Direct-to-consumer advertising and physician practice

One of the more controversial health care issues to emerge during the past decade is direct-to-consumer advertising (DTCA) of prescription drugs. In 1997 the U.S. Food and Drug Administration (FDA) released guidelines that enabled broadcast advertising for drugs. The result was that DTCA more than doubled between 1997 and 2001 – from $1.1 billion to $2.7 billion.

Does DTCA influence physician prescribing when patients requested a drug by name? According to a study in Health Affairs based on a survey of physicians:
 

• Physicians prescribed the requested DTCA drug in 39.1 percent of the cases, but were just as likely to recommend a lifestyle change (39.1 percent).
   
• Other actions doctors took included prescribing another drug (22.4 percent), referring the patients to a specialist (5.8 percent) or recommending a diagnostic test (9.3 percent).
   
• Interestingly, 12.2 percent of the time they recommended an over-the-counter drug.
  
  When the DTCA drug was prescribed:
   
• Some 46.1 percent of physicians said it was the most effective drug, while 48.4 percent said it was as effective as other medications and wanted to accommodate their patient's request.
   
• Patient encounters with the physicians led to new treatment for conditions more than half the time.
  
  The results of the study suggest that while direct-to-consumer advertising (DTCA) may lead to increased drug consumption, it also may have positive effects for patients "that transcend merely prescribing a DTCA drug," according to researchers led by Joel Weissman, an associate professor at Harvard Medical School.
  
  In only 5.5 percent of cases did physicians prescribe the requested drug to accommodate patients' wishes even if another drug or treatment option would be better.
  
  Source: Joel S. Weissman et al., Physicians Report on Patient Encounters Involving Direct-To-Consumer Advertising, Health Affairs, April 28, 2004.
  
  For Health Affairs http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.219
  
  For more on Drug Advertising http://www.ncpa.org/iss/hea/
  
  FMF Policy Bulletin\11 May 2004