Who has gone a day without seeing at least one advertisement for drugs or medical devices? These advertisements are part of almost every commercial break during primetime television. It’s big revenue for the stations and a major marketing strategy for the drug companies, who spent more than $3 billion on TV ads in 2012.
The U.S. and New Zealand are the only two countries that allow direct-to-consumer advertising (DTCA). FDA could do much more to regulate these ads to protect consumers. For instance, many consumer advocacy organizations like Community Catalyst have called for the FDA to start pre-reviewing ads before they’re released to the public to make sure they present information accurately. While FDA does have a Bad Ad Program to educate health care professionals about their role in reporting drug ads that are misleading, untruthful, or unbalanced, such monitoring occurs after these ads have already aired and done their damage.
Drug companies claim such ads are just a way to initiate conversations between doctors and patients. While DTC ads might start such conversations, these conversations often lead to the doctor agreeing to give patients a drug they ask for. Indeed, in a new study of simulated prescribing, 53 percent of patients with osteoarthritis who asked for Celebrex were prescribed the drug. However, Celebrex was prescribed to only 24 percent of participants who didn’t ask for a specific drug. Also, 19.8 percent of sciatica patients who requested oxycodone received a prescription for it, compared with just 1 percent of those making no specific request. Why is this a problem? Narcotics are not recommended for sciatica, and Celebrex is far more expensive ($200/month) than equally effective medications like ibuprofen ($7).
Why do doctors so frequently respond to such patient requests when the drugs may not be the best choice? This may be due, in part, to the fact that drug companies market the same products even more heavily to doctors than they do to patients. According to the Pew Charitable Trusts, drug companies spent over $24 billion in 2012 alone on marketing to physicians. This money has clearly not been wasted. A study from last year that surveyed 3,500 physicians, showed doctors who received food, beverages, or samples from the pharmaceutical industry or met with industry representatives were significantly more likely to acquiesce to patient demands for brand name drugs. This was found to be true even when a generic was available. Doctors in solo or two-person practices were more likely to acquiesce than those working in hospitals or medical schools-organizations that can provide more physician education and controls over prescribing.
Doctors may also respond to patient prescription demands because their income rests on patient satisfaction ratings. Although it wasn’t one of their major findings, the results of the Celebrex study showed that certain pressures on doctors, such as a high caseload or how patient ratings, can affect prescribing habits. If doctors are stretched thin and their salaries are determined by patient ratings of their care satisfaction, it seems logical doctors might be tempted to prescribe drugs to keep patients happy. Doctors may choose expensive drugs even when lower-cost, equally effective alternative drugs are available because both DTC ads and marketing pitches can overstate the benefits of drugs, while understating the side effects.
Patients should have the opportunity to communicate with their clinicians about their preferences—often called “shared decision-making” (SDM)—as this can improve health outcomes. However, industry marketing and lack of physician and patient education threatens to subvert this important process. Patients come to their doctor influenced by ads to request drugs that place an unnecessary burden on their wallets and can undermine their health.
To put shared decision-making on a solid footing, we need better oversight of drug marketing and more education of both patients and doctors. Patients need trusted sources of information to help them sort out which medications they really need to take and which are most affordable. Resources like Consumer Reports Best Buy Drugs and goodrx.com can help. Doctors also need to use the best, unbiased evidence when advising patients and should be trained in shared decision making; SDM is not currently emphasized in medical school curricula. Through such discussions, doctors can fully inform patients of the risks and benefits of the drugs they request, so that patients in turn can be empowered to state their values and ultimately collaborate in making the best decisions about their care.