Dukakis:
Ladies and gentlemen, may I have your attention,
please.
Annoucer:
Moderator Michael Dukakis has just called
tonight's meeting to order.
Dukakis:
Good evening, ladies and gentlemen, and welcome
once again to The Advocates in Boston's historic Faneuil Hall. Before we
begin our debate this evening, let me say to those of you in our viewing
audience who may have expected a debate on amnesty for persons who evade
military service that that program has been delayed until late February as a
result of our special program last week on Vietnam.
And now, to tonight's question. Should all drug advertising
be banned from television? Advocate Howard Miller says yes.
Miller:
There is a drug pusher in every home in the land,
and its name is television. Its message is constant. For every ill, real or
imaginary, take a pill. It's time to restore our sanity and our health by
banning all drug ads from television.
Dukakis:
Advocate Carolyn Bell says no.
Bell:
This proposal tonight represents one more
over-exaggerated reaction to a very real social problem. Over-the-counter
drugs have a positive contribution to make to society, and so does
advertising. The only people who are for the ban are those people who
believe consumers are stupid. I don't.
Dukakis:
Thank you Mrs. Bell and Mr. Miller, and we'll be
back to both of you shortly for your cases, but first some background on
tonight's question. Not long ago, Federal Food and Drug Commissioner Charles
Edwards remarked that when drug promotion reaches the point where antacids
are offered like martinis and laxatives are implied as essentials to
everyday happiness, then the time has come to take a good hard look at the
entire situation. Well, Congress has been taking such a look. The Senate
Sub-Committee on Monopoly, chaired by Senator Gaylord Nelson of Wisconsin,
has been holding hearings on the efficacy of drug advertising claims. And
Senator Frank Moss and his Consumer Sub-Committee have been recently looking
into the possible links between drug advertising and drug abuse. If it is
fair to say that such hearings have, so far, been inconclusive, it is also
true that they have produced a number of proposals from various groups for
clamping down on drug advertising.
Tonight, we consider one of the most dramatic of those
proposals: an outright ban on the advertising of drugs on television. At
present, only non-prescription drugs are advertised on television. And it is
only the advertising of those drugs, the kind of drug that you can buy over
the counter in a drug store without the prescription of a doctor, which will
be the subject of tonight's debate. All right, Mr. Miller, the floor is
yours.
Miller:
Are you feeling tense or nervous? Perhaps you've
just finished the first five minutes of the evening news with its compulsive
reporting of savagery and sadism. Or perhaps you are facing a difficult
discussion with your husband or wife or children. Or perhaps you have a job.
There's a problem at your work. Don't think about it. Don't talk about it.
Above all, don't turn off your television set. Listen first to an important
message from Marshall Efron.
Efron:
[VIDEO TAPE] Do you have that itching, throbbing,
aching-all-over feeling? When you feel specifically bad, try a handful of
Achaway. Achaway, the only painkiller that comes in the distinctive brown
paper bag. And Achaway tastes good, too. Hospital tested, hospital approved,
we guarantee indefinite relief of minor transitory indefinite pain. Fast
acting Achaway. Pick it up now at your drug store. No prescription needed.
If illness persists, see your undertaker.
Miller:
There is, of course, sense in the humor. The
message is constant. Do you have a headache, or a heartache? Do you have
trouble going to sleep, trouble keeping awake? Just take a pill. How is that
message distributed? It's distributed on television constantly. And what is
television? Two-thirds of all the houses in the United States watch
television six hours a day or more. At 10 o'clock at night, there are five
million twelve-year-olds watching television, and among all the messages are
the constant drug messages. What drug messages? First, of course, the false
and sometimes the fraudulent. But more important, the attempt by the drug
industry for its profit to impose its values on the general public - that
any problem can be solved by a pill, not by yourself. Better living through
its chemistry.
The first thing we must do, as a health reaction for our
own health, is to ban all those ads from television. And to tell us why, we
have as a witness Nicholas Johnson.
Dukakis:
Welcome to The Advocates, Commissioner
Johnson.
Dukakis:
Nice to have you with us.
Miller:
Nicholas Johnson is a commissioner on the Federal
Communications Commission. Mr. Johnson, is television special in dealing
with this problem?
Johnson:
Well, I think, of course, it is, both because it's
broadcasting by definition, reaching the entire population, unlike print
which often reaches specialized groups, and also because it's so powerful,
it's so effective, with the visual medium combined with sound.
Miller:
Have we had other bans of other things to be
advertised on television?
Johnson:
Oh, yes. We banned cigarette advertising, as a
matter of Congressional enactment. We banned hard liquor advertising, as a
result of industry agreement threatened with Congressional action. There are
other kinds of activities and things that can't be shown on radio and
television.
Miller:
Is advertising about drugs, is this problem
especially relevant to drug problem and drug advertising?
Johnson:
Well, I think so, and a great many people think
so. Those who are trying to sell the drugs are investing some 200 million to
240 million dollars a year, presumably on the theory that their advertising
is having some effect on drug consumption. Drug consumption is now about two
billion dollars a year of this product. And I think it's only natural to
conclude that probably this not only has an effect on the consumption of
over-the-counter drugs but our general attitude in our society towards drugs
in general. At least, that's been a position that's been expressed by a
great many people, from President Nixon, Senator Nelson, Senator Moss.
Legislation is being introduced by Congressman Pepper this session to ban
drug advertising on television. . .
Miller:
Is the audience simply made up of adults? Do we
broadcast this enormous information to a solely adult audience? What sets
our cultural standard?
Johnson:
Well, by definition, television is setting our
cultural standard for all people, including children, which is one of the
most difficult problems that we confront at the FCC in regulating
television.
Miller:
Well, why not simply these ads, then, if we're
concerned? Why not simply say you can only have honest ads or good ads and
move in that direction?
Johnson:
You know, when I first came on the commission, I
was quite hopeful that one could appeal to the responsibility of the
individual broadcasters. That didn't seem to work. I hoped for voluntary
action by industry groups, the code authority. That didn't work. I hoped,
perhaps, the Food and Drug Administration, the Federal Trade Commission
could deal with this problem. They're hopelessly caught up in the
bureaucratic snarl and the commercial and political pressure that heavy
campaign contributors in the drug industry have to bear. I'd hoped the
industry might accept the concept of counter-commercials. They fought that.
