|
Physicians have mixed opinions about
consumer-targeted pharmaceutical ads
Ads can improve communication but
may lead patients to seek treatments they do not need
BOSTON - April 28, 2004 - Most physicians responding to a
survey by researchers based at Massachusetts General Hospital (MGH)
indicated that direct-to-consumer advertising (DTCA) of pharmaceuticals
can contribute to better patient education and communication, although
it may also lead patients to seek unnecessary treatments. In their
paper issued online by the journal Health
Affairs, the investigators from the MGH
Institute for Health Policy (MGH IHP) report that patient-initiated
discussions of a DTCA drug were often about high-priority health
conditions and led to prescriptions for that medication in about
two out of five such visits.
"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.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
Information about Clinical Trials
|
|
 |
