Study: Advertising Can Influence What Doctors Prescribe

Patients requesting drugs they have seen advertised have an effect on what doctors prescribe for major depression, according to a new study that used actresses to get prescriptions from doctors in three cities.

Overall, 53 percent of “patients” who made brand-specific requests linked to direct-to-consumer advertising got a prescription for an anti-depressant, compared to 31 percent of those who made no request and 76 percent who made general requests for medication.

While the results underscore the notion that patients have substantial influence on what physicians do for them, they also “suggest that (direct-to-consumer) advertising may have competing effects on quality, potentially averting underuse, while also promoting overuse,” according to researchers led by Dr. Richard Kravitz of the University of California-Davis.

The researchers trained actresses _ middle-aged white women, most with professional theater experience _ to pose as patients for 298 visits made to 152 primary-care doctors and internists in offices in Rochester, N.Y., and the California cities of Sacramento and San Francisco.

The women secretly voice-recorded their encounters with doctors, who had already agreed to take part in a study in which patients would come in with a “combination of common symptoms” over the course of a year. After the visits, doctors were debriefed and then gave permission to use information from the visits.

Patients were assigned to portray either someone suffering from major depression of moderate severity or an adjustment disorder with depressed mood. They were also instructed to either request a particular drug _ Paxil, widely promoted when the study was done in 2003 and 2004 _ make a general request for medication or mention no medicine at all.

With the women pretending to have major depression, doctors prescribed antidepressants 53 percent of the time when Paxil was sought; 76 percent of the time when the patient made a general request for drugs based on having seen a special TV segment on depression; and 31 percent of the time when no request for drugs had been made.

Patients who portrayed the less-serious adjustment disorder received roughly the same response when specifically requesting Paxil (55 percent), but significantly fewer prescriptions when asking for any drug (39 percent) or no drug at all (10 percent).

“Drug ads are one way of getting patients to prompt their physicians, but it is not the best way,” said Dr. Ronald Epstein, a professor at the University of Rochester Medical Center in New York and co-author of the study, published Wednesday in The Journal of the American Medical Association.

“When patients brought up non-commercial information, they were more likely to get the correct treatment than if they brought up the drug advertisement,” Epstein added.

The researchers note that consumer drug advertising in the United States topped $3.2 billion in 2003. Their results “sound a cautionary note for direct-to-consumer advertising, but also highlight opportunities for improving care of depression and perhaps other conditions by using public media channels to improve (patient) involvement in care.”

In an accompanying editorial, Dr. Matthew Holton of the University of Washington said that most drug ads “provide a minimal amount of health information, describe the benefits in vague, qualitative terms and rarely offer evidence to support claims.”

He said that while it is unlikely the federal Food and Drug Administration will restrict the ads, the agency should set up better standards to ensure the content is educational and that marketing should be restricted or banned for new drugs until they’ve been on the market a few years and the FDA can be confident of the long-term safety of the pharmaceuticals.

On the Net: www.jama.com

(Contact Lee Bowman at BowmanL(at)SHNS.com. Distributed by Scripps Howard News Service, http://www.shns.com)

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