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MICHELE NORRIS, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Michele Norris.

MELISSA BLOCK, host:

And I'm Melissa Block.

In this age of direct-to-consumer advertising, drug makers have persuaded millions of us to take medicine we may not need. Drug companies spend $4 billion a year on pharmaceutical ads, and it seems to be paying off. Studies show more and more people are asking their doctors for drugs they've heard about on TV.

NPR's Allison Aubrey reports on what makes these ads so persuasive.

ALLISON AUBREY: If you happen to catch a recent episode of "Grey's Anatomy" or "Ugly Betty," you may remember an ad for the sleeping pill Lunesta. It begins with a pitch-black screen.

(Soundbite of ad)

Unidentified Woman: This is you. You've awakened in the dark because your sleep aid didn't give you a full night of sleep.

AUBREY: Watching the ad, we see a woman with long, flowing hair lying in her bed, tossing and turning, clearly frustrated. But over the next 45 seconds, transformation unfolds.

(Soundbite of ad)

Unidentified Woman: Tomorrow, ask your doctor about Lunesta.

AUBREY: On the screen, a magical effect takes hold. A glowing Luna moth flutters into the scene, gliding around the woman, lulling her into a deep, peaceful sleep.

Mr. AL TOMPKINS (Consultant, Poynter Institute): Oh, yeah. I mean, it's so restful. Who wouldn't want that? And when she wakes up, she is just gorgeous. And she sits right up and stretches and looks great. Who doesn't want that?

AUBREY: Al Tompkins is a former television producer, now with the Poynter Institute. He says ads like these are persuasive because they sell you a feeling.

Mr. TOMPKINS: I believe that you remember what you feel longer than what you know. And this spot is long on feeling, and clearly the things that you could know, the facts, the numbers, are things that you'll never remember.

AUBREY: Even when they're spoken loud and clear. In the Lunesta ad, there are lots of details, including a litany of side effects and warnings.

(Soundbite of ad)

Unidentified Woman: Until you know how you react to Lunesta, you should not drive or operate machinery. Do not take Lunesta with alcohol. Most sleep medicines carry some risk of dependency.

AUBREY: Listening now, you may catch the details. But when you watch the ad, it's different. The image of the Luna moth gliding through a valley is like watching an IMAX movie. And what happens to that list of side effects?

Mr. TOMPKINS: You just won't hear it, because when the eye and the ear compete, the eye wins when it comes to television.

AUBREY: This may explain why I couldn't remember half the side effects the first time I watched the ad. I was a little embarrassed when I mentioned that to Ruth Day. She's a cognitive scientist at Duke University and she studies drug ads.

Ms. RUTH DAY (Duke University): No, no, no. See, there is a tendency to blame is oneself that I was not paying attention. But there is so much information going on in one minute. It's a huge amount. You have cognitive overload.

AUBREY: Day's research documents lots of reasons that people can't recall the warnings mentioned in ads. One boils down to a principle known as the serial position effect.

Ms. DAY: And it basically says if you present a list of items, people are going to do better at the beginning and at the end, and they're going to have trouble with information in the middle and a little bit past the middle.

AUBREY: So you may catch the first two or three warnings, but by the time you get to the mention of Lunesta carrying a risk of dependency, attention is divided. Speed is also an issue. Side effects are usually spoken more quickly than the rest of the ad. And there is also readability. Day's research shows you only need a sixth-grade reading level to understand the benefits presented in most ads. These are the words aimed at selling you the drug. But you need a ninth-grade reading level to understand the risks.

Ms. DAY: Having a three-grade level difference between being able to understand some of the information versus other information is pretty striking.

AUBREY: Just 10 years ago, most medicines went by technical gobbledygook names that patients didn't pay much attention to, and we certainly didn't have much say over which drugs we took. That was the job of doctors.

But then the FDA warmed to the idea that TV commercials about drugs could help educate us. In theory, ads inform people about medical conditions and treatments they don't know about. But there's a hitch.

Dominick Frosch is a medical professor at UCLA.

Dr. DOMINICK FROSCH (UCLA): I think what consumers need to understand is that they're getting really a one-sided message.

AUBREY: A message that prompts more of us to ask for drugs we don't really need. One bit of evidence that this happens comes from a study that used paid actors to portray patients with a wide range of emotional problems. When the actors went to doctors and asked for one drug by name, Paxil, doctors often obliged.

Dr. RICHARD KRAVITZ (University of California, Davis): Well, there was a dramatic effect of patient request on prescribing rates.

AUBREY: Richard Kravitz of UC Davis led the research. He says in many cases those actor patients were describing symptoms that warranted the drug they asked for. But not always.

Dr. KRAVITZ: The downside is certainly the patients who may not have required an antidepressant prescription got one as a result of these requests. Therefore we could conclude that doctors are more malleable than we might hope.

AUBREY: Which can lead to problems, sometimes very serious. In one recent case, the overprescribing of a certain class of anemia drugs led to some deaths. The drugs are intended for certain cancer patients undergoing chemo, but a TV commercial made it seem other patients may benefit, too.

Dr. LISA SCHWARTZ (Dartmouth): I think in general that it's very important to approach these drugs skeptically.

AUBREY: Lisa Schwartz is a medical professor at Dartmouth. She says the problem with most drug ads is that they lead people to believe that the benefits are certain. Take, for instance, that Lunesta sleeping pill. According to the ad...

(Soundbite of ad)

Unidentified Woman: Non-narcotic Lunesta can help you sleep seven-to-eight peaceful, quiet hours.

AUBREY: Curious, Schwartz dug up the largest research study behind that claim, and she found...

Dr. SCHWARTZ: Most people were not getting seven to eight hours of sleep at all.

AUBREY: It turns out the volunteers in the study who took Lunesta slept on average six hours and 22 minutes per night. This compares to those who took a placebo, or sugar pill. They slept five hours and 45 minutes.

Dr. SCHWARTZ: So it was just 40 minutes longer of sleep.

AUBREY: Lisa Schwartz picked this research because it's the largest study of the pill. But Sepracor, the company that makes Lunesta, says the seven-to eight-hour claim is actually based on a different study, where people taking the drug spent three nights in a laboratory where they were closely monitored and were not disturbed for at least eight hours.

On those nights, 68 percent of the people who took Lunesta slept an average of seven hours or more. Of those who got the placebo, 37 percent slept that long. Some people may be glad for even an extra 40 minutes of sleep, and for them Lunesta may make sense.

But Schwartz worries that the commercial leads viewers to think that the drug's effect is much more dramatic, which may help explain how Lunesta generated a half billion dollars in sales last year. Former corporate advertising executive Bob McKinnon says drug ads are big business.

Mr. BOB MCKINNON (Former Advertising Executive): Yeah. I think it's huge. It's one of the largest growing categories in advertising spending and certainly their sales reflect that as well.

AUBREY: The ad campaigns, McKinnon says, use the same tactics that Madison Avenue perfected decades ago to sell dish soap or stain removers.

Mr. MCKINNON: They're produced in such a way to sort of create this ideal sense of life where, you know, everyone is happy and every problem you have can be solved with a quick fix.

AUBREY: And McKinnon says of course drugs aren't detergents and when you're deciding whether or not to take a pill, the stakes are a whole lot higher. Allison Aubrey, NPR News, Washington.

BLOCK: When an ad claims a drug is safe for long-term use, what exactly does that mean? You can watch a sleeping pill ad and get one scientist's take on how to read such claims at npr.org.

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