direct-to-consumer, or DTC, drug advertising. Pharmaceutical companies have been eager to take advantage of this regulatory permissiveness, and they spend more than $6 billion a year promoting their products to consumers via television, print, and digital advertisements, as well as social media campaigns. But here’s why you shouldn’t rush to ask your doctor about them:

  • Newer drugs aren’t necessarily better or safer (and they are almost always more expensive). For a drug to be approved by the FDA, the manufacturer needs to show that it is safe and effective for its intended medical use. But it doesn’t need to be safer or more effective than what’s already on the market. And manufacturers need not provide any stats about the new drug’s expected benefits in the ads. Older drugs aren’t just less expensive in most cases (in part because their patents have expired, so they’re available as cheaper generics); they’ve also been around longer, so their long-term safety has been established. In fact, it’s not unusual for the FDA or drug manufacturers to release additional warnings about certain new drugs after they have reached the market and have been used by millions of people—or even to withdraw a drug because of safety risks that emerge after approval. For example, the heavily advertised pain reliever Vioxx was taken off the market in 2004 after it was found to in­­crease the risk of heart attacks and strokes. A 2017 study found that among 222 “novel therapeutics” (in­­cluding 183 drugs) approved by the FDA between 2001 and 2010, one-third had some postmarket safety problem.
  • The drug may not be approved for your specific medical condition. Often, the drugs that get a lot of media attention are for uncommon conditions that your doctor may not have experience with. For instance, the FDA approved the first mari­juana-derived drug, Epidiolex, in June 2018, but only for treating two rare forms of epileptic seizures.
  • The drug may not be the best first-line or even second-line treatment for you. Diabetes medications are a good example. As rates of type 2 diabetes and prediabetes have risen, so too have ads for drugs like Trulicity, Januvia, Jardiance, and Victoza. But none of these are the preferred initial treatment for diabetes. If dietary changes, weight loss, and exercise alone aren’t enough to lower blood sugar to recommended levels, the older generic drug metformin is the preferred initial medication in most cases. New drugs should generally be prescribed only if the older ones don’t provide sufficient benefit or if they have intolerable side effects.

Bottom line: Don’t assume newer means better. Do assume newer means increased safety risk. While many advertised drugs offer modestly improved treatment, and some are true breakthroughs, most are at best simply additional options. As a general rule, we discourage people from taking drugs that have been marketed for less than three years unless there are no other options. Even with promising new medications, 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.

Also see Are You Being Misled by Medical Ads?

A version of this article appeared in the UC Berkeley Wellness Letter.

Originally published January 2019. Updated August 2019.