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Consumer Drug Ads May Influence Doctors' Rx Decisions

April 27, 2005
Patients requesting specific medications can have a profound effect on physicians prescribing medications for major depression, according to a new study in the April 27 issue of the Journal of the American Medical Association.

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Critics charge that direct-to-consumer (DTC) advertisements lead to overprescribing of unnecessary, expensive, and potentially harmful medications. Proponents counter that they can serve a useful educational function and encourage patients to treat conditions that may be poorly recognized or highly stigmatized.

The study noted that antidepressant medications consistently rank among the top DTC advertising categories -- with $3.2 billion spent on consumer ads for antidepressants in 2003.

Richard L. Kravitz, M.D., M.S.P.H., from the University of California, Davis, and colleagues conducted a randomized trial using trained actors as standardized patients to determine the effects of patients' DTC-related requests on physicians' initial treatment decisions in patients with depressive symptoms. The patients were middle-aged, white, non-obese women, most with professional acting experience.

They were trained to portray six roles and represented two clinical conditions: symptoms consistent with major depression or adjustment disorder, and three request types: a brand-specific drug request, a general drug request, or no request (control condition).

The scenarios included patients telling their doctor that they had seen an advertisement for Paxil on TV and asked for that drug by name; or patients saying they had watched a program on TV about depression and asking the physician if medication might help them.

The researchers chose Paxil because at the time of the study, it was widely promoted, priced higher than the generic fluoxetine, and available through the participating health care organizations in all three cities. In the control scenario, the patients reported the same symptoms but made no request for medication.

"Antidepressant prescribing rates were highest for visits in which standardized patients made general requests for medication (76 percent), lowest for visits in which standardized patients made no requests for medication (31 percent), and intermediate for visits in which standardized patients made brand-specific requests linked to DTC advertising (53 percent)," the authors found.

"Among standardized patients portraying major depression, paroxetine was rarely prescribed (approximately 3 percent) unless the standardized patient specifically requested Paxil; if Paxil was requested by name, 14 (27 percent) of 51 received Paxil/paroxetine, 13 (26 percent) received an alternative antidepressant, and 24 (47 percent) received no antidepressant," they said.

For standardized patients portraying adjustment disorder, physicians were less likely to prescribe antidepressants.

"These results underscore the idea that patients have substantial influence on physicians and can be active agents in the production of quality," the authors write. "The results also suggest that DTC advertising may have competing effects on quality, potentially averting underuse, while also promoting overuse."

In an accompanying editorial, Matthew F. Hollon, M.D., M.P.H., from the University of Washington, Seattle, writes, "Relying on emotional appeals, most advertisements provide a minimal amount of health information, describe the benefits in vague, qualitative terms, and rarely offer evidence to support claims."

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