Drug Advertising Leading To New Treatments, Lifestyle Changes
In Addition To Prescriptions For Advertised Pharmaceuticals

New Survey Reveals Physicians’ Prescribing Habits—Few Doctors
Prescribe Drugs Solely To Accommodate Patients’ Wishes

BETHESDA, MD—Physicians prescribed a drug that is advertised directly to consumers 39 percent of the time when patients asked specifically for that drug, but were just as likely to recommend that patients change their lifestyle to treat a medical condition, according to a new survey published today on the Health Affairs Web site.

Those encounters led to new treatment for conditions more than half the time, suggesting that while direct-to-consumer advertising (DTCA) may lead to increased drug consumption, it also may have positive effects for patients “that transcend merely prescribing a DTCA drug,” according to the survey conducted by a team of researchers led by Joel Weissman, an associate professor at Harvard Medical School.

Weissman’s survey is one of seven articles published today that examine issues surrounding direct-to-consumer advertising. A second survey, by Steven Woloshin and colleagues, tests whether a “prescription drug benefit box” would clearly communicate the chances of various outcomes with and without the drug being advertised.

Weissman and colleagues asked 643 physicians about how DTCA affected their practices and about the results of their most recent experience in which a patient specifically asked for an advertised drug.

While nearly three-quarters agreed “strongly” or “somewhat” that DTCA helps educate and inform patients about treatments available to them, a greater number, about four in five, agreed “strongly” or “somewhat” that DTCA also encourages patients to seek treatment they don’t need, and more than four in five agreed “strongly” or “somewhat” that DTCA does not provide information on risks and benefits in a balanced manner.

Physicians said male impotence (10.9 percent) led the conditions about which patients asked in the most recent DTCA-related encounter, followed closely by arthritis (10.5 percent), allergies (9.6 percent), and high cholesterol (8.7 percent). Twenty-five percent of DTCA-related visits resulted in a new diagnosis. About 41 percent of conditions initially discussed during the visit and 30 percent of new diagnoses were considered high-priority conditions.

Physicians prescribed the requested DTCA drug in 39.1 percent of the cases, but were just as likely to recommend a lifestyle change (39.1 percent). Other actions included prescribing another drug (22.4 percent), referring to a specialist (5.8 percent), recommending an over-the-counter drug (12.2 percent), and recommending a diagnostic test (9.3 percent).

In the cases when the DTCA drug was prescribed, 46.1 percent of physicians said it was the most effective drug, while 48.4 percent said it was as effective as other medications and wanted to accommodate their patient’s request.

In only 5.5 percent of cases did physicians prescribe the requested drug to accommodate patients’ wishes even if another drug or treatment option would be better. By specialty, only 1 percent of primary care doctors did that, but 10 percent of surgeons and 6.8 percent of other medical specialties had done that, although that may reflect their belief that surgery or other more invasive procedures are superior to drugs in those encounters, the survey said.

When asked about the impact of prescribing a requested DTCA drug on patients’ overall health, 22.6 percent of physicians said it would be a “large positive,” and 53.8 percent said it would be “somewhat positive.” Few said it would be “somewhat” or “large negative” (1.5 percent). Those percentages were largely true no matter if the physicians believed the DTCA drug was the most effective, as effective as, or less effective than other drugs or treatment regimens.

“When evidence exists on appropriateness, drug advertising may produce a social good by reducing underuse,” Weissman says. “On the other hand, in different circumstances drug advertising may encourage overuse of higher-cost drugs among patients who have little to gain. Our research provides further insight into the health and health care effects of DTCA, suggesting possible benefits, although it is by no means conclusive.”

You can read the survey at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.219.

Another paper, by Steven Woloshin and colleagues from Dartmouth, examines whether consumers want and can correctly interpret prescription drug benefit information. The Woloshin paper can be read at
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.234.

In addition to the Weissman and Woloshin papers, the package includes perspectives by Pat Kelly, president of U.S. Pharmaceuticals at Pfizer Inc.’s Pfizer Pharmaceuticals Group; David Riggs, a senior regulatory associate at Eli Lilly and Co., and two colleagues; U.S. Sen. James M. Jeffords (I-VT); U.S. Rep. Henry A. Waxman (D-CA); and Peter Pitts, associate commissioner at the Food and Drug Administration.

The perspectives can be read at the following addresses:

Kelly: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.246.
Riggs: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.249.
Jeffords: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.253.
Waxman: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.256.
Pitts: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.259.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Additional peer-reviewed papers are published weekly online as Health Affairs Web Exclusives at www.healthaffairs.org. Health Affairs Web exclusives are supported in part by a grant from the Commonwealth Fund.

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©2004 Project HOPE–The People-to-People Health Foundation, Inc.