I appreciated your article on direct-to-consumer advertising by the pharmaceutical industry ("Prime-Time Pushers," March/April). Given the importance of the issue, it would be nice to see a companion piece on marketing to medical professionals. I work as a psychologist in a children's hospital, where I see some of the marketing efforts firsthand. You can spot the pharmaceutical reps by their youth and designer suits. The companies provide food for luncheons and meetings, all manner of office products from Post-its to calendars, and even Halloween candy emblazoned with a drug's name. (A co-worker has a lavender-scented Paxil candle on her desk.) These items are difficult to resist, especially when many hospitals run at a deficit and supplies can be hard to come by. Those with prescribing privileges receive invitations to evening and weekend seminars where they receive gift certificates and "honoraria" in exchange for attending informational sessions on conditions that can be treated by a drug company's medications.
Consumer Reports found that teenagers who wear items with cigarette logos are likely to smoke, even though they say they are not susceptible to advertising. Why should medical professionals behave any differently? The trends I have observed certainly appear to reflect the marketing to medical professionals. Pressured by managed care companies, doctors frequently prescribe medications to children that do not yet have clear evidence of being effective for various psychological disorders, without research data from double-blind studies.
Your article also neglected to mention an important move by Eli Lilly. The company has repackaged Prozac as Sarafem and is marketing the drug to treat premenstrual dysphoric disorder (PMDD). Eli Lilly's patent exclusivity on Prozac runs out in August -- after that, it will be available as a less-expensive generic, significantly cutting the company's profits. By repackaging the drug as Sarafem, Eli Lilly adds seven years to its exclusive rights for the treatment of pmdd on a product that is pharmacologically identical to Prozac, but dressed up in nice pink-and-purple gelatin.
Jamaica Plain, Massachusetts
Lisa Belkin writes an excellent exposé as far as it goes, but it does not go to the core of the matter. Drug companies put thousands and thousands of dollars into pushing drugs. The most brilliant physician has a difficult time looking through it all to find the most effective drug, let alone the most effective drug per dollar. Our doctor is always checking with other specialists for the most effective drug and admits freely that he doesn't "know it all." The lack of interest in alternative, lower-cost treatment is staggering.
Your otherwise excellent article neglected to mention that television ads may also encourage patients to borrow a few pills from friends or relatives before paying for a prescription -- another dangerous option for the gullible sufferer. There is freedom of advertising and danger from advertising. Unfortunately, prescription-drug advertising in print or on television falls into the latter category. The federal Food and Drug Administration should stringently monitor and regulate for all advertised medication.
That was quite a hammer you took to the pharmaceutical industry -- an industry most of us probably wouldn't want to do without. How about taking your hammer to the "natural" medicine industry? It is arguably more culpable of the charges you bring, since it uses scare tactics to promote the sale of worthless and dangerous nostrums for poorly defined or undefinable conditions, as well as using vague promises of cures that will do everything for the "sufferer" except clean the house.
Thomas W. Daly
North Mankato, Minnesota
The Mother Jones 400,000
Despite the theme of your latest anti-Republican hit piece about all the fat cats supporting President Bush, I couldn't help noticing the results of the largest campaign contributors on the Mother Jones 400 ("Campaign Inflation," March/April). Gee, only 1 of the top 10 and only 42 of the top 100 gave money primarily to Republicans.
Of course, that doesn't include the hundreds of labor unions that gave almost 100 percent of their money to the Democratic Party, since they aren't individuals.
Question: Is it possible the Republican Party is supported mainly by the middle class and the little guys, and the Democratic Party is the primary beneficiary of the special interests? Your data seem to indicate so.
San Diego, California
I was fascinated by the creative writing exercise performed by your feckless Eric Bates. In describing Bush's decision to forgo campaign-matching funds and the resulting limitations during the primary phase, Bates states that Bush "instead turned to a relatively small group of corporate owners and executives eager to buy shares in his start-up venture." Wow -- this by way of describing the more than 300,000 Americans who contributed less than $1,000 each, in full conformance to all the current campaign finance laws! All of the donations were quickly posted to Bush's campaign Website, with appropriate identifying data and amounts contributed. Some grouping of corporate owners and executives, these!
But of course, Bates could not write the plain vanilla truth, or merely accurately describe the process by which Bush raised some $100 million in lawful contributions -- that would destroy the premise and pre-vailing bias of your article. So instead, we have your usual distorted reporting, artfully perverting, beyond all recognition, the process used to raise a small portion of the $100 million total in contributions. Yes, friends and supporters of George W., many, if not most of them, wealthy, early on acted as sponsors to seek out and obtain lawful, individual contributions of $1,000 per person or less to achieve their pledged goals of raising $100,000. Golly damn, isn't that terrible! Well, of course it is, in your twisted view, because it worked -- and because the candidate in question was not a socialist-progressive-leftist Democrat.