So I am necessarily brought to the position that the only remedy that I see
now, after six and a half years of experience in battling with this problem,
the only remedy that I see is a ban on drug advertising.
Miller:
Thank you, Mr. Johnson.
Dukakis:
All right, Mr. Johnson, before we turn to Mrs.
Bell, was that two billion dollar figure you used for all drugs or just
over-the-counter drugs, or did it include prescription drugs as well?
Johnson:
I'm afraid to say I don't know. I believe it's all
drugs, yes.
Dukakis:
Perhaps we'll get to that in cross-examination.
Mrs. Bell, you're on.
Bell:
Mr. Johnson, when was the last time you bought
anything because you saw it advertised?
Johnson:
I think that we're all influenced by advertising.
I'm reminded of a marvelous…
Bell:
Well, I asked you specifically what you bought.
Johnson:
Well, bicarbonate of soda is now, marvelously
enough, advertised on television, and I do buy bicarbonate of soda. I use it
for a great many purposes.
Bell:
Is it useful to you?
Johnson:
Oh, yes, indeed.
Bell:
And could you tell me about something that you bought
that you didn't like, that wasn't useful?
Johnson:
Well, I use to buy a great many things that I
found I didn't like.
Bell:
And why did you stop buying them? Are they not
advertised any more?
Johnson:
I stopped watching television.
Bell:
But you formed your own opinion about whether or not
you'd continue to buy it, did you?
Johnson:
No, I think I'm influenced by advertising as much
as anyone else.
Bell:
And how much do you think this is? Are you completely
helpless to form your own opinions, or do you think you do have some choice
about what you believe?
Johnson:
I think I have some choice, yes, indeed. My
colleagues on the Commission think I have too much choice, but that's
another issue, I gather.
Bell:
Do you think you're more subject to television
persuasion than other people or about the same?
Johnson:
I think that often we delude ourselves if we think
we're in a special category. There is a marvelous story of a woman who was a
PhD and asked what toothpaste she used. She said, "I use Gleem." And they
said, "Well, why?" She said, "Well, it's not because of the commercials.
It's not because of the commercials." And they said, "Well, why do you use
it? She said, "Well, I don't know. Just because I can't brush after every
meal." I think that's true of a great many of us.
Bell:
I'm having difficulty figuring out just what category
you're putting yourself in, Mr. Johnson, but I do hope you have more
confidence in your...
Johnson:
How about human being, for starters.
Bell:
Well, all right, I just hope you have more confidence
in your ability to make up your own mind and form your opinions and give us
advice. Let me ask you something about banning television advertising. You
remind us that this isn't new, that, in fact, cigarette advertising has not
been allowed since January 2, 1971. What's happened to cigarette sales since
that time, Mr. Johnson?
Johnson:
Well, as a result of taking the
counter-commercials off, that we're telling people something about the
adverse impacts of cigarette smoking, in fact, the consumption has
increased.
Bell:
How sure are you that it was the counter advertising
that was responsible for this.
Johnson:
The only evidence that I have of that . . .
Dukakis:
Mrs. Bell, Mr. Johnson, just so our audience
understands, these counter commercials, I take it, are those commercials
that were put on to, in effect, negate the effect of these
advertisements.
Johnson:
I want to remind you that cigarette smoking . .
.
Bell:
Yes. As long as . . .
Dukakis:
The opponents of cigarette smoking were given a
certain amount of time to put on their own commercials, I take it.
Bell:
As long as cigarettes were being advertised, then
counter advertising was given free time. This is no longer . . .
Dukakis:
To the opponents of cigarette smoking.
Bell:
Right. This is longer possible. And I'm curious as to
why you think, Mr. Johnson, that banning drug advertising would result in a
decrease in drug consumption.
Johnson:
I think the issue here is whether or not a medium,
which is licensed to serve the public interests, can fairly be allowed by
the regulatory body involved to use this very valuable public resource in a
way that at least bears significant suspicion of harm, if no more. There are
plenty of products to be advertised on television to provide revenue for
this industry. The question is whether or not the use of television for the
advertising of drugs is serving the public interests. That's a statutory
standard that I have to apply and my colleagues have to apply.
Bell:
But now, if over-the-counter drugs are so harmful and
lead to these problems for our society, why don't we ban all ads, not only
on television but on radio and magazines for drugs?
Johnson:
Well, I think we might, but I think there are
useful distinctions to be drawn. I think, for example, that broadcasters are
licensed to serve the public interest. We must make a finding they are doing
so. That is not true for newspapers. I think television has a much greater
impact than print. By and large, most three-year-olds do not read their
local newspaper.
Bell:
That's true of television programs also, isn't it,
Mr. Johnson? Would you like to remove from programs all the references to
pills and stop showing doctors suggesting that their patients take medicine?
Would that be reasonable?
Johnson:
Well, as you quite well know, the United States
Supreme Court has long made a distinction between commercial speech and
creative or ideologic speech, and so the standards we apply to commercials
are much different than those that we would apply to programing.
Dukakis:
Mrs. Bell, you're going to have an opportunity to
ask Commissioner Johnson another question or two, but let's go back to Mr.
Miller for one additional question. Mr. Miller.
Miller:
Mr. Johnson, does television, the question goes,
does television have the kind of special impact that requires special
regulation in this area, or is it simply like another medium of
information?
Johnson:
Well, the judgment of Congress has been that it a
special medium, that it has a tremendous impact on the American people, in
general. It's the use of a very precious national resource, as well. It
reaches all the American people, unlike any medium of print that we have
available in the United States, and it has a much greater psychological
propaganda selling impact on setting the national values and standards,
accepted behavior and ideals and whatnot.
Dukakis:
All right, gentlemen, let's go back to Mrs. Bell.
Mrs. Bell, another question or two.
Bell:
I'd still like to know, Mr. Johnson, do you think
people can make up their own minds after they've tried something?
Johnson:
After they've tried something.
Bell:
Uh huh. If they've tried a product and they like it,
can they decide to go on with it. If they've tried a product and they don't
like it, can they decide not to go on with it even if television is telling
them it's good?
Johnson:
One of the reasons for the proliferation of
products is that as television lies to the audience, they tend to buy the
product once and then go on to the next product that's bought, thereby
increasing the proliferation of products. But this does not decrease the
total amount of the gross national product spent on the product in question,
in this case, drugs.
