Published November 5, 2016
One of my favorite movie scenes is from “Die Hard 2” when Bruce Willis, in the character of Lt. John...
— William Wilberforce
Direct-to-consumer (DTC) advertisements are a dime and dozen on American television, Internet and radio these days. The United States and New Zealand are the only countries that allow DTC drug ads and it wasn’t until 1997 that the US Food and Drug Administration (FDA) offered guidance on such advertising.1 Since then, spending in this area quadrupled. In fact, of the tens of billions of dollars the pharmaceutical industry spends on marketing each year, DTC ads accounted for $4.5 billion in 2014—up from $3.8 billion in 2013 and $3.1 billion in 2012.2 3
Further, in 1999, shortly after the DTC ads took off, a survey revealed that approximately 30 percent of patients asked their doctor about the promoted drug and approximately 20 percent requested a prescription.4 DTC marketing is commonly used to push expensive brand-name medications and few people realize its costly impact.
Two studies provide evidence that those “Ask Your Doctor” ads sink in for consumers, and when patients make a request for a specific drug to their physician, they usually get that for which they ask.
Researchers created two videos—one in which actors presented with sciatica that caused back and leg pain and one in which actors presented with chronic knee osteoarthritis. Half of the sciatica patients specifically requested oxycodone and half of the arthritis patients specifically asked for Celebrex based on ads they had seen. The rest of the patients just requested “something to make it better.”
A total of 192 primary care doctors from Illinois, Indiana, Missouri, Massachusetts, New Hampshire and Rhode Island viewed the videos and were asked how they would manage the case and what drugs they may prescribe for treatment.
Among the sciatica patients requesting oxycodone, 19.8% received this prescription. Among those with no specific medication request and the same symptoms, 1 percent received oxycodone.
Among the arthritis patients requesting Celebrex, 53% received this prescription. Among those with no specific medication request, 24% received Celebrex.
“Although patient activation can empower patients for greater participation in health care decision making with their physicians, our findings suggest some potential adverse effects of patient activation,” the study authors wrote. “The medications requested in the clinical scenarios were carefully chosen to be plausible, but potentially undesirable, choices. Although narcotic pain medications can be helpful for short-term pain management, they are generally not recommended for the management of sciatica. Similarly, although non-steroidal anti-inflammatory drugs have a role in the management of knee pain, celecoxib [Celebrex] would be a much more costly therapeutic option than a nonselective cox-2 inhibitor, without additional therapeutic benefit.”5
A second study adds to evidence that when pharmaceutical companies stimulate patient interest in a drug via advertising and the patient makes a request to their doctor, the doctor often complies.
Researchers surveyed 1,891 physicians within seven specialties (i.e., pediatrics, cardiology). Forty-three percent of physicians in practice more than 30 years were willing to prescribe brand-name drugs when a patient requests, even though a generic alternative was available. Thirty-one percent of physicians in practice for 10 years or less acquiesced to specific patient requests.
Significantly more physicians honored patient requests when they had an industry relationship, such as those who received free food and/or beverages in the workplace or free drug samples from the pharmaceutical companies.6
1 World Health Organization. Direct-to-consumer advertising under fire. Bulletin of the World Health Organization, Volume 87. August 2009.
2 PharmaLive and Outcomes LLC. 2014 DTC Ad Spending on the Rise.
3 Pew Charitable Trusts. Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients. Pew Prescription Project. Nov. 11, 2013.
4 Bell RA, Kravitz RL, Wilkes MS. Direct-to-consumer prescription drug advertising and the public. Journal of General Internal Medicine. 1999; 14(11):651-657.
5 McKinlay JB, Trachtenberg F, Marceau LD, et al. Effects of Patient Medication Requests on Physician Prescribing Behavior: Results of A Factorial Experiment. 2014; 52(4):294-299.
6 Campbell EG, Pham-Kanter G, Vogeli C, Iezzoni LI. Physician Acquiescence to Patient Demands for Brand-Name Drugs: Results of a National Survey of Physicians. JAMA Internal Medicine. 2013;173(3): 237-9.