Doctors' orders
Feb 15,2008 00:00 by the St. Louis Post-Dispatch

For a physician who doesn't make house calls on a weekly television show or advise celebrities in meltdown, Dr. Robert Jarvik is a pretty well-known guy.

He's married to Parade magazine columnist Marilyn vos Savant, famous for having the world's highest IQ. Jarvik developed the eponymous Jarvik-7 artificial heart, which caused a sensation when it was implanted into a dying man in 1982. And since 2006, Jarvik has appeared in television commercials for the cholesterol-lowering drug Lipitor.

In them, he's seen talking about his father, whose death from heart disease inspired Jarvik's medical career, running with his adult son and rowing a racing scull across a mountain lake.

But Jarvik isn't actually a rower. The commercial reportedly was filmed with a stunt double and rowing apparatus mounted on a platform.

Nor is he a cardiologist, even though the commercial touts Lipitor's ability to prevent heart attacks. In fact, while Jarvik holds a medical degree, he's not currently licensed to practice medicine.

Now members of an influential congressional committee are asking questions about the ad. Their concerns go far beyond whether the drug's maker, Pfizer, misrepresented Jarvik's rowing and running skills.

The real issues are twofold: trust inspired by a well-known doctor and the ability of advertising to create demand for a particular medicine that might or might not offer benefits to patients who ask for it.

Lipitor is very effective at reducing levels of cholesterol in the blood. There's a clear relationship between high cholesterol levels and heart attacks.

Studies have shown that people who already had a heart attack can reduce their risk of dying from a subsequent heart attack by taking so-called statin drugs, including Lipitor. It stands to reason, then, that people who haven't had a heart attack also would benefit. That's how statin drugs most often are used.

But there's no clear evidence that giving Lipitor and other statins to people without heart disease will extend their lives. The drugs have potentially serious side effects in some people.

Brand name drugs such as Lipitor are fairly expensive, especially compared to other statins that now are available in generic form. Pfizer began airing ads with Jarvik just as a generic version of Zocor, Lipitor's biggest competitor, become available.

Drug companies say advertising makes patients aware of potential treatments. But, they say, doctors make the final decision about what to prescribe. Still evidence shows that advertising increases the number of prescriptions written, even to people who wouldn't necessarily benefit.

Exhibit A is Vioxx, an arthritis drug that was pulled off the market in 2004 after it was shown to increase the risk of heart attack and stroke. That heavily advertised drug had one narrow advantage over older, less expensive ones: It was less likely to cause ulcers. But it was widely used even by people with no history of stomach problems.

At a time when primary care doctors spend an average of 10 minutes or less with patients, it's reasonable to wonder whether they're taking the time to fully explain the risks and benefits of heavily advertised drugs to their patients before writing prescriptions.

Drug ads aimed at consumers were rare before 1996, when federal restrictions were eased. After Vioxx was withdrawn, the drug industry announced voluntary guidelines. But the Lipitor ad suggests they're not completely effective.

With the potential safety hazards that medications pose and the role advertising plays in fueling national health spending of $2.1 trillion in 2006 - $216.7 billion for prescription drugs - Congress is right to demand answers.

Reprinted from the St. Louis Post-Dispatch – CNS.