The People's Perspective on Medicine

Why Do Drug Companies Love Long Lists of Side Effects?

Be honest now. Do you zone out when long lists of side effects are recited on drug commercials? Do drug company lawyers use that information to avoid blame?
Magnified focal area over the warning information of a prescription medication

A long time ago, drug companies worried about long lists of side effects. They feared that if they warned people about serious adverse drug reactions, no one would want to take their pricey pills. When FDA commissioner Dr. Arthur Hayes asked pharmaceutical manufacturers in 1983 if they were going to seek prescription drug advertising directly to consumers, most of them replied that:

“No, that would be a terrible idea” (Stat, Dec. 11, 2016). 

In a 1984 letter to the powerful Michigan Representative John Dingel, Allan Kushen, Senior VP of Public Affairs for the Schering-Plough drug company, stated: 

“We have serious concerns about proposals to allow advertising directly to patients. We do not believe it is in the public health interest; indeed we believe that in most cases it cannot safely be accomplished.”

What Changed?

In case you have been hibernating in a cave or you never watch any television, prescription drug ads with long lists of side effects have proliferated. An article in JAMA (Jan. 8, 2019) noted that direct-to-consumer (DTC) advertising jumped from $2.1 billion in 1997 to $9.6 billion in 2016. Drug companies now spend about a third of their marketing dollars on DTC advertising.

Why Are There Such Long Lists of Side Effects?

If you’ve ever watched a prescription drug commercial on television or looked at a drug ad in a magazine, you know that there are long lists of side effects. Some of the adverse reactions are really scary. Why do drug makers do that?

We used to think that pharmaceutical companies reluctantly included long lists of side effects because the FDA made them do it. That is no doubt true, but there may be a more self-serving reason.

Telling patients about lots of nasty adverse reactions might provide a legal defense in case of litigation. And people tend to zone out after about the tenth or eleventh side effect anyway.

The J&J Litigation:

You may wonder why drug company lawyers might embrace long lists of side effects. Here’s the latest example. A recent trial in Philadelphia resulted in an $8 billion verdict against Johnson & Johnson, the manufacturer of Risperdal (risperidone).

The plaintiff claimed that he was given this schizophrenia drug for autism spectrum disorder when he was a youngster. He developed prominent breasts, which caused him anguish as a teenager. The condition is known as gynecomastia.

Needless to say, J&J is not happy about this ruling. The company will appeal. Part of its defense is expected to be that the company notified health professionals of this side effect in the prescribing information.

The company responded to the verdict that:

“…the jury did not hear evidence as to how the label for Risperdal clearly and appropriately outlined the risks associated with the medicine…”

Loving Long Lists of Side Effects:

We interpret that to mean if a patient takes a medication that causes serious harm, the drug manufacturer should not be liable for the damage, provided it has notified doctors about the risk. Most companies do this in the official prescribing information.

A patient who develops a life-threatening skin reaction brought on by a medicine probably cannot sue the manufacturer if the prescribing information lists Stevens-Johnson Syndrome.

What is Stevens-Johnson Syndrome (SJS), you might ask? Trust us when we tell you it is horrific! Some drug references may describe this as a skin rash. It is way worse than any skin rash you could ever imagine.

People develop a fever, sore throat and eye irritation. Mucus membranes are affected throughout the body. The lesions are extremely painful and can make eating and drinking excruciating. If SJS progresses to toxic epidermal necrolysis (TEN), the skin can literally peel off in large sheets. This is a life-threatening condition!

Alerting Patients to Side Effects:

Drug companies do not have to warn patients directly. For legal purposes, all they have to do is make sure prescribers and pharmacists have access to the information.

If a direct-to-consumer drug commercial warns about liver failure, heart attacks, kidney disease or cancer, the company could be off the hook if one of those complications occurs. Even if the manufacturer does not mention all the possible adverse reactions in a TV commercial, it could still avoid litigation. That’s because the doctor has access to the long list of side effects in the prescribing information. If he does not mention every single problem, lawyers for drug companies may argue that’s not their problem.

Learning from the J&J Litigation:

What is the take-home message from the latest lawsuit? Physicians must understand the pros and cons of every medication they prescribe. They should alert their patients to symptoms of potentially serious adverse reactions. Here’s an example of statins and rhabdomyolysis.

“Rhabdo” AKA Rhabdomyolysis:

A side effect that is considered relatively rare, like rhabdomyolysis, can cause irreparable harm.

We heard from one person who experienced this reaction:

“My horrible muscle-destroying experience began with 40 mgs of simvastatin twice a day. It led to the muscle wasting disease rhabdomyolysis, where myoglobin spills from destroyed muscle into the blood stream. Once that overwhelms the kidneys, which cannot clear it fast enough, the result is severe: whole body muscle pains and darkened urine (color of iced tea) indicating acute kidney failure.

