A medical device company called Medtronic recently ran a full-page ad in the New York Times promoting an implantable cardiac defibrillator, or ICD. The ad claimed the device could protect those who have suffered a heart attack, or who have heart failure, from sudden cardiac arrest, “one of the nation’s leading causes of death.”

Since readers are more likely to admire promotions for the newest in fragrances or designer handbags, the ad struck an odd note. What was the purpose? Were those with heart disease, presumably already getting medical care, supposed to call their forgetful doctor and remind him to prescribe an ICD? Were healthy people supposed to jot down this beneficial item and keep it in a safe place, just in case? Was it aimed at investors, alerting them to the cool new devices Medtronic had to offer?

According to a Medtronic spokesman, the campaign is meant to be educational. Most people don’t know much about sudden cardiac arrest, which reportedly kills nearly 1,000 Americans each day. Some of those people, the company says, could be saved through the use of an ICD.

The alarming Medtronic message is representative of a tidal wave of advertising coming from the pharmaceutical and medical device industries. At best, such ads help the public by informing it of serious heath issues. At worst, they raise unnecessary anxieties and promote needless spending.

Anyone who has watched television, listened to the radio, or read the newspaper recently has been inundated with ads for pills that help you sleep, that will lower your cholesterol, reduce your social anxiety, improve your sex life, and calm your stomach. Overall, the industry ranked fifth in the total amount of ad dollars spent in 2005, laying out a grand total of $8.5 billion. For perspective, that amount, according to Ad Age, compares with only $2.2 billion for beer, wine, and liquors.

So? What’s wrong with the drug companies cluttering our psyches with all these messages? Plenty, says the associate director of the Center for Medical Consumers, Maryann Napoli. First, Ms. Napoli explains that the drug companies “frequently convince the public that newer is better. The newer drugs are more expensive than the older generics, and often aren’t any more effective. The drug companies are not required to conduct head-to-head drug tests. They only need to prove that their drug is safe and more effective than a placebo.”

Ms. Napoli points to a study in 2002 that compared a number of drugs used to treat hypertension. The study found that the most effective product on the market was also the oldest — a diuretic that had been available for 50 years. Needless to say, that finding did not show up in many ads.

Many observers are consequently concerned that advertising skews what might be considered best practices. According to one study by the FDA, consumers are indeed persuaded to seek drugs that have been advertised, and doctors feel pressured to prescribe them. About three-quarters of the doctors surveyed thought their patients had unrealistic expectations about the drug requested.

It has only been since a rule change in 1997 that drug and medical device companies began to advertise aggressively to consumers. The Government Accountability Office reported in 2002 that a tripling of direct-to-consumer advertising between 1997 and 2002 contributed to an 18% annual escalation in spending for prescription drugs during the same period. Spending on heavily promoted drugs rose 25% during that time compared with 4% for those not advertised. In most other countries, the practice is illegal. Various groups in America have promulgated standards and guidelines that are intended to govern the industry’s ads, but the regulation is slight and the rules flimsy, according to some.

In Ms. Napoli’s view, the system is broken. The FDA, which is supposed to monitor direct-to-consumer advertising by the medical companies, is understaffed and unable to deal with the industry’s huge volume of promotions. Typically, regulators are not able to screen ads before they are published, and so rely on competitors or consumers to red-flag rules violations. Even then, there is only a small chance of a retraction or correction.

The current onslaught of marketing is tied, some say, to the expiration of patents for many leading drugs in recent years and the industry’s frantic efforts to replace lost revenues. The omnipresent ads for Lunesta, for example, are likely tied to the 2007 expiration of Ambien’s patent.

Is there anything positive about the drug industry directly advertising to the public? In theory, one can argue the more consumers know about health care, the better equipped they are to weigh competing treatments or regimens. In some cases, seeing an ad for a medical condition could increase awareness of a disease, and encourage those afflicted to seek treatment.

Consumers are, after all, taking a more proactive role in many arenas these days. Inspired by the ever increasing flow of information available on the Internet, consumers are becoming bolder shoppers, travelers, borrowers, and investors. It is perhaps a given that they will also become more demanding patients

That would seem to be the rationale for the large number of ads running these days on CBS Radio for a medical lab group called Lab-Corp. The gist of the campaign encourages consumers to demand that their doctor send their lab tests to LabCorp, presumably because the outfit offers better pricing or reliability than Quest, for example, the industry leader. Thus, the consumer is asked to play a role in making a decision that heretofore he probably never even thought about.

On a larger stage, the drug industry will no doubt come under increasing scrutiny as America begins to tackle the thorny issue of excessive health care costs. Critics of the industry will likely argue that advertising outlays could be better spent coming up with new drugs. Others insist that the campaigns inspire unnecessary treatments and wasteful overdiagnosis.

Perhaps most worrisome of all is the possible undermining of Americans’ confidence in their essential well-being. Noted medical researcher Lewis Thomas once warned, “The new danger … is in becoming a nation of healthy hypochondriacs, living gingerly, worrying ourselves half to death.” Amen.

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