Prescriptions More Likely When Patients Mention Specific Drugs From Advertisements, Study Finds
Actors who posed as patients with symptoms of stress and fatigue were five times as likely to be given a prescription for an antidepressant if they mentioned television ads about GlaxoSmithKline's antidepressant Paxil, according to a study published Wednesday in the Journal of the American Medical Association, the Washington Post reports (Vedantam/Kaufman, Washington Post, 4/27). In the study -- led by Richard Kravitz, a University of California-Davis professor of medicine -- middle-aged white women posed as patients for 298 visits to 152 primary-care physicians and internists in three cities during 2003 and 2004 (Bowman, Scripps Howard/Detroit News, 4/27).
The doctors previously had agreed to participate in a study "assessing social influences on practice" and were told they would receive two undercover visits several months apart. In one script, the actors played the role of a 45-year-old divorcee who had just lost her job and was experiencing stress, fatigue and back pain -- symptoms of an adjustment disorder that usually can be treated without medication. In another scenario, the actors posed as a 48-year-old divorcee who had feelings of sadness for one month, did not sleep well, had appetite loss and lost interest in usual activities -- symptoms of a major depressive disorder.
Some of the actors said, "I saw this ad on TV the other night. It was about Paxil. Some things about the ad really struck me. I was wondering if you thought Paxil might help me." Others said, "I was watching this TV program the other night. It really got me thinking. I was wondering if you thought a medicine might help me." Other actors made no mention of TV advertisements or specific medications. Visits were recorded on a mini-disc in the actors' purses (Zarembo, Los Angeles Times, 4/27).
The study found that:
- Most actors who did not demonstrate symptoms of depression were not given a prescription;
- Actors who asked for Paxil received a prescription 55% of the time and half of the time they were diagnosed as depressed (Washington Post, 4/27);
- Actors who displayed the symptoms of major depression and requested to be prescribed Paxil were given antidepressants 53% of the time. Paxil was the drug prescribed in 27% of those instances;
- Actors who requested a prescription but did not mention a specific drug received a prescription 76% of the time; and
- Actors who did not specifically request a prescription received one in 31% of cases (Reuters/Wall Street Journal, 4/27).
In addition, actors who mentioned the Paxil ad received appropriate treatment for depression -- a prescription, a referral to a mental health specialist or a follow-up visit in two weeks -- 90% of the time, while actors who did not mention the Paxil ad received appropriate treatment in 56% of the cases. Kravitz said the best care for patients with a major depressive disorder or adjustment disorder occurred when the actors mentioned antidepressants but did not name a specific drug (Los Angeles Times, 4/27).
According to the report, "These results underscore the idea that patients have substantial influence on physicians. ... The results also suggest that direct-to-consumer advertising may have competing effects of quality, potentially averting underuse (by making people aware of drugs) while also promoting overuse." The study states that its findings should "sound a cautionary note for [DTC] advertising but also highlight opportunities for improving care of depression (and perhaps other chronic conditions) by using public media channels to expand patient involvement in care" (Reuters/Wall Street Journal, 4/27).
In an accompanying JAMA editorial, Matthew Hollon, an internist at the University of Washington, wrote, "It is a haphazard approach to health promotion that is driven primarily by the pharmaceutical industry's interest in turning a profit. The most overlooked problem in the health care system today is the extent to which it is permeated by avarice." Hollon wrote that 80% of physicians believe that patients request medications they do not need because of DTC ads and that 10% of physicians believe DTC ads are a positive influence.
Hollon and researchers who conducted the study suggested that DTC ads be "tempered" by improved physician training and public service announcements funded by a tax on the pharmaceutical industry, the Post reports. Hollon and researchers also recommended considering a ban on ads for new drugs until their risks are fully documented.
Billy Tauzin, president and CEO of the Pharmaceutical Research and Manufacturers of America, said, "We can do a much better job with the advertising. The ads can do a great job making sure people who need medications and are undertreated get help. We can also make it clear that a particular product is meant for people with this particular problem and for those people only." Tauzin said pharmaceutical companies are working to develop a code of conduct for DTC ads that will be an improvement upon federal legislation.
Nancy Leone, a spokesperson for GSK, said it was "difficult to draw conclusions" about the study because Paxil was not marketed extensively during the study period. She said that doctors are not overly influenced by ads and that such "education campaigns" do not lead to inappropriate prescribing (Washington Post, 4/27). An abstract of the study is available online.