Dukakis:
Mrs. Bell, I sorry, I'm going to have to
interrupt. Mr. Johnson, it's been a pleasure to have you on The
Advocates.
Miller:
You know, it's wonderful. Whenever anyone talks
about restricting advertising, advertising representatives always say, "We
really don't have much an effect after all." I wonder if that's what they
tell their clients when they're making their sales pitches as well. But
whatever they tell their clients, on television with regard to drugs, the
message is unrelenting, with one theme clearly repeated: any difficulty, or
almost any, can be solved simply by taking the pill.
Annoucer:
[VIDEO TAPE] Worry leads to tension, tension leads to
stress, and stress leads to failure.
Hi, Honey, I'm home. I was a failure till I took Al's
Pills. I'd been looking for a job for six months, and then today I had my
first interview. I was really scared, but before I walked in, I took one of
Al's Pills. And Mr. Barnes was really nice, and I got the job. Honey, Honey.
"I've gone to live with Bill. Love, Jill." Gosh. When you have a problem,
take Al's Pills. And you won't care anymore. Al's Pills. Hospital tested,
hospital approved.
Miller:
To talk to us further about the actual health
problem created by these ads, we have with us Dr. Richard Feinbloom.
Dukakis:
Welcome to The Advocates, Dr. Feinbloom.
Miller:
Dr. Feinbloom is a doctor of medicine, Professor of
Medicine at the Harvard Medical School, and Director there of its Family
Practice Program. Dr. Feinbloom, what kind of ad would you write for the
over-the-counter drugs like Compose or even aspirin?
Feinbloom:
I think the only honest ad that could be written
about Compose is not to take it. And the only honest ad that could be
written about aspirin is to take it only as a last resort, which wouldn't
really be an ad at all.
Miller:
Tell me, do the drug ads themselves create a kind
of health problem?
Feinbloom:
I think they do. They're barraging the public
with one message which is, when you have an ache or pain or discomfort, take
a drug. And I think that is a problem in itself. Drug advertising is
hazardous is advertising to your health.
Miller:
And what about the direct side effects, though, of
drugs? Are there some direct dangers in taking some of the drugs as
well?
Feinbloom:
Well, these things are never mentioned. You
asked about Compose. Compose was recently analyzed in the Journal of the
American Medical Association. It was shown in a recent study "not only to be
no more effective than a sugar pill but also to contain all of the harmful
side effects of some really effective tranquilizing agents that require
doctor's prescriptions have, like drowsiness, confusion, dry mouth, and
dizziness. And I think taking Compose and then going to drive, for example,
is a real hazard. That's never pointed out in the advertisement.
Miller:
What about the other effect, though, of the
advertising, in terms of advice on how to handle anger and other natural
human situations? Is that socially harmful, as well?
Feinbloom:
Well, the drug companies are practicing medicine
without public license to do so. They've defined what regularity means.
They've also said that one should not get angry or should not have angry
feelings but should take a drug instead. They've also made being a woman a
disease for the first time in history, and a few other things like that.
They're engaged in the practice of medicine, and no one really gave them the
license to do so.
Miller:
Well, we certainly have a need for real and good
health information. Can't we use television to have that health information
in spite of these commercials?
Feinbloom:
I think that as long as the drug companies have
the control that they do over the industry with their constant message of
pain-drug, pain-drug, one after another, the chances of getting objective
health information, which I think the public really needs very much, is
almost impossible. We do need information about headaches. We do need
information about aspirin. We need information about how to use
over-the-counter drugs. And instead, all we're being told is to take them,
but never when not to take them.
Miller:
Thank you, Dr. Feinbloom.
Dukakis:
All right, Dr. Feinbloom, let's turn to Mrs. Bell
who has some questions to ask you about a number of these problems including
women and maybe disease, I don't know.
Bell:
I want to ask you about over-the-counter drugs.
Should they be banned?
Feinbloom:
I don't think over-the-counter drugs should be
banned, no.
Bell:
They are effective; they serve some useful
purpose?
Feinbloom:
Sometimes, but I think that has to be
qualified.
Bell:
Would you rather have a consumer who has ignorant
about what these drugs or one who was informed?
Feinbloom:
I would much rather have an informed
consumer.
Bell:
And most of the information about how to use the
drug and when to use it and when to see your doctor is on the label. Isn't
that correct?
Feinbloom:
I would wonder how many people read the label.
I would hope that some of them would.
Bell:
Oh, you're worried again about the poor ignorant
consumer that Mr. Johnson was worried about.
Feinbloom:
I think people come away with not the warnings
on television but really that, if you're tense, take Alka-Seltzer; if you
have a headache, take Anacin, or what have you. They're not told about what
the harmful effects are or what the hazards are.
Bell:
Don't you think it might be much better to have this
information in print, Dr. Feinbloom, just in case the person happened to not
be looking at the television that minute? He might be out in the kitchen
getting a beer. Let me ask you about something else. If over-the-counter
drugs are powerful and dangerous, as you suggested, if they can produce
problems when they're taken in combination with other drugs, should they be
sold without a prescription?
Feinbloom:
I think there's a place for over-the-counter
drugs, but what we really need and the way that television could really help
the public would be to indicate when they can be used appropriately and when
not . . .
Bell:
So you're really not against banning television ads;
you're for reforming television ads.
Feinbloom:
I don't believe you can reform them. I don't
believe that there can be an honest ad on television for a drug.
Bell:
Not even an ad that says aspirin exists? That's not
an honest ad?
Feinbloom:
I would like to see the Bayer Aspirin Company
sponsor such ad.
Bell:
I don't think they have to, Dr. Feinbloom. I think
people know aspirin exists. You mentioned that people are urged not to cope
with their anger and other frustrating problems. Aren't they better able to
look for real solutions to real problems if they feel well?
Feinbloom:
They may be, but that's not what the message of
the ads is. It's telling them, "Don't look for real solutions. Adapt to your
situation. Don't rock the boat. Take a pill and make the discomfort go
away."
Bell:
Well, I wonder if that's really what the ads always
say. Don't doctors also say to us, "Look, the way to a better life is
through chemistry. We have drugs that can help you."
