In JAMA article, UW senior fellow calls for more controls on prescription drug ads

The “controversies” section of the Jan. 27 issue of the Journal of the American Medical Association (JAMA) focuses on the question of whether consumer ads for prescription drugs are providing useful information. One of the two articles included is written by Dr. Matthew Hollon, a senior fellow in the UW Department of Medicine, who calls on the federal Food and Drug Administration to consider stricter controls on “direct-to-consumer” ads.

After many years of directing advertising for prescription drugs toward physicians, the pharmaceutical industry began marketing these drugs directly to patients in the early 1980s, according to the Journal. The Food and Drug Administration imposed a moratorium on this marketing strategy in 1983, and then lifted it in 1985. Prescription drug ads on television, as well as in magazines, are now common.

And studies indicate that people who see the ads are going to their physicians in record numbers to discuss the health problems mentioned.

Alan Holmer, an attorney for the Pharmaceutical Research and Manufacturers of America in Washington, D.C., writes the article supporting the value of the direct-to-consumer ads.

“While such advertising prompts more people to seek professional help,” Holmer writes, “it does not dictate the outcome of the physician visit or the kind of help patients eventually receive. Direct-to-consumer advertising merely motivates patients to learn more about medical conditions and treatment options and to consult their physician. Once the dialogue is started, the physician’s role is pre-eminent.”

He cites a 1998 survey in Prevention magazine that found more than 53 million consumers have talked to their physicians about a medicine they saw advertised. An additional 49 million sought information from another source, such as the Internet, and approximately 21 million talked to their doctors for the first time about conditions they saw in ads. Holmer noted that as many as 12.1 million consumers received a prescribed drug as a result of seeing a direct-to-consumer ad.

He concludes that direct advertising, when it leads people to consult their physicians, can improve public health because millions of people have diseases or conditions that have not yet been diagnosed or adequately treated.

In his article urging more scrutiny and stricter controls for prescription drug ads, the UW’s Hollon writes that the pharmaceutical industry, “driven in part by financial motives, is providing information of suspect quality and thus minimal benefit.”

Hollon claims that the discussions between patients and physicians precipitated by these ads place pressure on physicians to prescribe that drug, citing a study reporting that prescriptions for some drugs were written “at a rate far greater than that warrented by scientific evidence of their effectiveness,” often due to patient demand for those specific drugs.

He also cites a study from 1992 in which physicians reported that 88 percent of patients asked for a drug by brand name, up from 45 percent in 1989. “At the same time,” Hollon writes, “a survey revealed that 63 percent of consumers do not believe they can tell if they are being misled by advertisements for prescription drugs.”

“Neither physicians nor patients are immune to the effects of marketing,” he notes. “However, while physicians are not immune, their education and knowledge presumably make them more competent than consumers in interpreting promotional material for prescription drugs. Additionally, unlike consumers who hear of just one drug, physicians are capable of offering sound advice to patients about a range of therapeutic options.”

Hollon concludes that “Until well-designed, independent studies based on available observtional data prove the information from direct-to-consumer marketing has public health value and desirable effects, the FDA should consider stricter—not more permissive—regulations.” ¶