Marketing and Medicine: Part One

Brand recognition is a huge part of the American shopping experience. We frequently buy things based solely on whose name is on the package. A study I read a while back suggested that children ages 3 to 5 reported food in McDonald's wrappers tasted better, even if the food was identical to food in plain wrappers or the food--carrot sticks, for example--wasn't served at McDonald's.

This creates a huge problem when it comes to self-medication.

The aisles of your typical community corpo-pharmcy are well-stocked with a plethora of available options. Colorful boxes with household names like Tylenol, Advil, Sudafed, Mucinex and Robitussin stand out amongst less well-marketed remedies like Chlor-Trimeton. The average American consumer cannot be expected to remember each and every ingredient that goes into typical OTC products, so they rely on friendly packaging to tell them what to buy. The Tylenol brand alone has a dizzying number of spin-offs: Tylenol Allergy, Tylenol Sinus Congestion and Pain, Tylenol Chest Congestion, Tylenol Cold Multi-symptom, Tylenol PM, Tylenol Sore Throat Daytime, Tylenol Sore Throat Nighttime, Tylenol Cough and Sore Throat Daytime...according to the Tylenol website, the Tylenol corporation manufacturs 14 products to treat cough, cold and flu symptoms in adults. And that's just a sample.

The problem is that what's on the front of the label has nothing to do with what's in the medication.

I think the best example is Pepto-Bismol. Pepto-Bismol is one of those ubiquitous drugs that some people just love to death. It is often touted as the cure for every possible source of nausea known to man, hangovers, heartburn, diarrhea, intestinal abuse by five-alarm chili, and jock itch. I even managed to find a blogger talking about making Pepto-Bismol ice cream as his ultimate remedy for "the morning after."

In case it weren't obvious, I was joking about the jock itch.

Pepto-Bismol, if you've been living in a cave with no television for the past several decades, is a thick, pink liquid that contains an ingredient called bismuth subsalicylate, or BSS for short. BSS is a pretty interesting drug in that scientists aren't entirely sure how it works for some of its purposes; the stomach-soothing effects are mediated by affecting gastrointestinal mucosal linings, for example, but the heartburn effects are less well-understood. It also comes in a chewable tablet form for those who dislike having to chug the more traditional form of the pink stuff; it's also a whole lot more convenient for travelling, unless you really like carrying an 8-ounce bottle of pink goo.

Then there's Children's Pepto. The packaging for Children's Pepto is very similar to the regular Pepto, though it only comes in chewable tablet form. Children's Pepto doesn't contain BSS at all. In fact, Children's Pepto contains calcium carbonate, which, aside from being a mainstay of blackboards across the globe, is the acid-neutralizing compound found in Tums and Rolaids. It isn't chemically related to BSS at all, and it doesn't have nearly the same versatility; unlike BSS, Children's Pepto isn't going to do anything for diarrhea, for example.

The issue is not that Children's Pepto contains an "inferior" ingredient. The issue is that regular Pepto's BSS is a salicylate, like aspirin. And use of salicylates in children is linked to the development of Reye's syndrome, a life-threatening neurological disorder.

Pepto-Bismol has plenty of warnings on the back telling you not to give it to children--if you read the fine print. But it's an easy mistake for a parent to make, given the fact that brand recognition, not the drug facts on the back label, is what motivates most people to make their OTC purchases in the first place. Children's Tylenol is still Tylenol, but at a lower dose; it's easy to see why someone might assume the same is true for Pepto-Bismol, a drug commonly thought to be totally harmless, and administer it to their child.

So pay absolutely zero attention to what's on the front of a medication label. Turn it around and read the back. Read it closely. Check the active ingredients. And if you're uncertain in the least whether or not a product is right for you, ask your pharmacist. That's what they're for.