Pushing pills.

Byline: The Register-Guard

Having trouble concentrating? Can't seem to finish reading even the most scintillating editorials?

Here's what you need to do: Watch television.

In a single evening, you can see 15 or more advertisements for prescription drugs. Over the course of a year, you'll see about 16 hours of drug ads - far more time than you're likely to spend with your primary care doctor.

The ads will help you decide whether your difficulty concentrating arises from insomnia, depression, restless leg syndrome, allergies, erectile dysfunction, acid reflux, irritable bowel syndrome, high cholesterol, toenail fungus or social anxiety disorder. If you're like many people, you'll see something in one of those commercials that vaguely matches the way you sometimes feel.

More important, you'll want to get your hands on the pill that makes you look and feel like the people at the end of the commercial: happy, successful, lucky, well-rested and free of horrifying mustard-colored lice-like creatures tearing up the tender skin underneath your toenails. The very next time you see your doctor you'll ask for a prescription for Lunesta, Ambien, Cialis, Nexium, Lipitor, Lamisil, Buspar or whatever the latest magic pill may be.

It's called direct-to-consumer marketing, and since the Food and Drug Administration relaxed its rules on such advertising by drug companies in 1997, pharmaceutical manufacturers have spent billions touting the benefits of prescription medicines on television. In the four years between 2001 and 2005, drug industry spending on TV commercials shot from $654 million to $1.2 billion.

There's no question that the ads are effective. A 2003 Harvard Public Health study commissioned by the Kaiser Family Foundation determined that for every $1 spent on direct advertising, drug companies took in an additional $4.20 in sales.

Despite an acknowledgment that most ads make factual claims and can promote important conversations between patients and their doctors, criticism of direct drug marketing is mounting. A study published last week in the Annals of Family Practice found that most TV drug ads relied on emotional appeals, failed to mention lifestyle changes as an alternative, left out important information about how common a condition was or oversold the benefits of taking the advertised drug.

Although the toenail fungus drug Lamisil wasn't one of the medications examined in the recent study, its advertising campaign offers a prototypical example of the problems with direct-to-consumer drug marketing. Toenail fungus is an inconsequential condition characterized by yellow nails and occasional minor pain. But after launching a clever ad campaign featuring an ugly cartoon character called "Digger the Dermatophyte" being crushed by a giant Lamisil pill, millions of people were moved to battle the hidden menace of toenail fungus.

A 2006 Forbes article reported that 10 million Americans have taken Lamisil. What Digger didn't tell them was that a three-month supply of the drug costs $850, and it cures the problem in only 38 percent of the patients. Digger also didn't mention that no one has ever died from toenail fungus, but federal regulators have linked Lamisil to 16 cases of liver failure and 11 deaths.

The Forbes report said the ad vastly overstated the benefits of the drug, and federal regulators raised objections that resulted in the campaign being withdrawn. Nonetheless, Lamisil sales surged 19 percent to hit $1.2 billion worldwide.

The Lamisil example goes to the heart of the problems with direct-to-consumer drug marketing. TV drug ads induce impressionable consumers to self-diagnose health conditions based on 60 seconds worth of incomplete information. Patients then pressure their doctors to prescribe expensive name-brand drugs they may not need and the risks of which they often don't understand.

The United States and New Zealand are the only two developed countries that allow direct drug marketing, and New Zealand is considering banning drug ads to consumers. First Amendment protections of commercial speech make an outright ban unlikely in the United States, but that shouldn't preclude stricter regulation.

A committee headed by Sen. Edward Kennedy of Massachusetts plans to hold a series of hearings this year on strengthening FDA oversight of drug advertising. Among the suggestions physicians have made is that pharmaceutical companies be required to demonstrate a compelling public health benefit from a direct-to-consumer ad campaign.

Adopting that suggestion might help ensure that Americans learn more about diabetes and heart disease from direct-to-consumer ads than about erectile dysfunction and insomnia. As a bonus, everyone would rest easier about the costs and benefits of drug advertising.