Physicians 1, Drug-Makers 0

A shift in consumer drug ads is bringing a new dimension to patient care. Is the new way the old way?

The battle between drug-makers and consumer advocates over direct-to-consumer (DTC) advertisements has been churning since 1997, when the FDA eased its ban on them.

Drug companies say DTC ads alert patients to medical conditions that might otherwise go unnoticed, urging people to seek treatment. Consumer advocates complain that the ads drive unnecessary usage of the healthcare system, inflate national medical costs, and detract from better patient care.

Moreover, they say, notwithstanding the ads' exhortations to "ask your doctor," they are in fact a way "to [circumvent] ... physicians," as one marketing executive put it - reducing your leverage in deciding which drugs to prescribe.

You know the routine. Patients bring drug ads to your office and ask for a drug by name. And when so much of your success is based on patient satisfaction, there's pressure to accede to requests for specific medicines.

"Given a choice between spending 15 minutes to educate the patients, or one minute to write a prescription, many physicians are writing the prescription," says Michael Wilkes, MD, PhD, a University of California, Davis, researcher. In an article in the Journal of the American Medical Association earlier this year, Wilkes found that for patients with depression, physicians' prescribing patterns are directly tied to patient demand, and may not always be supported by medical need.

The amount spent on DTC advertising has exploded: from the late '90s through last year, expenditures went from $791 million to approximately $4 billion, according to industry accounts.

And the ads work. The average number of prescriptions written per person has increased annually since 1997.

But as the volume of DTC ads grew, so did complaints: the ads minimize risks and overemphasize benefits, some said; others wondered why their children were seeing ads for erectile dysfunction (ED) during halftime of the Super Bowl.

Meanwhile, as the audience watching network television news declined, so too did the ads' power. For example, drug-makers spent $400 million last year promoting their ED medications, but sold only $100 million worth of medicine.

The drug-makers have also been hit hard by juries, which have awarded hundreds of millions of dollars in damages to plaintiffs who claim to have been injured by the likes of Vioxx and Celebrex. Those two drugs, for which their manufacturers spent $189 million in DTC advertising, were pulled from the market following claims that they endanger patients.

Undoubtedly such claims surprised patients who had urged their doctors to prescribe the medicines. Were they really safe? How to evaluate the risks? Patients were in a quandary; their physicians were no better off.

Questions also mounted about the ads themselves, putting the industry on the defensive. Jockeying then started among the politicians. Sen. Bill Frist (R-Tenn.), the Senate Majority Leader and a physician, pushed for a two-year waiting period on DTC advertising for new drugs.

Other lawmakers went further, proposing increased authority and budgets for the FDA. Meanwhile, opinion polls showed the public supported limited but mandatory bans on DTC promotions for new drugs.

The industry responded by proposing a series of guidelines for consumer drug advertising, including voluntary bans - of an unstated timeframe - on new medicines.

Any of these proposals would be a step in the right direction, because they would enhance the power of physicians in determining patient care. Any DTC ad ban means patients who obtained information primarily through advertising will need a new source - you. As it should be.

How has direct-to-consumer advertising affected your practice? Would patients and physicians be better off if there were fewer ads aimed at consumers? Write to me at karpay@physicianspractice.com. The views expressed here are my own, and do not necessarily reflect those of Physicians Practice.

This article originally appeared in the October 2005 issue of Physicians Practice.