DEAR DR. ROACH: As I watch TV, I see a lot of drug advertisements. Why would the drug companies advertise to the general public when doctors are the people prescribing the new drugs? Or are they advertising to doctors through TV and the general public just sees the advertisement? — C.S.

ANSWER: I do not agree with prescription drugs being advertised directly to the public. However, pharmaceutical companies would not spend a great deal of money on the advertisements unless they were effective, which they are. Although doctors certainly see the ads, the main way they work is that people with the conditions will often come to their doctors asking about a particular treatment for their condition. Doctors are human and want to please their patients. They are more likely to prescribe something the patient asks for even when, if they were to take the time to think, they might realize a different medication may be better or less expensive — or even that a patient might not need prescription medication at all. Patients should try not to ask for specific treatments, and physicians should be more diligent about ensuring their prescriptions are the most appropriate, but human nature has its way. Drug companies are very, very good at getting their messages across.

Big pharmaceutical companies are not evil by their nature. The development of multiple safe and incredibly effective COVID-19 vaccines is one recent triumph of the pharmaceutical companies, and just the most recent example of advances that are responsible for immense benefit to mankind. But they are, generally, publicly traded companies that are trying to make a profit for their shareholders, and there is the potential for a conflict of interest between profit and service to humanity that advertising can exacerbate.

DEAR DR. ROACH: What can you tell me about the survival odds in an adult male diagnosed with undifferentiated pleomorphic rhabdomyosarcoma? The surgeon feels he was able to remove it all but would have liked a wider margin in one area. Due to a bundle of nerves there, it wasn’t possible. He did remove the pectoralis major and a portion of the deltoid. Chemotherapy was done, and some radiation. Thank you for any information you can shed. It has been almost five years, and so far no recurrence. — P.

ANSWER: Sarcomas are cancers of connective tissue and are much less common than carcinomas. Most lung, breast, prostate and colon cancers are carcinomas. Only 1% of cancers diagnosed in a year are sarcomas. In this case, we’re talking about the muscle tissue — “rhabdomyo” refers to muscles attached to bones, such as the pectoral or rib muscles.

My personal experience with sarcomas has mostly been in hospitalized patients, often with relapse after surgery, and the prognosis in such cases is generally poor. However, since the male in question has gone nearly five years with no evidence of disease, the prognosis is much better. Eighty percent of recurrences happen within the first two years. He has a very good chance of having been cured.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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