Feinbloom:
I think the medical profession has very much
the same problem the public has with its advertising.
Bell:
You think doctors are overprescribing for us?
Bell:
And in what way would banning television
advertising, which does not exist for prescription drugs, influence the
doctors?
Feinbloom:
Well, I would hope that there would be some
carryover and that we would finally break into this constant public message
which is that the way to deal with life problems is through chemistry, and
the doctors might get the message from the initiative that would be taken on
television sets.
Bell:
So you want television, in fact, to improve the
medical profession. Well, that is a switch, certainly, from the usual
medical expert's advice about television. Mr. Miller and Mr. Johnson and you
have all implied a fundamental conflict in this television advertising
between the motives of the corporation, the drug industries, and the
possibility of having a responsible solution to our health problems. Now, of
course, profits are one form of income. People want to get more profits or a
higher income. Can you tell me which group of people in this country have
the highest incomes?
Feinbloom:
Physicians, I am told.
Bell:
They earn, in fact, as of 1970, about four times the
income of an average American. Are you suggesting that this is in direct
conflict with the responsibility of physicians for good health care in this
country?
Feinbloom:
I think you could make a case for that, to some
extent only, though. If what you're getting at is whether I'm worried about
the profits of the drug houses, I'd have to say no. I think I'm much more
interested in the health of the nation and in the fact that the American
public gets the best health information that's available on a given problem
rather than a very particular kind of information whose main objective is
not the health of the people or how to deal with their headaches but really
rather to sell their product. If, for example, the Bayer Aspirin were really
interested in headaches, they would have to say that generic aspirin is just
as good as Bayer Aspirin and much cheaper.
Dukakis:
Dr. Feinbloom, generic aspirin, I take it, is a
non-brand name type of aspirin.
Dukakis:
All right, Mrs. Bell.
Bell:
Dr. Feinbloom, people have been saying that about
Bayer Aspirin for at least two generations. Why do you suppose people go on
buying Bayer Aspirin?
Feinbloom:
I think that the answer is obvious - because of
the advertising. . .
Bell:
Because it works. Because it works for the
individuals. Again, the consumer tries it; it works for him; it works for
her; she doesn't pay any attention to the advertising. She knows it works.
The advertising can't make her buy it if it doesn't work. This is the . .
.
Dukakis:
Do you agree with that Dr. Feinbloom?
Dukakis:
All right, we're going to go back to Mr. Miller
for a question. Mr. Miller.
Miller:
Let me continue on that theme of whether the
$60,000-a-minute commercial selling Bayer Aspirin can provide health
information. In fact, if all the studies that have been done have
demonstrated what about the various brands of aspirin, Bayer, Excedrin,
generic aspirin, and the rest.
Feinbloom:
They're really quite equivalent.
Feinbloom:
They're really all the same in terms of their
effectiveness.
Miller:
They are all the same. Thank you.
Dukakis:
All right, Mrs. Bell, we're back to you for a
question or two.
Bell:
Why do you think banning drug ads would have any
effect on consumption? We didn't see this happen with banning cigarette ads.
I might also point out for Mr. Johnson's benefit, even though he's had to
leave, that alcohol sales have increased steadily despite the ban on
television advertising.
Feinbloom:
I can't really predict what it would do to
consumption. I think it would offer to the public the hope that television
could be liberated to fulfill its true potential in terms of giving good
solid health information which would include, mind you, appropriate use of
over-the-counter drugs.
Bell:
Which would be on commercial television. So you're
talking about reforming and not banning. Thank you.
Dukakis:
Dr. Feinbloom, thank you very much for being with
us on The Advocates. Mr. Miller.
Miller:
I hope the standards of accuracy of representation
of the commercials are more accurate than that representation of Dr.
Feinbloom’s testimony. The over-the-counter drugs not only administer to
problems you really do have but also administer to problems that you can
barely imagine you have, that is until you hear the message.
Annoucer:
[VIDEO TAPE] They whisper. And you can't hear.
Do people come up to you on the street and whisper, "Your
ears stink", and you can't hear them? Your problem may be waxy buildup in
the ears. And for that, most doctors recommend, in most cases, new heavenly
blue Ear-Fi. A few drops in your ear containing XP-7, the miracle jive
ingredient, and the wax and its accompanying unpleasant odor disappears, as
if by magic. Mankind has struggled with the embarrassing problem of earwax
for centuries, afraid to ask their physicians. But now, gentle, safe,
heavenly blue Ear-Fi has broken through the wax barrier. So try it tomorrow
before your day is through, if not, try and call your doctor.
Miller:
Does anyone really want to maintain for himself or
for his children a distorted system of information whose constant message
is, "For ills, real or imagined, take a drug?" It's time to stop.
Dukakis:
Thank you Mr. Miller. For those of you at home
who may have joined us late, Mr. Miller and his witnesses have been arguing
in favor of a ban on all drug advertising on television. And now, we're
going to turn to Mrs. Bell and her witnesses who are going to oppose that
proposal. Mrs. Bell.
Bell:
Each of the words in our program title tonight is
loaded. Everybody in this room has very firm convictions about advertising
and television also. And the word drug, that's scary. That makes you think
about problems you don't want to think about that are very real in our
society. Let's see if we can be objective about some of the issues that have
been raised here tonight.
Mr. Miller makes two assertions: Relying on
over-the-counter drugs is leading us to an overmedicated society, and it's
television advertising that makes us use too many drugs. Neither statement
is valid, so his proposal to ban advertising is unnecessary. We don't want
to ban nonprescription drugs, themselves, although I'm not quite sure from
either Dr. Feinbloom or Mr. Johnson how they really feel about this, but to
prevent simple remedies from being sold over the counter would put an
intolerable burden on our medical system.
And if useful drugs exist, why not advertise them. The
people have a right to know that these things exist. Don't forget the
federal government has the power to regulate the truth and accuracy of all
advertising. We think these regulations and these ads can be improved, but
that's not what we're talking about tonight. We're talking about a total ban
on advertising. Why? You've heard that advertising has a magic power. I want
you to meet an advertising executive who will tell that advertising can make
you do one thing: buy it once. But if you don't like it, advertising cannot
make you go on buying it.
But first, we'll have some medical testimony. I'd like to
call Dr. Nathan Kline to the witness stand.
