Direct-to-Consumer Advertising: Bad News for Most Patients and Doctors

A recent study of patients and doctors has found that most people in both groups have very negative views about the impact of prescription drug direct-to-consumer (DTC) advertising campaigns, now costing the public — which ultimately pays for the campaigns — about $3 billion a year. The study, published in the Archives of Internal Medicine in February, examined the attitudes of 784 doctors, in Colorado and nationally, and 500 Colorado households about many issues concerning DTC advertising.

At the most general level, 71% of public respondents did not think that DTC advertising is a positive trend in health care. For physicians, an even higher proportion, 90.2%, did not think so. Whereas 42.9 % of physicians, fewer than one-half, thought that DTC advertising made patients better informed about their medical problems, only 28.6% of the public respondents thought it made them better informed.

Only 10.5 % of the public thought that DTC advertising motivated them to seek medical care; 64.4% of physicians thought so. The authors pointed out, however, that unlike an individual patient’s experience, a physician’s experience involves a large number of patients and if any of them would have demonstrably sought health care because of DTC advertising, that doctor would have had the view that the ads encourage the seeking of medical care. Similarly, although only 11.3% of public respondents thought that DTC advertising would change their expectations of their doctors’ prescribing practices, 67% of doctors thought so. Only 13.3% of patients thought that DTC advertising led them to request specific information while 80.7% of doctors thought so.

The answers to more detailed questions were equally interesting. Only 45.2% of doctors and 51.6% of public respondents thought that DTC advertising did a good job of informing about adverse effects. Only 5.1% of doctors and 15.1% of public respondents thought that the ads provided enough information on other treatments. Only 1.3% of physicians and 5.4% of public respondents thought that DTC advertising provided enough information on the costs of the medications and only 3.5% of doctors and 3.2% of public respondents thought that DTC advertising leads to a decrease in cost of medications. Fifty-three percent of public respondents (doctors were not asked this question) thought that it increases the cost of medical care. (see article in this issue entitled “Prescription Drug Ads and High Drug Prices: A Relationship?”).

There were other questions that were asked only of physicians. Whereas only a minority of physicians (23.5%) acknowledged that DTC advertising changes their prescribing practices, if this is true, that translates into an enormous impact on the prescribing of new drugs, very few of which are actually superior or as good as older drugs and most of which are much more expensive than older drugs. Sixty-one percent of physicians also thought that DTC advertising increases overall drug consumption. Consistent with recent data on drastically decreased enforcement by the FDA over prescription drug advertising (an 85% decrease from 1998 through the end of 2003), 68.8% of physicians thought that DTC advertising needs better regulation. As we have said previously, largely unregulated prescription drug ads that all too often overstate the benefits and understate the risks can lead to inappropriate prescriptions that could arguably cause serious injury or even death to patients who would otherwise have gotten a safer and more effective drug.

The World Health Organization, referring, in part, to the expensive and powerful drug promotion campaigns by the pharmaceutical industry, has stated that there is “an inherent conflict of interest between the legitimate business goals of manufacturers and the social, medical and economic needs of providers to select and use drugs in the most rational way.”

The shift toward much more DTC advertising coincides with a tripling of the national spending on pharmaceuticals in the past 10 years. This increased use of DTC advertising comes at a time when, for understandable reasons, patients are demanding a larger and more active role in health care. This role can only be meaningful and actually helpful to the patient if the information that enables more active participation is accurate and unbiased. To place the concept of prescription drug advertising and accurate and unbiased information in the same sentence is a contradiction, and DTC advertising is an exploitation of the notion of empowerment of patients. It is a contradiction that brings to mind the words of Canadian economist Stephen Leacock in his 1924 book on advertising, The Garden of Folly: He defined advertising as “the science of arresting the human intelligence long enough to get money from it.”

What You Can Do

The most important thing for patients or potential patients to do is to pay as little attention to DTC advertising (none would be the healthiest) as possible. We have repeatedly offered the same advice to physicians with the additional advice of not looking at any prescription drug advertising, including that directed only at physicians, nor wasting time meeting with drug salespeople.