A full-page advertisement in The New York Times for the oral anticoagulant apixaban (Eliquis) prompted us to prepare an article for The Medical Letter on Rethinking Warfarin, which is what the advertisement urged its readers to do. Apixaban is the latest of 3 new oral anticoagulants that are competing with warfarin for a huge market. But the evidence that needs to be considered before deciding on one oral anticoagulant or another for a given patient is very complicated. Should the patient be making that decision? Or trying to force it on his or her doctor? Why am I still taking bad old warfarin when I could be taking new and better apixaban?
I can understand the reason for advertisements in newspapers, on TV and on the Internet for Cialis to treat erectile dysfunction. Men who might not seek out medical help for sexual dysfunction are encouraged to do so. But advertising an oral anticoagulant for atrial fibrillation or an inhaled corticosteroid/long-acting beta agonist combination for COPD (Advair Diskus) seems out of line.
Of course these medications are advertised to the public because pharmaceutical manufacturers have found that, somehow or other, these ads increase sales. If they didn’t, one of the most successful industries in Western economic history would not be wasting its money on them. There was a time when the FDA did not permit pharmaceutical advertising to the general public, but that has passed, one small part of the price we pay for the greater good of the First Amendment. So all we can do is make our readers aware of the advertising pressure and examine the wisdom of its message. Rethinking Warfarin. Watch for it in an upcoming issue of The Medical Letter.