Dukakis:
Welcome to The Advocates, Dr. Kline. Nice to have
you with us.
Bell:
Dr. Kline is a physician who has spent his life in
drug research and clinical psychiatry. Dr. Kline, do you think
over-the-counter drugs can make a positive contribution to American
health?
Kline:
Not only can, they already do.
Bell:
Can you tell us how.
Kline:
The medical system at present is very much
overburdened by the expectations of people who are entitled to treatment. If
aspirin or drugs for upset stomach or allergies were to become prescription
items, why it would be impossible to get into a doctor's office.
Bell:
You've heard the suggestion made that we have an
overmedicated society. What can you tell us about that?
Kline:
In point of fact, it's just the other way around.
There was a study done last year by Baiter and Levine from the National
Institute of Mental Health. I know about it; it's my own specialty. In terms
of psychic distress, they measured a randomized sample of about 2500 people,
which is large for a poll. And they found that of those people who had used
a so-called tranquilizer in the past year, about 70 percent of them had high
psychic distress; and of the remaining, about half had moderate psychic
distress. What they had not expected at all was that half of the people who
had high psychic distress were in need of treatment, had not used medication
of any sort. So that in this sense, they were under medicated. A recent
issue of Newsweek which dealt with treatment of drugs for depression, I
couldn't get a copy; it had been sold out in New York. And finally, most
important, in my own private practice, my greatest problem really is trying
to keep patients on medication when they should be on it. Every doctor has
this difficulty. There is so much talk about the dangers of drugs that
people who are on it don't stay on, and you have to weigh the consequences
of not taking medication as well as taking it.
Bell:
The people who want to ban advertising tell us that
we shouldn't have the parallel pain-take drugs. They tell us, you've got
pain, you should suffer and be still. What do you think about this
argument?
Kline:
Well, I was sort of taken that Dr. Feinbloom said
that aspirin was a drug of last resort. It should be taken only as a last
resort. I must say that people who like walking around with a headache for
three or four days simply because they won't take a pill are, from a
psychiatric point of view, slightly suspect as to why they're doing
it.
Bell:
What about pain? What does it tell us?
Kline:
Well, pain is a warning signal that there's
something out of kilter; and once you've been warned, you're entitled to
relief from the pain. If prescriptions are followed or labeling is followed,
all of them say that if a pain persists beyond certain lengths of time that
one should seek medical treatment, so that there is a built-in
protection.
Bell:
And what are some of the consequences of not taking
proper medication?
Kline:
Well, there are a great number. Well, one, as we
mentioned, was sending people to physicians when they don't have to go,
which is expensive and not important. And also, I frankly don't see any
great value in suffering per se. I think that we live in a society which has
enough real problems. You can deal with your problems much more effectively
if you don't have a headache, if you're not irritable, if you're not
depressed, if you've had a good night's sleep. So the consequence is not
only to the individual himself. Perhaps, if he wanted to suffer pain, it
would be his privilege, but, as a result, his job suffers and so does his
family, as a rule.
Bell:
And finally, doctor, what about this claim that it's
television advertising that's causing drug abuse?
Dukakis:
A quick answer, please, doctor.
Kline:
Right. All the evidence is against it. It may
bring to your attention the drug, but it certainly doesn't force you to
continue taking it.
Dukakis:
All right, Dr. Kline, Mr. Miller has got some
questions for you, and here he comes.
Miller:
Dr. Kline, I do not stand here and side in favor
of suffering nor in favor of inadequate or improper medication. Let me ask
you about the people in your study who were in high psychic distress. Would
those people in high psychic distress who were under medicated have been
aided by an over-the-counter drug?
Kline:
I can't really tell as to what kind of drug they'd used.
Miller:
Ah. That's right.
Kline:
The study is not mine, by the way. I wish I had
done it, but I have to give the credit to. . .
Miller:
But you don't know. In fact, the term high psychic
distress, at least to me, suggests that perhaps the care of a physician and
perhaps prescription drug.
Kline:
Well, I frankly think that there are a large number
of drugs which could be over-the-counter drugs which are not, and certainly
included in those are a number that would be useful for psychic
distress.
Miller:
Well, let me ask you, the advertiser says that the
most bought drug for nervous tension in the United States is Compose. I
asked Dr. Feinbloom the question. I'll ask you the same question. What ad
would you write for the drug Compose?
Kline:
Well, based on the study in the current J.A.M.A. by
Dr. Rickles, I would write the same ad Dr. Feinbloom would.
Dukakis:
What is the J.A.M.A.?
Kline:
The J.A.M.A. is the Journal of the American Medical
Association, a sort of Bible for physicians. I'm certainly not advocating
that we keep on the market drugs which are demonstrated to be
ineffective.
Miller:
And in fact, despite the talk about government
checking, so long as the manufacturer combines previously approved elements
in any way, he may market it over the counter without getting Federal Drug
Administration approval.
Kline:
He may but not for very long. The Food and Drug
Administration is presently reviewing all the over-the-counter drugs, and
undoubtedly, the article by Dr. Sickles to which Dr. Feinbloom made
reference will have a large influence, and we applaud this.
Miller:
How many over-the-counter drugs are there?
Kline:
I'm sure that there are as many as hairs in my
head, but I really don't know. I don't even know if the Food and Drug
Administration knows.
Miller:
Without commenting on hairs in your head, nobody
knows. The New York Times estimates between 100,000 and 500,000. How long is
it going to take the FDA to make that study?
Kline:
I think that this is a kind of hypothetical
question. Probably, there aren't more than 100 of them that make
up 98
percent of the drugs sold. There are probably all sorts
of odds and ends of
over-the-counter drugs.
Miller:
We know one that made up a substantial
percent.
Kline:
No, I suspect they will ban those that have not
been approved by the review committees.
Miller:
And, in fact, despite the talk about
government-approved ads, there is no Federal Trade Commission or other
previous, approval of advertising copy that goes on television. It simply is
put on, and if it's inaccurate, then the government steps in and has a long
hearing and says, "Wait a minute."
Kline:
But don't you think it's much more important that
they're going to ban from sale those drugs which have not been demonstrated
to be effective. They're presently doing precisely this.
Miller:
Now, do you think hard liquor ought to be
advertised on television?
