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mid the ongoing debate over the wisdom of pharmaceutical advertising, a new analysis suggests that doctors agree more often than not to write prescriptions for patients who have seen drug ads. At the same time, however, the analysis also found that only 1 in 10 consumers were moved by such advertising to ask a doctor for a prescription.

The results present a slightly conflicting picture of the extent to which so-called direct-to-consumer advertising poses an unhealthy dilemma, according to the authors of the analysis, published Tuesday in the Journal of Clinical Psychiatry. While the pharmaceutical industry insists its ads educate consumers, doctors argue some ads too often encourage patients to seek medicines unnecessarily.

“I think the data suggests that, if you take a deep dive, we see a mixed bag,” said Sara Becker, an assistant professor of behavioral and social sciences at Brown University, who coauthored the analysis. “Across the board, consumer requests (for prescriptions in response to drug ads) are not happening all that often. But when it does, it raises prescribing volumes.”

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The analysis arrives as drug ads — which are only permitted in the United States and New Zealand — come under fire as a means by which the pharmaceutical industry promotes expensive medicines that increase health care costs. Ad spending soared more than 60 percent in the last four years, hitting $5.2 billion last year. The American Medical Association has called for a ban, and one Washington lawmaker wants to eliminate advertising tax breaks for drug makers.

Whether such efforts will prompt any changes is uncertain, but they are being raised partly in response to the increasing cost of prescription medicines, a hot-button issue that has angered many Americans. As a result, the virtues of drug advertising — which has been widely debated on and off for many years — are once again being scrutinized.

The latest analysis does have some limitations, though.

In an effort to capture what the researchers considered real-time activity involving patient requests and physician prescribing, they ignored after-the-fact surveys. Instead, they reviewed studies that tracked interactions between patients and doctors at what they called the point of service. However, they found just four studies to analyze, but these had not uniformly explored the topic in the same way.

For instance, one was a randomized, controlled trial that looked only at the effect of advertising on prescribing antidepressants, and actors were hired to role play. The other three were observational studies, including one that examined prescribing a wider variety of medicines in Canada, where drug advertising is not permitted, although many Canadians may well view ads that can be seen in the US.

[UPDATE: It is also worth noting that those three observational studies did not address the extent to which patients may have actually needed medicines for which they sought prescriptions. Becker called this a “big, unanswered question.”]

“Our review doesn’t necessarily suggest that advertising is horrible or great,” said Becker. “Although we’re moderately confident that this tells us there can be competing effects on the quality of treatment quality — both better patient adherence and overprescribing. It may have helped in some cases, but less so in others. But more research is needed.”

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  • Re: Pharm Ads Results

    “a new analysis suggests that doctors agree more often than not to write prescriptions for patients who have seen drug ads. At the same time, however, the analysis also found that only 1 in 10 consumers were moved by such advertising to ask a doctor for a prescription.”

    Very misleading! If “consumers” as used, refers to all consumers of the ads (those who watch them) there is one result, but if it refers to those who watched the ads AND HAD THE TARGETED MALADY, then there is BIG difference.

    I see no reason to be concerned if the former is true, and a lot to be concerned with if the latter hold.

    IMHO pharm ads should be banned!!!!

    • Hi David,

      Thanks for the note and that’s a fair point. As far as I can tell, it doesn’t seem apparent whether any of those folks had one of the maladies that were the subject of ads, although the one trial that hired actors did attempt to cover that base. But I’ve asked the lead author to address this more specifically.

      All best
      ed

    • Hi David,
      Thanks for posting. I agree with you completely the statistic in the first paragraph (and especially the term “consumer”) is lacking important context. The four studies in our review found that less than 10% of patients were requesting advertised medications, but most of the studies did not address what percent of patients actually NEEDED medication. Without that information, we can’t conclude whether the 10% number is too high, too low, or just right. Only one study addressed this issue directly – a clever randomized controlled trial by Kravitz and colleagues had “standardized patients” (or actors) present to doctors’ offices and make requests for antidepressants they had seen advertised. The standardized patients had two different levels of depression severity – depression serious enough to merit a prescription (major depression) or depression not serious enough to merit a prescription (an adjustment disorder with depressed mood). The study found that ALL of the actors who asked for medication were more likely to leave with prescriptions than the actors who didn’t make a request. For those actors with more severe depression, the authors found that the requests for medication resulted in better adherence to treatment guidelines (meaning patients that needed treatment were more likely to get it). On the other hand, for those actors with an adjustment disorder, the authors found that the requests for medication resulted in over prescribing (meaning patients that didn’t need a prescription were more likely to get one). This study in particular supports the title of Ed’s piece that the effects of advertising are a “mixed bag.”
      Thanks for raising this important point!
      Sara

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