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Direct-to-consumer drug ads losing their punch

Watching TV news could make you think America faces a crisis of irritable bowels, malfunctioning genitals and insomnia. The pharmaceutical industry spends billions of dollars each year to make sure you know about these, and other, conditions.

But a new study appears to show that all those direct-to-consumer ads for prescription drugs to treat such conditions have much less effectthan previously thought, a finding that could be bad news for pharmaceutical companies and the media outlets with which they advertise.

Only 3.5 percent of patient visits to a group of Colorado doctors’ offices and public health clinics included a patient request for a prescription for a specific drug, says the study, published in the Annals of Family Medicine. This was about half the rate reported in a somewhat comparable study from 2003.

The marketing of prescription medications has been controversial since 1997, when the government loosened restrictions on drug ads. Prescription drug advertising, allowed only in the United States and New Zealand, has exploded in the years since. It now tops $5 billion annually, according to a report by TNS Media Intelligence, a marketing research firm, though spending began falling off in 2007.

Debate about the practice has exploded, too. Drug companies argue that advertising medications provides an important public health service by alerting consumers to potentially undiagnosed, or undertreated, disorders. Some doctors and health advocates, on the other hand, argue that ads entice patients to insist on unnecessary or ineffective drugs and to forgo healthy lifestyle changes that might obviate the need for drugs in the first place.

The new study supports both sides.

Twenty-two primary care practices in Colorado participated. The researchers surveyed 1,647 “patient encounters” — appointments. During those appointments, 58 patients, or 3.5 percent, asked about obtaining a prescription for a specific drug. When the data was sifted to include only queries about specific drugs that had been advertised in recent years, the number fell to 43, or 2.6 percent.

Requested drugs not docs' first choice

Importantly, when a patient did ask about a specific drug, that drug was usually not the doctor’s first choice of treatment. “Nevertheless,” the study found, “the physician prescribed the [requested] medication about one-half the time.”

This does not necessarily mean doctors are caving in and practicing bad medicine, said Dr. Richard Kravitz, a professor and vice-chair of research in the Department of Internal Medicine at the University of California Davis, and an investigator on the 2003 study.

“It might be bad if it is more costly, but it is not as bad clinically as it sounds,” Kravitz explained. “A lot of decisions in medicine have no clear right or wrong.”

Indeed, doctors in the new study described the “overall effect of the patient request as neutral or positive in 90 percent of the visits.”

The study’s lead author, Dr. Bennett Parnes, an associate professor of family medicine at the University of Colorado School of Medicine, described the results as surprising. “It is not the dreaded event where you have to deal with a patient who wants medications the provider does not want to prescribe. It is just not happening that much.”

Half the time there was a specific patient drug request, Parnes said, a new condition was identified and there was “some patient education going on. That’s not a bad thing.”

But Dr. Lisa Schwartz, an associate professor of medicine at Dartmouth Medical School who has long studied consumer drug advertising, isn’t persuaded. She pointed out that the Parnes study population, which included a number of community health centers serving a low-income population, may not be the best measure. Such health centers often have limited drug choices, and the patients may not have have had as much exposure to drug ads.

“(That) makes it hard to make strong inferences that direct-to-consumer advertising does not work,” Schwartz said.

Worrying about frequency of requests may miss the point, she said. It may be more important to know if consumers who do request a drug truly understand what they’re asking for. Many ads, she argued, do not include enough information on how well drugs work.

“If it is supposed to be educational for consumers, why doesn’t the ad contain that piece of information?" she said.

The sleep drug Lunesta, for example, advertised with a gentle moth floating in through a bedroom window, gets patients to sleep 15 minutes faster after six months of treatment and provides 37 minutes more sleep per night. Patients ought to have that information, she said, to help judge whether the cost is justified.

Skepticism about ads may be growing

Parnes speculated that if the rate of requests for drugs is falling, it could be because Americans and their doctors have become inured to drug advertising. “Clinicians 10 years ago may have been shocked by a patient asking, but now they are comfortable with hearing it and responding to it and patients overall are more empowered than 10 years ago.”

Plus, in the wake of recalls for drugs like Vioxx, Americans may be more skeptical of what they see advertised, he said. 

Kravitz, who has done studies showing higher request rates than Parnes’ work demonstrates, remains suspicious of a general drop. He agreed with Parnes that the nature of the ads themselves has changed. There are more ads for extremely expensive drugs like Humira, a medication for rheumatoid arthritis, and for less common conditions, he said. Both could limit requests.

The new research is not likely to quell calls to ban drug ads. In 2007, Dr. Kurt Stange, the editor of the Annals of Family Medicine, declared it “time to ban direct-to-consumer advertising of prescriptiondrugs” because such ads “provide biased educational material and emotional appeals that promote drugs over healthy alternatives.”

Of course, those are claims the industry vigorously disputes.

Regulated by the federal Food and Drug Administration, direct-to-consumer advertising “increases people’s awareness of disease and available treatments,” according to online guidelines from the Pharmaceutical Research and Manufacturers of America, a drugmakers’ trade group. Because of the advertising, patients may be more likely to talk to their doctors, PhRMA contends.

“It fosters an informed conversation about health, disease and treatments between patients and their health care practitioners,” the guidelines suggest.