Kline:
Probably because of the influence it would have on
the sale to ... I'm not so sure whether it shouldn't or not.
Miller:
The influence it would have, I'm sorry, you mean
people wouldn't taste it once…
Kline:
No, I started to say it has some . . .
Miller:
…not like it, and refuse to buy it again?
Kline:
Yeah. It may have an influence on individuals who
are borderline.
Miller:
Yes, and what about violence in commercials in
programs for children? Would you exercise any regulation over the violence
that children see on television?
Kline:
I suspect that it's a very good idea to limit
it.
Miller:
To limit it. Well, you're concerned about the
violence. You at least have an initial concern about liquor ads. Then
over-the-counter ads do influence conduct. They do cause people to go out
and do something.
Kline:
Yeah. But we're not selling either violence or
liquor as being therapeutically beneficial, which over-the-counter drugs
are.
Miller:
Yes. But the important point in terms of the
advertising point is, in your opinion as a psychiatrist, the advertising, in
fact, does cause people to go out and buy the over-the-counter drug. That's
clear.
Kline:
I certainly hope so.
Miller:
So do the drug companies. Now, talking about the
harmful effect of over-the-counter drugs. There are a lot of people in the
United States admitted to hospitals regularly because of over-the-counter
drug reactions - about 300,000 last year. Why does that occur?
Kline:
First of all, I would seriously question the figure
which you use. I've seen some of the data on which it supposedly is based,
and, one, I would question the amount. I would also point out that there are
probably more patients admitted to hospitals because they didn't use
medication...
Miller:
On what data do you base that?
Miller:
On what data do you base that?
Kline:
On my own private practice, among other things,
that patients who go off of medications much more frequently land in the
hospital than those who continue on.
Miller:
Can you tell me one ad on television that gave
what you consider to be genuinely helpful information about an
over-the-counter drug.
Kline:
I'm afraid I'm in Mr. Johnson's category. I don't
watch television that much to give to any kind of an authoritative
answer.
Dukakis:
Mr. Miller, I think I'll have to interrupt. I
don't understand. Dr. Kline doesn't watch it very much. Mr. Johnson doesn't
watch it very much. Somebody's watching television.
Kline:
People in the audience.
Dukakis:
Let's go back to Mrs. Bell for an additional
question.
Bell:
Well, Dr. Kline, did we, in this country, have a
drug problem before we had television?
Kline:
Oh, in the turn of the century, three to four
percent of the people in the United States were habitual users of opiates.
Almost all of the household remedies contained opiates. And since that time,
it's declined very greatly. The greatest use of drugs in modern times has
been in Japan when after the war two million out of 90 million population
were habitual users of amphetamines...
Bell:
And there was no television.
Kline:
No television. Probably the country with the
greatest drug problem, greater than ours, is Sweden, with their problem with
amphetamines and amphetamines are slightly off, but morphine is up now - and
they have no commercial television. So, it's, in my mind, very difficult to
connect commercial television with the abuse of drugs since it's occurred
many places without it.
Dukakis:
All right, Dr. Kline, let's go back to Mr.
Miller.
Miller:
You don't suggest that commercials on television
decrease drug use?
Kline:
No, I don't think that they're really basic at all
to the problem of drug abuse. I think that it's a cop out just as people
say drugs are a cop out. It's a cop out for society to try to pin drug abuse
on . . .
Miller:
Well, we're not trying to . . .
Kline:
Let me finish, please. You asked me a question. Let
me finish. It's a cop out on the part of people who are trying to solve the
drug problem to say that it's due to television advertising. It's a
simplistic nonsensical solution.
Dukakis:
Mr. Miller, I'm sorry I have to break in. Dr.
Kline, thanks very much for being with us. All right, Mrs. Bell, another
witness, please.
Bell:
I'd like to call at this time a man who really knows
something about advertising, Mr. Richard Earl.
Dukakis:
Welcome to The Advocates, Mr. Earl.
Bell:
Besides being a Vice-President of the Grey
Advertising Agency, Mr. Earl is President of the National Council on Drug
Education. You've heard tonight the term, television is the biggest drug
pusher. What do you think of this statement?
Earl:
I think it's emotional. I think it's irrational. And
if I tried to use such language in a television commercial, not only would I
not get it out of my office, it would never get to the air.
Bell:
Television's a very powerful medium. We know that,
Mr. Earl. What about television advertising? Just what power does it
have?
Earl:
Well, I wish it had the kind of power that everyone
says it has here tonight. I'd get very fat-headed. In fact, television has a
very tough job to do. The consumer has become very wise. I think that's
healthy. The consumer has become very strong. The consumer has become very
suspicious. And if the consumer does not believe advertising, then
advertising has no effect.
Advertising has done a lot to put its own house in order,
I think more than most people realize. Mr. Miller said that no advertising
is checked for accuracy until after it's on the air. Actually, every bit of
advertising copy which I write goes through about five levels of the
toughest kind of legal scrutiny and scientific scrutiny. I think it's very
hard for an ad today to be dishonest or not representing actual fact.
Bell:
It's also true, isn't it, that both the FTC and the
FDA have issued guidelines for advertisers to use which is, in effect, a
kind of preclearance?
Bell:
What would be the effect on this so-called drug
environment that we're supposed to have in this country if we banned
television advertising for drugs?
Earl:
Well, let me put my other hat on for that. I am
President of the National Coordinating Council on Drug Education. One of the
things the council attempts to do is to isolate and identify the causes of
drug abuse. And, frankly, the more we study it, the more we find there are
no simplistic answers. You know, last year, suddenly somebody discovered
that rock music talks about drugs, and so the FCC then moved to ban rock
music. They moved and they said to stations that were playing it, "Any rock
lyrics that talk about drugs we'll scrutinize your license." And the
Coordinating Council sued the FCC because we said there is no simplistic
link, and I'm proud to say that Commissioner Johnson stood up with us on
that issue. I'm curious as to why he is standing up on the other side of
this very simplistic thing. Over-the-counter drug advertising has not caused
drug abuse. Drug abuse has been caused by a great many other factors.
Bell:
Well now, tell us as an advertising man. Put on your
other hat. What would happen if drug ads were banned from TV?
