Bioethics Forum Essay

The Secret Life of the Lunesta Butterfly

I’ve got an idea I’m just dying to pitch to the FDA.

You know those fantastically seductive animations the drug companies are using to sell prescription medications? There’s the allergy medication ad that shows a woman being harassed by pollen-heavy weeds that are growing up around her as fast as Jack’s beanstalk. And, oh, the Lunesta ad with the bioluminescent butterfly who alights silently on your pillow to gently put you to sleep. And my personal favorite: the NuvaRing TV spot that pictures the insertable rings of birth-control hormones as adorable pink hula-hoops swinging ever-so-slowly around the shapely hips of pretty young things.

These ads are so seductive! I swear, every time I see the NuvaRing spot, I want to head down to Nordstrom’s with a print copy of it and exclaim to the first saleswoman I meet, “I want those shoes, that skirt, and the hula-hoop-birth-control!” I mean, it’s a serious fashion statement. The first time I saw this ad, I told my internist-husband, “Honey, good news-you’re like Tommy Hilfiger now!”

These drug-induced animations have gotten so connected in my mind to the medications they represent, I now find that when a friend tells me what prescription she’s on, I want to ask her, “Is that the drug that drives the little purple car? Or is it the green one that does the push-ups at the gym?”

Now, being in a capitalistic, free-speech society, I know I’m not supposed to complain about direct-to-consumer marketing of prescription drugs. The drug companies have the right to speak, and they’re doing patient education, right? I should just keep to myself my sense that patient education might be better achieved with, oh, actual patient education that explains the real-world complexities of diagnosis, disease, and treatment

I know I should also just keep to myself my frustration that, like all good advertising, prescription drug marketing isn’t just pushing the product, but is pushing a concept of who you must be, and how you must purchase the product to be that person. If you get two kinds of publications delivered to your door as we do, one a set of “mainstream” magazines like Timeand Martha Stewart Living, and the other medical journals like JAMA, you can’t help but notice that drug ads come in two flavors depending on whether they’re pitched to “consumers” or “providers.” The ones in the mainstream mags tell patients they should all be permanently happy, virile, well-rested, popular, free of blemishes or wrinkles-and that they must not, under any circumstances, be caught being the worst thing possible: single.

Meanwhile the ads directed at doctors make sure physicians know that if a patient has high blood pressure, high cholesterol, anxiety, impotence, or is single-all this is because the doctor is just a bad doctor who is too cheap, too stupid, or too uncaring to dash off the right prescription. (“Effexor XR: The change they deserve.” What’s your problem, doc?)

But, whatever-free speech, right? I should just shut up already about how direct-to-consumer ads aggravate the healthcare crisis by their unified message that healthcare is all about consumption.

Anyway, here’s the compromise I’m looking to suggest to the FDA. Let the drug companies keep their seductive little animations. But make them use the same cutesy computer wizardry not just to pitch the drug’s intended effect, but also to vividly illustrate the side effects and dangers!

So, as it is now, the end of the Lunesta sleeping-pill ad tells us that the drug should not be taken with alcohol because alcohol can intensify the drug’s effect. Under my new plan, this part of the advertisement would show the woman waking up with an empty bottle of wine on her bedside table and the Lunesta butterfly languishing on the pillow next to her, smoking a cigarette. The look on the woman’s face clearly says, “Oh my god, what just happened?!”

In the allergy medication ad, when they get to talking about how the drug may cause dry mouth, we could see the allergy-prone woman with the magical weeds growing inside her mouth. (I’m thinking thistle.)

The NuvaRing hoola-hoop ad, when it gets to the risk of stroke, could show a woman happily twirling her pretty pink hoop, when all of a sudden her hoop creeps up her body, tightens around her neck, and makes her stroke out.

The added benefit of my plan is that it could be used to teach about the reality of statistics-not only about what percentage of people have various side effects (like stroke from birth control hormones, and sexual dysfunction from depression medications), but also to illustrate how the drugs don’t actually work for everybody. How many people in one hundred are actually bitten by the butterfly or choked by the hula-hoop? Show it!

Now, when I pass this proposal by some of my friends, they object that hey, control-top pantyhose and Intel chips don’t work for everyone all the time either, but we don’t make those advertisements vividly speak the truth about product limitations. Well, call me old-fashioned, but I think health care should be understood differently from other realms of life-that it shouldn’t be a matter for bald capitalism-that it matters that these drug ads corrupt what’s left of the nobility of medicine, that they push regressive social norms, that they contribute to unrealistic expectations and wasting of resources.

Or maybe I should stop lying awake thinking about these things. In fact, maybe I should talk to my doctor about inviting the little Lunesta butterfly into my bed. So long as I’ve got my hula-hoop, I should be OK.

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Hastings Bioethics Forum essays are the opinions of the authors, not of The Hastings Center.

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