Harvard Health Ad Watch: A fibromyalgia treatment ("But you look so good!")

It's something I've heard countless times from patients with fibromyalgia. They're telling a friend or family member about their condition and the response is, "But you don't look sick" or "But you look so well." Sometimes, the reaction is more of an eye roll or some other response that reflects skepticism that the problem is even "real."

Those are issues addressed head-on in a TV ad for Lyrica (pregabalin), a treatment for fibromyalgia. "To most people, I look like most people," a woman says. "But on the inside I feel chronic, widespread pain." After clarifying that the pain is real, this direct-to-consumer drug advertisement moves on to say one of the current theories about the origin of pain in fibromyalgia is that it's "thought to be caused by overactive nerves."

The mood of the ad is somber at first. Sad music serves as backdrop to a woman who is clearly suffering as a man — perhaps her husband? — plays in the park with two adorable kids. That all changes when she talks about taking Lyrica. Then the music soars and the voiceover tells us that "Lyrica is believed to calm these nerves." The now-smiling woman looks into the camera and pronounces, "I'm glad my doctor prescribed Lyrica." The scene brightens and she's smiling as she goes about setting up for a neighborhood block party. The voiceover informs us that, "For some, Lyrica delivers effective relief for fibromyalgia pain and improves function."

Then comes the litany of side effects that might accompany treatment. More on those shortly.

The good

The ad gets a number of things right, including:

• the fact that the condition may be "invisible" to others
• the notion that the cause of fibromyalgia is unknown, but experts believe it may be due to "overactive nerves"
• the character in the ad who has fibromyalgia is a woman — in fact, the condition is up to six times more common in women than men
• mentioning the risks (and not just benefits) of a medication is important. The most common, and many rare, potential side effects are described. Keep in mind, though, that including a description of side effects or referring consumers to more information is required by the FDA, as I noted in my initial blog on direct-to-consumer ads describing pros, cons, and words to consider very carefully).

What's missing

Some important information is missing from this ad, including:

• The limited effectiveness of the drug. Note the language in the ad: Lyrica works well "for some." You might wonder just how many "some" is! A recent analysis of past studies found that only about 10% of treated study subjects reported excellent results, and only about 40% reported very good or excellent results. Lyrica was only modestly better than a placebo pill. Another analysis found that among prior studies, only 20% to 25% of study subjects experienced "at least 50% pain intensity reduction" within two to three months of treatment.
• The ad only mentions one treatment option: medication. But that's not the only option. In fact, nondrug options, such as regular exercise and improved sleep, are considered vital for the successful treatment of fibromyalgia.
• No comparison to other medications. A number of other medications are approved and prescribed for fibromyalgia, yet there's no mention of how Lyrica measures up to these other medications prescribed. According to a recent review, Lyrica seems to be no better (or worse) than other approved medications, including milnacipran (Savella) and duloxetine (Cymbalta).
• As with nearly all drug ads, the price of the drug is not mentioned. In November, the price of Lyrica was about $12 per 75-mg capsule, according to Drugs.com. The recommended starting dose is 75 mg twice daily, which adds up to around $24/day or more than $760/month. Often, higher doses are needed, which pushes the price even higher. Of course, medication costs are a moving target, because health insurance coverage, copayments, deductibles, drug company coupons, and other factors may affect the price you pay.

The risks of treatment

The list of side effects in this commercial is so long that many (or perhaps most) viewers will tune out. While common side effects include dizziness, sleepiness, weight gain, or swelling of the extremities, "severe allergic reactions" and "suicidal thoughts or actions" are the first ones mentioned. These risks are listed against a visually interesting and wonderfully distracting backdrop — in this ad, it's giant bubbles and puppies. Yes, bubbles and puppies! Maybe providing a distraction from the list of things that could go wrong if you take Lyrica is not a coincidence. In fact, most drug ads do this.

The bottom line

Ads for drugs are not meant to be thorough or balanced. Their intent is to increase sales of their drug. Drug makers often talk about the importance of these ads to educate the public about treatment options. But the obvious (and understandable) bias toward the drug being advertised — Lyrica, in this case — makes the quality of the education suspect. That's why I'm opposed to direct advertising to consumers for medications and medical procedures, and that's probably a reason most countries don't allow it.

Yes, fibromyalgia is a real and troublesome condition that's invisible to others. But medication treatment, such as Lyrica, is only one part of standard treatment. And it's not always effective. Want more complete and balanced information about fibromyalgia? Talk to your doctor or consult unbiased sources that aren't trying to sell you anything. A pharmaceutical advertisement may not be your best bet.