Direct-to-Consumer Ads Get Patients to Act

The survey was conducted by a team of researchers from Harvard University, Massachusetts General Hospital, and Harris Interactive. Telephone interviews with a national probability sample of 3,000 adults were conducted between July 2001 and January 2002 using random-digit dialing and random household-member selection. A $10 incentive was offered for completion of the survey, and a toll-free number was offered so that respondents could complete the survey at a convenient time. The response rate was 53 percent.

Approximately 86 percent of the sample had seen or heard a direct-to-consumer ad in the previous year, and about 35 percent of the sample had a physician visit during which direct-to-consumer advertising was discussed. Twenty-five percent of the sample received a new diagnosis, and more than half also reported actions taken by their physician other than prescribing the advertised drug.

The most common new diagnoses were allergies (9 percent), high cholesterol (6 percent), arthritis (6 percent), hypertension (6 percent), diabetes (5 percent), and depression (5 percent).

Much criticism of DTCA has been directed at its possible impact on health care costs generally, while reaping windfall profits for the pharmaceutical industry.

Leitman acknowledged that the survey did not address such cost-related issues. “What we did find is that there wasn’t a lot of trivial activity [generated by DTCA],” he said. “Diabetes, depression, high-blood pressure, high cholesterol—these are high-priority conditions. What don’t appear on the list are trivial diagnoses like hair replacement.”

The survey article was accompanied in the journal by several others, including one by Thomas Bodenheimer, M.D., whose article called the survey “little more than an advertisement for drug advertisements.”

Bodenheimer criticized the study methods for what he called overinterpretation of patient responses and for the failure to include a control group of patients who had not seen drug advertising.

But Bodenheimer was especially critical of the survey for failing to ask respondents about the cost of drugs—the subject that he called “the expensive elephant in the living room.”

Noting the steadily rising cost of prescription drugs, Bodenheimer said that between 1997 and 2000, 28 percent of the increase in drug spending “resulted from newer, higher-priced drugs that were replacing older, less-costly drugs, and 48 percent came from the increasing number of prescriptions written.”

He added, “TV drug advertising is a strategy used by the pharmaceutical industry that covers up the astounding statistic that over the past 10 years, only 15 percent of the newer, expensive drugs arriving on the market offer significant improvements over already existing, lower-price medications.”

Leitman told Psychiatric News that the effects of DTCA may ultimately boil down to a question of medical ethics.

“If people get diagnosed earlier than they might have and if the condition is important, does it have an impact on cost?” Leitman asked. “I would say we haven’t done the math. If the condition were diagnosed later, it might cost more. And if the condition is diagnosed earlier and it costs more, what we have is a question of medical ethics: Is it a good and desirable expense? An argument can be made that it is a good expense.”