"Fears that direct-to-consumer advertising of pharmaceuticals would lead to overuse of expensive drugs has led to calls for stricter limits on ads, but until now there has been very little information on the effect of DTCA on health or health care, says Joel S. Weissman, PhD, of the MGH IHP, the report's lead author. "This study allowed physicians to report on their actual experiences with DTCA and to say whether they prescribed certain drugs in order to accommodate their patients wishes when other equally effective drugs were available."
Until the mid-1990s, efforts to market prescription drugs were almost exclusively targeted at physicians. Following clarification of Food and Drug Administration regulations in 1997, advertising targeted at consumers has grown radically – more than doubling in the following three years. This increase has been quite controversial, with several individuals and organizations expressing concern that DTCA could lead to inappropriate prescriptions and contribute to rising health care costs. In 2003 the same research team, including colleagues from Harvard University and research firm Harris Interactive, published a study of patient experiences with DTCA, concluding that such advertisements could lead to valuable discussions with physicians and finding no adverse long-term effects.
As a followup, the researchers developed a survey that was mailed to a random, national sample of 1,300 physicians. Respondents were asked about recent visits in which a patient had brought up a medication he or she had seen advertised, including the problems the drug was designed for, whether the patient had that condition, whether the discussion led to a new diagnosis, and whether the DTCA drug or other actions had been prescribed.
They also were asked their overall attitudes about DTCA, reasons why they did or did not prescribe the drug a patient asked about, and whether they predicted a positive or negative outcome for the DTCA drug or other prescribed measures. A total of 642 physicians responded to the survey – 31 percent in primary care, 37 percent medical specialists and 31 percent surgical specialists.
Physician attitudes towards DTCA were mixed: 40 percent said they thought the overall effects on patients and physician practices were positive, 30 percent thought the effects were negative, and 30 percent felt there was no effect. More than 70 percent thought DTCA helped educate patients, and 67 percent thought it led to better physician-patient discussions. However, about 80 percent believed that DTCA does not present balanced health information and that it leads patients to seek unnecessary treatment.
In the recent DTCA visits, survey respondents reported prescribing the asked-about medication only 39 percent of the time. In other instances they may have prescribed another medication or test, suggested lifestyle changes or taken no action. The most frequently cited reason for not prescribing the DTCA drug was that another drug was either more effective or equally effective and less expensive. The conditions discussed at DTCA visits included many considered to be of high priority by the public health community – including arthritis, high cholesterol, diabetes and depression.
The study addressed the possibility that physicians may be influenced by their patients to prescribe DTCA drugs. In instances when the DTCA drug was prescribed, 46 percent of physicians thought it was the most effective option, while 48 percent thought it was as effective as other medications and wanted to accommodate their patient's request. They generally predicted positive outcomes for their patients, although 20 percent thought the DTCA drug would have no effect on overall health. Only 5 percent of respondents reported accommodating a patient's request for a DTCA drug when another treatment would have been more effective, a result that the researchers said was of concern, however small.
Weissman explains, "From a public health perspective, DTCA is a blunt tool – providing much-needed patient education and encouragement to see doctors about important health conditions but possibly leading patients to seek treatment they do not need, according to our survey. Given concerns over the rising cost of health care, we need to learn more about what happens when a patient asks for an advertised drug and how doctors present the tradeoffs between different treatment strategies and their effect on patients' health as well as their pocketbook."
The study was supported by a grant from the American Medical Association-Industry Roundtable Steering Group and members of the Ad Hoc Working Group on the Economics of the Pharmaceutical Industry. Weissman's co-authors are David Blumenthal, MD, director of the MGH IHP; Sandra Feibelmann of the MGH IHP; Alvin Silk, PhD, of Harvard Business School; and Kinga Zapert, PhD, Michael Newman and Robert Leitman of Harris Interactive.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $400 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, medical imaging, neurodegenerative disorders, transplantation biology and photomedicine. In 1994, MGH and Brigham and Women's Hospital joined to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups, and nonacute and home health services.
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