Dr. David Becker,

a board-certified cardiologist with Chestnut Hill

Temple Cardiology in Flourtown, Montgomery County, wrote this for www.philly.com/health.

What is your first reaction to the TV ads for new medications? Do you wonder whether the drugs will help you?

Maybe the question you should be asking is, "From where does the money come?"

There are big bucks to be made when a new medication comes to market, so commercials keep getting more clever. They show happy, healthy consumers jogging in parks, laughing with friends, and even holding hands in mountaintop bathtubs.

I recently received a letter from the manufacturer of a medication called Eliquis. The company is getting ready to begin an ad blitz and wanted doctors to be in-the-know. This blood thinner, used most often to prevent blood clots that can be caused by atrial fibrillation, is one of four new medications that the FDA has approved for this specific condition.

It is meant to replace warfarin, the inexpensive generic form of Coumadin. Warfarin is a hassle for doctors and patients because weekly blood tests are needed to determine the proper dose. Plus, it was once the main ingredient in rat poison, which is not especially appealing.

The four new medications don't require frequent blood tests. The first of them cleared by the FDA was Pradaxa, and recently, it has received a lot of bad press. A report in BMJ suggested that the manufacturer might have cut corners to be first on the market. It has been a hit: Sales were $1.66 billion in 2013.

The second product was Xarelto, already being advertised on TV - along with ads from a lawyer suggesting patients sue the manufacturer over side effects.

That brings me back to the Eliquis letter.

Why do pharma companies feel the need to direct campaigns at consumers? Because they truly believe the medication is better? Perhaps, but the financial stakes are huge; the winner of this competition is estimated to bring in up to $9 billion in sales.

If you're considering switching from warfarin to one of the new drugs, I would suggest considering the following:

Are you on other medications that have drug interactions with warfarin? The new anticoagulants have the advantage of not having as many interactions.

How much will it cost out of pocket per month? The new medications are expensive, not available in a generic form, and may not be covered by your insurance.

Is the lack of an antidote to reverse the bleeding effects of the new medications a deal breaker for you? You need to wait 24 to 48 hours for the effects to wear off from all of the new blood thinners if you should need emergency surgery. Warfarin, on the other hand, has an antidote.

How much of a problem are frequent blood tests for you?

Will you need to stop other blood thinners that work very differently, such as aspirin or Plavix? Neither of these blood thinners is especially effective in preventing stroke when you have atrial fibrillation, so it is important to understand the differences between these blood thinners as you make this decision.

Even if you are already on one of these new medications, it is never too late to ask questions. And if you happen to stumble upon two bathtubs on a mountaintop, enjoy!