MEDICATION NATION

St. Louis Post-Dispatch: Even if you don't have social anxiety disorder, persistent heartburn or high cholesterol, you can probably name some drugs used to treat those conditions. Advertising for medications like Paxil, Prilosec and Zocor has exploded in recent years. Not coincidentally, so has spending on prescription drugs, the fastest growing part of the rise in health care spending.
Experts have questioned whether some heavily advertised, expensive new drugs are substantially better than existing treatments. Others complain that ads such as those touting the antidepressant Paxil for "social anxiety disorder" blur the line between a real illness and ordinary conditions like shyness.
As Congress and state legislatures begin crafting plans to give senior citizens access to affordable medicines, a report released last week by the National Center for Health Statistics will add fuel to the debate. The report, based on a representative survey of physicians, suggests that television and print ads directed to patients are hyping demand.
Celebrex: More than 80 percent of newly approved, heavily marketed drugs were listed among the most commonly prescribed medications in 1999, the year covered by the survey. Among them were Celebrex, an arthritis drug that can retail for $1.65 per pill; Viagra, for erectile dysfunction, at $9 per pill or more; and the diabetes drug Rezulin, withdrawn last year after being blamed for patient deaths. Just 10 percent of drugs that were not heavily marketed made the list.
Spending on prescription drugs grew by a staggering $17.7 billion between 1998 and 1999. Just four drugs -- all heavily marketed -- accounted for $2.1 billion of that increase. The widely advertised allergy drug Claritin, which sells for up to $2.65 per pill, was the most commonly prescribed medicine.
The correlation between advertising and sales isn't exact, in part because some new drugs do have important advantages over existing therapies. But the relationship is strong enough to cause concern. At stake is more than money. Rezulin was linked to more than a dozen deaths before being pulled from the market.
Advertising: Drug companies justify their high prices by pointing to the steep cost of research and development. But a recent survey by the liberal advocacy group Families USA found large pharmaceutical companies spend substantially more on advertising, marketing and administration than they do on research and development.
America's elderly shouldn't have to go bankrupt paying for the medicines they need. But a complex problem demands a sophisticated solution. Shifting the burden onto taxpayers, without first addressing the factors causing prices to skyrocket, will only change who goes broke.
TEAMING UP AGAINST AIDS
Providence Journal: It would be hard to exaggerate the threat to developing nations posed by the AIDS pandemic. Some have called it the greatest public health scourge since the Black Death in the 14th century. The numbers tell why: across the world, nearly 22 million dead, 13 million orphaned and more than 36 million either living with AIDS or with the virus that causes it. The loss of workers has devastated national economies and in many places imperils food production.
Milestone: Last month's United Nations summit on AIDS was a milestone in confronting the disease. With 189 nations participating, the meeting was the world body's first devoted to a health issue. Sharp differences arose. But the attention paid was an important prelude to global action.
To be sure, the United Nations is famous for being long on talk and short on deeds. And where it does act, red tape often impedes its efforts.
Still, the conferees did set forth some laudable (if unenforceable) goals. The declaration calls for a 25 percent drop by 2005 in infection rates among 15- to 24-year-olds in the hardest-hit nations. Member nations are asked to develop strategies for confronting the epidemic by 2003, and to tailor them to their cultures.
Such flexibility is essential. In Mauritania, for instance, condoms are now virtually illegal. In Kenya, the sharing of needles for genital mutilation has helped spread the disease. Both situations must change if the infection rate is to slow.
The conference forced some difficult conversations on the way many countries treat women. Kofi Annan, U.N. general-secretary, noted that women and girls are especially vulnerable to AIDS, either because of cultural practices or national policies. He correctly called for their empowerment through education and a broadening of rights.
With the conference past, attention will now turn to the global AIDS fund being set up by Mr. Annan. So far, nations and corporations have pledged $644 million. But Mr. Annan estimates the need at $7 billion to $10 billion annually.
Prevention: The fund must provide for both treatment and prevention, and spending must be carefully controlled. While pharmaceutical companies have been much pilloried for keeping the price of AIDS drugs out of reach, several have lately softened their stance. It will be important to keep the pressure on. But the drug controversy should not become an excuse for ignoring prevention. In many nations, a frank reckoning with ancient cultural practices is crucial.
Change is clearly a matter of life and death.