Earl:
I think, first of all, the well-advertised brands
that everyone knows about today would continue to sell. The thing that would
be detrimental to the public, I think, is that companies would be deterred
from introducing new products. And I believe that part of the whole new
product story is that these products generally are more efficient, they work
better, I think the public benefits from them. Why should a company
introduce a new product if they are prohibited from advertising it to the
public at large?
Bell:
Well, you've heard it earlier, and now I'll ask you
too. What do you say when people say they're aren't any new products?
They're all just alike.
Earl:
I could only say that the advertiser who comes up
with a parody product, that is, a product which is exactly the same as
what's out there, has a very tough time. The big thing is the consumer is
not stupid. They are not sheep that flood into the store based upon the
hypnotism that somehow we create. What I'm saying is that the consumer tries
our products based on the representation that we make. If they work for
them, they buy it again. If they don't, they stop buying them, and that puts
us out of business faster than any regulation, faster than anything
else.
Dukakis:
All right, Mr. Earl, let's turn to Mr. Miller.
He's got some questions for you. Mr. Miller, you're up.
Miller:
Perhaps Mr. Johnson's view on the rock music and
the advertising was that it's not the music, it's the words, that cause the
problem. Let me ask you, Mr. Earl, about these new products. Tell me about
Sterling Drug Company and one of its ads that's now before the FTC. Sterling
Drug Company makes two asper type products, Bayer Aspirin. And in its Bayer
ads, Sterling advertised that it's more effective than any product, that
buffering is not necessary, it says in the ads for Bayer. It also makes
Vanquish, same company. And in its Vanquish ads, it says that the consumer
deserves extra strength and gentle buffering. How did those two ads get by
these layers of controls that are nongovernmental, by the way?
Earl:
O.K. One of the things that I hope is clear, and
that is that people who make ads must study their products. You've asked me
to make a snap judgment on two products that I've never studied, I've never
advertised, and...
Dukakis:
It's not your agency, I take it.
Miller:
It's not yours. Dr. Kline doesn't watch television
as much…
Earl:
I watch a lot of television.
Miller:
Let me ask you about the overall budget, then. The
drug companies spend over 200 million dollars a year on drug advertising.
Why?
Earl:
Why do they spend the money?
Miller:
Yes, why, if all it does is tell people about new
products with or without buffering or about products that don't work, the
consumer won't buy? Why do they do it?
Earl:
Well, it's very obvious that these companies are in
the business of selling drugs.
Miller:
And why is it that the drug companies must spend
14 percent of their revenue for advertising while food companies only spend
three percent, tobacco companies only spend six percent, other retailing
companies only spend five to nine percent? Why must the drug companies spend
at least 150 percent and more than other industries on their
advertising.
Miller:
Well, could it be because of what Commissioner
Edwards of the Federal Drug Administration, who is one of these checks,
Commissioner Edwards says that "Drug store sales of over-the-counter
hypnotics and sleeping aids increased by 10 percent from 1967 to 1969. This
is a market created largely by advertising." Do you disagree with
Commissioner Edwards?
Earl:
I think that's possible. I take it that you're
assuming that there is no need for these products.
Miller:
Well, I'm assuming that between '67 and '69 we
suddenly didn't have a 10 percent rise in sleeplessness. Can you suggest
any…
Earl:
No, I would suggest that some of the people who had
sleepless nights now don't have them.
Miller:
Or that some of the people who never had sleepless
nights are taking pills who don't need them.
Earl:
Well, again, I think you are assuming that the
consumer is somewhat stupid.
Miller:
Well, let's ask about the consumer now, about this
aspirin controversy. Do you know, is there any medical difference, say,
between plain aspirin and something with an antacid or with a buffering
compound in it?
Earl:
Oh, I think there's a great difference.
Miller:
There's a great difference?
Miller:
Well, the Handbook of Non-prescription Drugs, the
1971 edition of the American Pharmaceutical Association says, "Combination
analgesic products (and those are referring in this passage to internal
pain-killing products) appear to have no clinical advantage over single
combination products. The rationale that they produce fewer untoward effects
also has not been demonstrated in controlled clinical evaluations." Same
quotes from AMA in other studies. Now you're an intelligent consumer, and
you thought there was a difference.
Earl:
No, I am a consumer, and I get headaches, and I've
tried all the analgesics, and I do know for a fact that the extra strength
products, so advertised, cure a stronger headache. The faster acting
products work faster on me, and I wager that thousands of consumers have
made the same test themselves.
Miller:
Now, you're paying more for that extra strength
product. In fact, you're paying more...
Miller:
you're paying more for the brand named Bayer over
something that's manufactured otherwise.
Miller:
Now, if all the scientific studies indicate that
it's exactly the same in terms of killing pain, aren't you, in fact, paying
more because of what you've heard on the advertisement?
Earl:
No, I deny that they're exactly the same, and I
would question those studies. I've seen many studies that demonstrate that
the faster acting product works faster, and, in fact, I've tested it myself.
It does work faster on me. And other consumers have tried it and would not
continue to buy it unless they felt that to be the true effective
product.
Miller:
Let me read to you from an AMA study of medicines
since I think, Mrs. Bell, we have here the classic case of the consumer who
can't be fooled. The AMA says, "It has not been demonstrated that these
mixtures (referring to these various brands) produce results of faster
onset, greater or longer analgesic effect. There appears to be no sound
basis for giving one of the buffered preparations in preference to plain
aspirin,"
Earl:
Do you think that a consumer who had no different
effect would pay more for the other product unless he really felt that it
was working better for him? Why should he do that?
Miller:
This is really the heart of the issue. Because in
blind studies, where people didn't know what they were taking, it has been
scientifically demonstrated there's no difference. You hear the advertising
and think there's a difference. The only conclusion we can come to is that
what you're hearing is the advertisement.
Dukakis:
Mr. Miller, let's let Mr. Earl respond to that
briefly.
Earl:
No, I do some of the advertising, and I've seen the
other studies. You have a study, and I've seen studies.
Miller:
What other studies, by the way? There are none to
my knowledge that indicate a difference. What other studies?
Dukakis:
A brief response, please, Mr. Earl.
Earl:
There are a number of studies, and they're available
from the pharmaceutical . . .
Dukakis:
All right, you'll have an opportunity to get back
to that Mr. Miller. Mrs. Bell, another question, please, for Mr. Earl
Bell:
Mr. Earl, are people different?
