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Consumer Ads Can Alter Prescribing Patterns

Study finds patient requests for medications make a difference

TUESDAY, April 26, 2005 (HealthDay News) -- Direct-to-consumer advertising appears to be affecting prescribing practices, according to new research that shows doctors are influenced by patient requests for antidepressant medications.

"No matter how the request is phrased, patient requests were very powerful influences on physicians' decisions to prescribe," said study author Dr. Richard L. Kravitz, director of the Center for Health Services Research in Primary Care at the University of California, Davis. His report appears in the April 27 issue of the Journal of the American Medical Association.

Direct-to-consumer advertising (DTC) of prescription drugs, which totaled $3.2 billion in 2003, has come under increasing scrutiny since the cox-2 painkiller controversy, and the withdrawal of two of them, Vioxx and Bextra, from the market.

Some experts have argued that such advertising could help people get treatment for conditions like depression that are chronically underdiagnosed. Others argue that it might result in individuals taking drugs they don't really need.

To address the issue, the study authors conducted a randomized trial using actors to play six different "standardized patient" roles in doctors' offices. The "patients," all middle-age white women, had either major depression or adjustment disorder with depressed mood (this latter condition is usually a temporary response to a stressful life situation).

The three scenarios involved the "patient" telling the doctor that she had seen a TV ad for Paxil and asking for that specific medication; asking about medications in general; or making no request for medication.

At the time of the study, Paxil was heavily marketed and more expensive than many other antidepressants.

A majority (76 percent) of the patients who made a general request for medication received a prescription, vs. 53 percent of those making a specific request and 31 percent of those making no request.

For patients with adjustment disorder, 55 percent making a brand-specific request received a prescription, compared with 39 percent of those making a general request and only 10 percent of those making no request.

"General requests were a little more potent in major depression, and brand-specific requests were a little bit more potent in adjustment disorder, which is not the way you'd want it if you were doing an all-out DTC advertising campaign," Kravitz said. "You'd like your message to increase prescribing for those who need it, and to have little effect or no effect on those who don't need it."

The bottom line is that DTC advertising is not translating into best-care practices, the researchers said.

"Most physicians are trying to do their best for patients, and I think this highlights that [it] influences both patients and physicians in a way that's not necessarily good," said Dr. Matthew F. Hollon, author of an accompanying editorial and an assistant professor of medicine at the University of Washington, Seattle. "It appears that [it] undermined optimal therapeutic decision-making."

The study authors recommended that pharmaceutical companies do more educating and less selling in their marketing campaigns. If that doesn't work, Kravitz said, "the federal and/or state governments should impose a tax or surcharge on this type of advertising to support public-service message announcements to consumers that would provide them with the balanced information they need."

Still, it's too early to render judgment, Hollon added. "The real missing data point is the extent to which [such advertising] does bring those at highest risk for health problems to care," he said. "Does it motivate those at highest risk for high cholesterol, depression, osteoporosis, or does it preferentially motivate those at low risk."

The system, as it stands now, is also biased against those with the least resources, he added.

"Those at highest risk may be those that don't have health insurance," Hollon said. "If New Zealand passes a ban on [such advertising] this year, the U.S. will have the distinction of being the only advanced industrialized country that allows [it], does not limit pharmaceutical price increases and does not have any national policy guaranteeing health care. My patients, many without adequate insurance, pay the highest prices in the world for prescription drugs and when you look at the money spent on [this advertising], you wonder if it's really worth it."

More information

The American Academy of Family Physicians has a statement on direct-to-consumer advertising.

SOURCES: Richard L. Kravitz, M.D., professor, medicine, and director, Center for Health Services Research in Primary Care, University of California, Davis; Matthew F. Hollon, M.D., assistant professor, medicine, University of Washington, Seattle; April 27, 2005, Journal of the American Medical Association
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