Posted on 04/27/2005 7:47:44 PM PDT by neverdem
Offbeat Study Finds Familiar Brand Name Can Evoke Diagnosis Staff Writers
Actors pretending to be patients with symptoms of stress and fatigue were five times as likely to walk out of doctors' offices with a prescription when they mentioned seeing an ad for the heavily promoted antidepressant Paxil, according an unusual study being published today.
The study employed an elaborate ruse -- sending actors with fake symptoms into 152 doctors' offices to see whether they would get prescriptions. Most who did not report symptoms of depression were not given medications, but when they asked for Paxil, 55 percent were given prescriptions, and 50 percent received diagnoses of depression.
The study adds fuel to the growing controversy over the estimated $4 billion a year the drug industry spends on such advertising. Many public health advocates have long complained about ads showing happy people whose lives were changed by a drug, and now voices in Congress, the Food and Drug Administration and even the pharmaceutical industry are asking whether things have gone too far.
Nearly every industrialized country bans such advertising, and physicians said the new study raises new questions.
"It is a haphazard approach to health promotion that is driven primarily by the pharmaceutical industry's interest in turning a profit," said Matthew F. Hollon, an internist at the University of Washington in Seattle, who wrote an editorial accompanying the study in today's Journal of the American Medical Association. "The most overlooked problem in the health care system today is the extent to which it is permeated by avarice."
Hollon and the researchers who conducted the study said it was not realistic to expect such marketing to be abolished, given the climate of deregulation in Washington. But they said the ads should be tempered by educational messages funded by a tax on...
(Excerpt) Read more at washingtonpost.com ...
Here's the abstract.
Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants
A Randomized Controlled Trial
Richard L. Kravitz, MD, MSPH; Ronald M. Epstein, MD; Mitchell D. Feldman, MD, MPhil; Carol E. Franz, PhD; Rahman Azari, PhD; Michael S. Wilkes, MD, PhD; Ladson Hinton, MD; Peter Franks, MD
JAMA. 2005;293:1995-2002.
Context Direct-to-consumer (DTC) advertising of prescription drugs in the United States is both ubiquitous and controversial. Critics charge that it leads to overprescribing, while proponents counter that it helps avert underuse of effective treatments, especially for conditions that are poorly recognized or stigmatized.
Objective To ascertain the effects of patients’ DTC-related requests on physicians’ initial treatment decisions in patients with depressive symptoms.
Design Randomized trial using standardized patients (SPs). Six SP roles were created by crossing 2 conditions (major depression or adjustment disorder with depressed mood) with 3 request types (brand-specific, general, or none).
Setting Offices of primary care physicians in Sacramento, Calif; San Francisco, Calif; and Rochester, NY, between May 2003 and May 2004.
Participants One hundred fifty-two family physicians and general internists recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%.
Interventions The SPs were randomly assigned to make 298 unannounced visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. The SPs made a brand-specific drug request, a general drug request, or no request (control condition) in approximately one third of visits.
Main Outcome Measures Data on prescribing, mental health referral, and primary care follow-up obtained from SP written reports, visit audiorecordings, chart review, and analysis of written prescriptions and drug samples. The effects of request type on prescribing were evaluated using contingency tables and confirmed in generalized linear mixed models that accounted for clustering and adjusted for site, physician, and visit characteristics.
Results Standardized patient role fidelity was excellent, and the suspicion rate that physicians had seen an SP was 13%. In major depression, rates of antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific, general, and no requests, respectively (P<.001). In adjustment disorder, antidepressant prescribing rates were 55%, 39%, and 10%, respectively (P<.001). The results were confirmed in multivariate models. Minimally acceptable initial care (any combination of an antidepressant, mental health referral, or follow-up within 2 weeks) was offered to 98% of SPs in the major depression role making a general request, 90% of those making a brand-specific request, and 56% of those making no request (P<.001).
Conclusions Patients’ requests have a profound effect on physician prescribing in major depression and adjustment disorder. Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse.
Author Affiliations: Center for Health Services Research in Primary Care (Drs Kravitz, Franz, Azari, Wilkes, Hinton, and Franks) and Departments of Internal Medicine (Drs Kravitz and Wilkes), Statistics (Dr Azari), Psychiatry (Dr Hinton), and Family and Community Medicine (Dr Franks), University of California, Davis, Sacramento; Departments of Family Medicine and Psychiatry and Center to Improve Communication in Health Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (Dr Epstein); Division of General Internal Medicine, Department of Medicine, University of California, San Francisco (Dr Feldman).
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The more the government pushes individual choice and responsibility out of the medical arena the more perverse the outcomes.
OMG, I didn't know this.
I blame doctors for this. They're the ones who need to say no to people. I think the worse is the amount of antibiotics that are prescribed.
The implications are pretty profound... this is why I find pharmaceutical advertising to be extremely unethical - at best. At worst, it could be deadly.
I don't understand. Would you like the government to control the outcome?
You think they don't? It's a classic moral hazard. The workplace healthcare requirements in combination with the government giveaways have hidden the costs of healthcare from individuals. They aren't sheilded from the impact it has their wages stagnating, but since it isn't coming out of their pocket it isn't as easy to identify and correct.
Thats a bit much - I don't get much sympathy when I ask for Vicodin. You have to bleeding from the ears to get pain killers.
As far as SRSS or other psyche drugs - they don't have a lot of serious side effects, certainly not the life-threatening kind. Accounts of increased incidence of suicide are just that - accounts. I am very leery about accepting a causal relationship as the patient pop taking these drugs have a higher incidence of suicidal ideology to begin with.
Pain killers seem to be the one type of drug it's hard to get your hands on. Unless of course you mean the illegal kind, in which case it's very very easy.
Well.....THAT depends...RE: antibiotics.....case in point....ME.....had to see a Rheumatologist because of pain....all over.....his diagnosis (blood tests are NOT conclusive)....I have Rheumatoid Arthritis......told me I'd be paying $10K a year for Humira or similar drugs advertised on TV. I told him I wanted to try antibiotics based on research I had done, and the fact that it could be Lyme disease (I think it is)...or some other infection....(costs me $15 for 2 months worth of antibiotics, and a little more for the 4-6 aspirin I take daily).....he very much did NOT want to do that, but relented......I'm on my way to recovery, based on the fact that I INSISTED on antibiotics....and did NOT buy into the ADVERTISING for Humira. Moral: Caveat emptor. Do your RESEARCH.
You think they don't? It's a classic moral hazard.
Indeed, who should the outcome?
I don't think I should have to buy pills I don't want for people I don't know. I don't ask them to buy me crap.
If they complained of the proper symptoms of a condition and a doctor believed they weren't professional liars, why wouldn't they get prescribed medicine?
Caveat Emptor indeed. Don't buy this study.
bttt
Yup, I always ask my doc for quailudes and vicodins. I say i saw it in a ad and i get 10 extra for mentioning the ads :) /sarc
While I appreciate the value of the experiment--the "patients" have committed both crimes and torts in the hoaxing of doctors.
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