Earl:
Yes, very different.
Bell:
And so, a product that would work for one person,
even though clinically it might be the same as another product, might not be
as good for a second person.
Bell:
And that's why, in fact, people buy different brands
of different things and not the advertising.
Earl:
That's right. And I say to these people, if they see
our advertising and try our product and it doesn't work for them, try
somebody else's.
Dukakis:
All right, we're back to Mr. Miller. Mr.
Miller.
Miller:
In other words, Mr. Bell . . .
Miller:
I'm sorry. Another case, Mr. Earl, and Mrs. Bell.
The American drug companies are better physicians than the AMA and the
American Pharmaceutical Association?
Earl:
No, I wouldn't say they're better. I would say this,
though . . .
Miller:
They're different, in any case.
Earl:
Different, yes, and they certainly know their
products.
Miller:
They know their product.
Miller:
Thank you, Mr. Earl.
Dukakis:
All right, Mr. Earl, thank you very much for
being with us. Mrs. Bell.
Bell:
Well, you've heard Mr. Miller be an expert on
advertising. You've heard Mr. Miller be an expert on drugs. I might take
issue with his statement that sales of over-the-counter drugs have increased
between '67 and '69. The ones he's worried about, the sedatives and
tranquilizers, have decreased over those years; and they represent a very
small and rather steady fraction of total drug sales. The drug sales that
are zooming are, of course, the prescription drugs under, we all know, the
careful care of our medical profession.
I would come back to what I began with. The people who
want to ban this advertising on television do so because they do believe
that the doctors know best and the consumers don't. If buffered aspirin is
no different than aspirin, then why shouldn't the consumer use buffered
aspirin if the consumer thinks it's better than aspirin. And on this, both
our witnesses have testified, the doctor, who has said that, in fact, there
is a difference, and the advertising man, who has said that, in fact, he
cannot make people buy things which they're not satisfied with.
Dukakis:
Thank you, Mrs. Bell. All right, Mr. Miller, you,
too, have some time to summarize your case.
Miller:
I think we have a classic case of the errors of
advertising. Consumer Reports has been reporting for over 30 years than
plain aspirin and all the others are the same. The Federal Trade Commission,
on whom Mrs. Bell relies so strongly as a government agency, now is urging
all the drug companies, as part of a hearing which they are contesting, to
put out corrective advertising which includes statement that this buffered
product is no more effective than aspirin for the relief of minor pain. In
fact, that's what the government agencies have concluded. That's what every
scientific study has concluded. So aspirin is the classic case. Common
ordinary aspirin is as good as anything; and yet for a multiple of the
price, four-way tablets, all sorts of things are sold. Why? In the blind
experiments, where the subjects don't know what they've taking, there are
uniform results that they're the same. Only when subjected to the crossed
and the misleading information of advertising are they different.
What clearer case of the effect of misinformation on the
American public. What clearer case than Compose, now in the Journal of the
American Medical Association. I'm not an expert on advertising nor on drugs,
Mrs. Bell. Every statement I've made about a drug here tonight has been
cited from a scientific study. And the one thing that I think we can say
from all those studies and from the effect of advertising is that drug ads
are a health problem and the cure is to ban them. Thank you.
Dukakis:
Mr. Miller, I'm going to let Mrs. Bell make one
brief response to that, and then we'll have to wrap it up.
Bell:
I only want to say that I think you've heard tonight
the greatest libel on the American people I've ever heard. These people are
telling you that if you listen to the Boob Tube, you're enslaved to the Boob
Tube because you're Boobs. You don't know enough to go to your doctor. You
mindlessly persist in going on buying drugs when they don't do you any good
at all. My team doesn't believe it, and I don't think you do either.
Dukakis:
Thank you, Mrs. Bell and Mr. Miller, and now,
ladies and gentlemen, it's time for you here with us in Faneuil Hall in
Boston and those of you at home who are watching us to get into the act and
to let us know how you feel about tonight's question. What do you think?
Should drug advertising be banned on television? Let us know, and write us
on a letter or postcard to The Advocates, Box 1973, Boston 02134. The
question is an important one. Bills dealing with regulating drug advertising
are being readied for introduction at this new session of Congress. A
government cannot be wiser than its people, and it's most important that you
let us know how you feel. We're particularly delighted that over 15,000
people wrote us on our abortion show, and we want you to take the same care
and as many of you as possible to write us on this particular, issue. So
send us your votes, and we will tabulate them and distribute them and make
them known to the members of Congress who will be concerned with this issue
and will be discussing it and deliberating on it during the coming session.
Remember that address again, The Advocates, Box 1973, Boston 02134
In addition, we receive many letters from people
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And now, the news you've been waiting for - our report on
two of our most recent programs and the mail results from you, our
listeners, who have sent us your letters and postcards and your votes. In
early December, from the State Capitol in Sacramento, California, we debated
the question, "Should newsmen be allowed to keep secret their sources of
information without fear of jail?" Of the more than 3700 letters we received
on that program, 77 percent said that newsmen should be protected, and their
sources of information should be protected from prosecution. And 23 percent
disagreed with that and said that they should not and that shield laws
should not be passed by state legislatures or by the Congress,
A week later, we debated the question, "Should women be
permitted abortion on demand. We received over 15,000 letters on that
program, and the results, as you can see, were very, very close. Forty-nine
percent of our viewers who sent us their votes said that they were in favor
of abortion on demand, and 51 percent were against it. We did that show,
again, in the Assembly Chamber of the State Capitol in California, and we
were pleased, I might add, to receive a vote from the Governor of the State
of California, the Honorable Ronald Reagan. He voted no, and we appreciate
his vote and his compliments which he sent to us on that particular show.
And now, let's take a look at next week's program.
Annoucer:
[VIDEO TAPE] The traffic situation here on the Mystic
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Should half the federal dollars reserved for highways be
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Advocates.
Dukakis:
That's going to be a very special occasion
because your moderator's going to step off the moderator's podium, and he's
going to be an advocate in favor of that proposal. He and we hope you'll be
watching us on that particular show.
And now, with thanks to our advocates and to their very
distinguished witnesses for a very exciting program, we conclude tonight's
debate.
Annoucer:
The Advocates, as a program, takes no position
on the issues debated tonight. Our job is to help you understand both sides
more clearly.