Speaking as one nonwealthy, retired senior citizen, I was proud to be a donor to that phase of the Bush campaign fundraising.
Greenville, South Carolina
The record $3 billion spent on Republicans and Democrats during the last campaign can't compete with the $250 I forked over to an off-brand presidential candidate at a small gathering in my hometown last summer. I expected nothing in return. But in Ralph Nader's tireless denunciation of the abhorrent merchandising of political influence under our campaign finance laws, I got more than my money's worth.
San Diego, California
Thank you for a knowledgeable article describing a rebellious event in American farming history ("Highway 75, Iowa," March/April). Verlyn Klinkenborg's informed portrayal of Iowans and farmers "priding themselves on politeness" sets the appropriate context. Because of their somewhat humble disposition, farmers have often (but not always) taken a quiet seat on the past American century's ride through history. Such small but enlightening articles inform the public about a dying American institution -- the family farm.
Scott A. Yocom
Brooklyn, New York
This Dam Is Your Dam
In her review of the documentary Roll On Columbia (Media Jones, March/April), Suzanne Boothby calls Woody Guthrie's musical celebration of federal dam building an "unlikely union of social activist and massive government project." In fact, there was nothing unlikely about it at all. fdr's public works projects in the 1930s, including dams, were celebrated by working people and family farmers for the jobs they provided and for making rural electrification possible with low-cost power from the dams. (The practice of investor-owned utilities was -- and continues to be -- to deny electricity to rural people.)
I grew up 18 miles from the huge Fort Peck Dam project in Montana in the 1930s, and it is accurate to say that ordinary people there loved Franklin Roosevelt for making the dam possible. It provided the first hope for a decent life many of them ever had.
To be sure, there are many legitimate environmental objections to the dams now, but that wasn't known then. So it was a glorious time in many ways, a time when federal government really seemed to care about ordinary people -- surely a state of affairs rare enough to deserve celebration in Woody Guthrie's ballads.
Truth in Advertising
Your top-five list of antidrug ads ("Don't Get Ad-dicted," March/April) underscored how Nancy Reagan's "Just Say No" program backfired dramatically. The children who grew up being force-fed "Say No" were the very ones most intrigued by drugs when they became old enough to test their independence. My own children began school with that program and then, later, got swept up in the street-gang life when they realized (1) there was money to be made with drugs, and (2) the "No" program had not been totally truthful, creating a false and dangerous distinction between "drugs" and "alcohol." Children will eventually explore most things they have been told not to do, when they are old enough to question what "authorities" have been telling them. The best we can do is promote open discussions.
Your otherwise well-researched article about online education ("Digital Diplomas," January/February) failed to mention how some colleges are utilizing technology to enhance learning while making it possible for adults to earn degrees. Not all colleges are simply asking, "How can this technology generate profit?" but are genuinely examining how to provide a rigorous and meaningful education to adults for whom the campus experience is not a necessary or viable option. Let's be honest about the "campus experience": It is often a first-time-away-from-home, coming-of-age ritual, the value of which diminishes after a couple of years.
It's indeed a scary thought that a college education could be limited to those who choose to spend four years on campus. The alternative is a combination of online and face-to-face learning. No amount of online interaction can replace human contact; the key is to emphasize the time students spend together. Here at Presidio World Campus, a program of Goddard College, adult learners attend weeklong residencies each semester, enabling them to develop close-knit relationships that rival bonds made in twice-weekly classes.
For those of us who see the possibility of combining life in the real world with lifelong learning, technology can pave the way. Let's not throw the baby out with the bathwater, but rather look for ways to provide an intellectually rigorous and personally meaningful education where high tech meets high touch .
Presidio World Campus
San Francisco, California
I was horrified to read the story about Cytotec ("Forced Labor," January/February). I was well prepared for a natural, drug-free labor and delivery and had a perfectly healthy pregnancy. At 41 weeks' gestation, my doctor used scare tactics to get me to induce, leading me to believe that I was putting my baby at risk by not inducing. I received Cytotec after two days of other induction drugs failed to work. No one ever told me the drug was not approved for this use. No one ever indicated that uterine rupture or other complications could kill me or my baby. Upon his birth, my son did not breathe and had to be resuscitated as I hemorrhaged and lost several pints of blood. I just assumed that this was standard normal procedure -- and I was well read going into it. I am afraid that informed consent does not exist in obstetrics.
I am a fortysomething, left-wing, radical feminist who happens to be an obstetrician/gynecologist. And here I am, face-to-face with this article about Cytotec, which happens to be one of the only safe and effective drugs we have to induce medical abortion for women who cannot undergo operative procedures. What are you thinking? The very few adverse events when Cytotec has been used to induce labor have probably occurred with physicians who were not following the protocols outlined by the studies. This is a very safe drug, if used properly. Please don't taint one of our few resources for quiet, personal, noninterventional pregnancy termination, especially in light of the repugnant government currently in power.
Palo Alto, California