Web Exclusive: Consumers' Reports On The Health Effects Of Direct-To-Consumer Drug Advertising

We conducted a national telephone survey about health care experiences associated with direct-to-consumer advertising (DTCA) of prescription drugs. Among the 35 percent of our sample who had a physician visit during which DTCA was discussed, 25 percent received a new diagnosis, of which 43 percent were considered high priority according to authoritative sources. More than half also reported actions taken by their physician other than prescribing the advertised drug. Despite concerns about DTCA’s negative consequences, we found no differences in health effects between patients who took advertised drugs and those who took other prescription drugs. U nt il just a few years ago advertising of prescription drugs was aimed almost exclusively at physicians and other health professionals. Although physician drug detailing (in-person visits by drug company representatives) has been criticized for exerting undue influence on prescribing habits, physicians’ training and experience equip them, at least in theory, to process and evaluate advertisers’ claims and make informed prescribing decisions for their patients. The near-exclusive focus on physicians changed in the late 1990s, when the pharmaceutical industry increased its use of direct-to-consumer advertising (DTCA). Although modest at first, spending on DTCA more than doubled to approximately $2.5 billion in 2000 following the relaxation of regulations from the U.S. Food and Drug Administration (FDA) in 1997. The practice of DTCA is controversial because it operates at the nexus of health W 3 8 2 2 6 F e b r u a r y 2 0 0 3 D a t a W a t c h ©2003 Project HOPE–The People-to-People Health Foundation, Inc. Joel Weissman is an associate professor in the Department of Medicine, Harvard Medical School, where David Blumenthal is a professor. Weissman and Blumenthal are also members of the Department of Health Care Policy, Harvard Medical School, and the Institute for Health Policy, Massachusetts General Hospital, all in Boston. Alvin Silk is the Lincoln Filene Professor Emeritus, Graduate School of Business Administration, Harvard University. Kinga Zapert is vice-president, Health Policy Research, at Harris Interactive in New York City. Michael Newman is a senior research manager there, and Robert Leitman is division president, Health Care. on A uust 7, 2017 by H W T am H ealth A fairs by http://conealthaffairs.org/ D ow nladed fom care and for-profit enterprise. Views on DTCA center on three effects: cost, communication, and health of the public. Critics claim that DTCA raises health care costs by stimulating consumers to demand newer, more expensive drugs, often with high profit margins. Some members of Congress are so concerned about this possibility that they have suggested limiting Medicare beneficiaries’ access to heavily advertised drugs. The pharmaceutical industry rejects arguments that DTCA is inflationary, and while not denying the profit motive, it points out that DTCA serves a patient education function. The industry’s argument is that patients are highly motivated to seek the best available treatment for their condition, and they need and deserve more and better information on which to base their judgments. Some patients may be even more informed than their physicians are regarding particular treatments. DTCA critics take a skeptical view of this claim, fearing that pressure from patients erodes physicians’ authority and may lead to inappropriate prescribing. Others worry that patients are confused by deceptive advertising and that precious time is wasted during physician office visits to discuss minor conditions or cosmetic issues brought to patients’ awareness by ads. Jane Henney, former FDA commissioner, summarized the debate by asking, “Do these advertisements provide consumers with information that empowers them to care for their health, or are they misleading in a way that presents a public health hazard?” There is scant research on the health effects of DTCA. Prior surveys by the FDA and Prevention magazine consider mainly indirect effects of DTCA on health by examining consumers’ understanding of advertisements and patient-doctor interactions. Most Americans are aware of DTCA, and huge numbers are having discussions about advertised drugs with their physicians. However, past investigations have not explored the types of conditions that are discussed with physicians during these conversations, the actions that result from discussions about DTCA between doctors and patients, and the effect, if any, on health outcomes. This paper reports results of a survey of a national sample of consumers who have discussed advertised drugs with their physicians. Our goal was to describe actual health care experiences and outcomes, rather than opinions and attitudes. The underlying assumption was that DTCA stimulates patients to discuss advertised drugs during physician visits and leads to actions taken that result in healthrelated outcomes. Using patients’ reports, our research sought to determine the health-related value (or harm) resulting from these visits. It addressed three questions: (1) What sorts of conditions or problems are discussed during physician visits that include a discussion about an advertised drug? (2) What actions are taken by physicians—including additional tests and treatments—as a result of these visits? (3) Do outcomes of care differ by whether the patient takes the advertised drug that was discussed during the visit or some other drug? D r u g A d s H E A LT H A F F A I R S ~ W e b E x c l u s i v e W 3 8 3 on A uust 7, 2017 by H W T am H ealth A fairs by http://conealthaffairs.org/ D ow nladed fom