“That happened eight years ago. Since that hospitalization, I’ve dodged subsequent dialysis so far. However, my kidney function is only 50 percent of normal, and one kidney is now half normal size.”

Other symptoms of rhabdo include muscle pain, muscle weakness, unexplained bruising, nausea and vomiting. The doctor should test for creatine kinase (CK), myoglobin and potassium.

What Should Patients Do About Long Lists of Side Effects?

Even if a list of side effects is long and daunting, it is still essential to read and understand the implications. That’s the only way to realize you might be running into trouble. And remember, you may not be able to hold the drug company responsible for a life-altering adverse drug reaction if they warn about it on TV or in the official prescribing information.

Learn more about how to protect yourself from drug complications in our book, Top Screwups Doctors Make and How to Avoid them. You can also download our free Drug Safety Questionnaire and Medical History. Take it with you to every doctor visit. Give a copy to your pharmacist to fill out as a double check. 

Share your own story about drug side effects in the comment section below. If you value The People’s Pharmacy as an independent drug watchdog, please consider supporting our work by going ad-free at this link.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Citations
  • Schwartz, L.M. and Woloshin, S., "Medical Marketing in the United States, 1997-2016," JAMA, Jan. 1, 2019, doi: 10.1001/jama.2018.19320
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Show me a drug without side effects, and I’ll show you a drug without activity.

Unfortunately, American consumers naively believe that if something has a benefit then more or stronger is better. I read a marketing paper years ago where consumers reacted to the long list of side effects by thinking “Wow, that must be a powerful drug if it can do all that – I want that powerful medicine.” Needless to say, shallow intellectual processing is a problem in our consumerist society. Doctors will tell you that patient demand for new drugs drives a lot of their prescribing.

Great article.

I think the drug companies love the side effects because the patents every time attach to the company, and the company is more profitable. I have been buying my drug from a Canadian-based online pharmacy. I love the price and services. This company is not doing this type of activity like “side effects love,” etc.

A respected doctor once told me that all drugs have side effects. I read the list before deciding if I will take the drug.

People need to know that you can develop side effects after many years on a drug. It is known that some blood pressure drugs cause coughing. After being on 5 mg of Lisinopril for 9 years, I developed a cough that kept me awake at night and felt like phlegm in my throat that would not go up or down. I was exhausted from lack of sleep. The doctor said, “Stop taking your blood pressure medicine.” That night I slept soundly and have ever since.

I have a problematic child who is on several meds which have changed over the years. I also have 6 PDRs dating back to 2000. What a help they are! I got them specifically because they list all the side effects. It’s also interesting to see how the side effects (including anticholingeric load) have changed over the years. I am so glad I have them. If anything the drug companies and other websites play down and/or provide only a minimal list of side effects.

So the drug companies protect themselves by detailing every possible side effect which, at the same time, can be extremely difficult for the patient. Also informative. I am currently trying to decide whether to take a second attempt at taking a bisphosphonate for osteoporosis. First one gave me flu-like symptoms after a month. This time a second doctor prescribed actonel, which also causes many side effects including stomach pain, joint pain, etc. I have friends opting out of taking meds and instead exercising and modifying diet. This is a difficult decision for me since I have advanced scoliosis, too.

In a perverse way, the drug companies are telling you what you can look forward to as to what side effects you may encounter. In this manner, they are more than willing to have you take other drugs to counter the effects of the first few drugs. In any event, if there was any truth from Big Pharma, they would admit that most drugs are useless and harmful or poisonous to the body. Never mind the side effects, those are secondary. Never mind the money wasted on useless cures. You may not experience any side effects, but that doesn’t mean that long term damage isn’t being done. Again, drugs might be ensuring patients for life.

Big Pharma OWNS the media, politics, our governmental bodies and the minds of much of the public. No way for Big Pharma Not to Win on All Levels. Wake Up! America is beyond any possibility of hope! Too Late and Too Little Time to Wake Up!

My mother took several statins and developed peripheral neuropathy and muscle weakness. Often she fell to the floor and could not rise. Neurologists and orthopedists deny that this was due to statins. She is 90 years old. 10 years ago she stopped taking statins and also stopped falling. What disturbs me is that doctors deny evidence. Why?

I also took Inegy for a short time. I stopped taking when I read in the leaflet “Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness. This is because on rare occasions, muscle problems can be serious, including muscle breakdown resulting in kidney damage; and very rare deaths have occurred.”

Another stupidity: Doctors ask us to put our lives at risk to lower LDL cholesterol!

Why comment? Nothing will change in favor of patients and consumers. We are here to do, pay, and die, not to question why.

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