Direct-to-consumer pharmaceutical ads may lead to new diagnoses, other physician recommendations

February 26, 2003

Direct-to-consumer advertising (DTCA) of prescription drugs appears to be a powerful source of information that can affect patients' interactions with their physicians, according to a report issued via a special website by the journal Health Affairs. Conducted by researchers from the Institute for Health Policy at Massachusetts General Hospital (MGH) and colleagues from Harvard University and the market research firm Harris Interactive Inc., the study found many patients report that DTCA led to discussions with their physicians and that those conversations had a variety of results. Several patients saw their physicians for important conditions, some visits resulting in new diagnoses. While the design of the study does not allow any firm conclusions about the effect of DTCA on health outcomes, no obvious short-term adverse effects were seen.

Until the mid-1990s, efforts to market prescription drugs were almost exclusively targeted at physicians. Following a relaxation of Food and Drug Administration regulations in 1997, advertising targeted at consumers has grown radically, more than doubling in the following three years.

"There has been a lot of attention paid to the economics of DTCA, particularly its effect on health care costs, but not much to its impact on patient care," says Joel Weissman, PhD, of the MGH Institute of Health Policy, the paper's lead author. "Despite the obvious intent to increase sales of certain drugs, part of the potential of DTCA is its ability to stimulate patient/physician communication, especially around underdiagnosed conditions, and we felt it was important to look at the impact of that. The question still remains whether DTCA is the best way to provide these benefits." Weissman is an associate professor of Medicine and Health Policy at Harvard Medical School.

The research team designed and conducted a national telephone survey of 3,000 adults. The survey was designed to focus on physician visits during which patients discussed concerns prompted by DTCA. Among those responding, 86 percent recalled seeing or hearing a pharmaceutical DTCA in the previous year, and 35 percent reported having a discussion with their doctor as a result of DTCA. The discussions did not focus solely on prescription drugs but also addressed new medical concerns and possible changes in treatment.

One half of patients with a DTCA-prompted discussion addressed an existing condition, and one quarter of them received a new diagnosis, many for significant conditions like high cholesterol, arthritis and diabetes. As a result of these visits, 73 percent of patients received a new prescription not always for medications featured in DTCA. Specialist referrals were made for 33 percent of patients, and others received lab tests or recommendations for lifestyle changes or over-the-counter medications.

Overall, 95 percent of patients with a DTCA-related discussion reported some action being taken by their physician. Patients who received and took a new prescription as directed, reported improvement in their symptoms and overall well being no matter whether the medication was or was not one featured in DTCA.

"We found that DTCA-inspired discussions led to benefits beyond just talking about drugs," says Weissman. "And we were particularly impressed by what we did not find. Contrary to some expectations, the discussions were not focused on lifestyle or cosmetic conditions, and patients did not identify more negative outcomes resulting from DTCA drugs than from other medications. In fact they reported some positive impacts, such as reduced side effects."

The researchers add several cautions about their study. Because patients report many sources of health information, it is not possible to say that the benefits seen here were prompted only by DTCA. In addition, patients who are interested in finding out about and improving their health may be more likely to notice and remember the information in pharmaceutical advertisements. The authors also stress that some of the most controversial aspects of DTCA, whether it leads to increased usage of medications that may be too expensive or inappropriate were not addressed by this survey. The research team has just begun analyzing data from a follow-up survey of physicians on their DTCA-related experiences.
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The report will be available at http://www.healthaffairs.org/WebExclusives/Pharma_Web_Excl_022603.htm after the embargo time.

The study was supported by a grant from the American Medical Association-Industry Roundtable Steering Group and members of the Ad Hoc Working Group on the Economics of the Pharmaceutical Industry. Weissman's co-authors are David Blumenthal, MD, director of the MGH Institute for Health Policy; Alvin Silk, PhD, of Harvard Business School; and Kinga Zapert, PhD, Michael Newman and Robert Leitman of Harris Interactive.

Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $300 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, the MGH joined with Brigham and Women's Hospital to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups and nonacute and home health services.

Massachusetts General Hospital

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