Consumers are going to their physicians in record numbers to discuss health problems addressed in ads targeting the general public, and this is a good thing, according to a pharmacy industry spokesperson. However, a critic denies the benefit. Both explain their views in the “controversies” section of a recent issue of The Journal of the American Medical Association (JAMA).

“Pharmaceutical companies have both a right and a responsibility to inform people about their products under the supervision of the FDA, which regulates prescription drug advertising,” writes Alan F. Holmer, J.D., of the Pharmaceutical Research and Manufacturers of America in Washington, D.C.

He adds, “While such advertising prompts more people to seek professional help, it does not dictate the outcome of the physician visit or the kind of help patients eventually receive. Direct-to-consumer (DTC) 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.”

Holmer 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 direct-to-consumer advertising "encouraged a projected 21.2 million consumers to talk with their doctor about a medical condition or illness they had never talked with their doctor about before seeing an advertisement." Holmer adds that as many as 12.1 million consumers received a prescribed drug as a direct result of seeing a DTC advertisement.

“Direct-to-consumer advertising that encourages millions of Americans to consult their physicians can help to improve public health because a number of leading diseases are underdiagnosed and undertreated,” Holmer writes. “For example: an estimated 8 million undiagnosed cases of diabetes exist among adults in the United States; only about 10 million of the 30 million Americans with high cholesterol levels take cholesterol-lowering drugs; only one depressed person in 10 receives adequate medical treatment, and one-third of people with major depression do not seek treatment; millions of Americans are estimated to have undiagnosed high blood pressure.”

FDA Should Consider Stricter Regulations on Drug Ads

Matthew F. Hollon, M.D., from the Department of Medicine at the University of Washington in Seattle, believes the pharmaceutical industry, “driven in part by financial motives, is providing information of suspect quality and thus minimal benefit.”

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

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

Hollon questions the accuracy of claims made in pharmaceutical advertisements. He cites one study in which investigators concluded, “Standards of evidence used to justify advertising claims are inadequate.”

The author adds that providing poor quality information can have costs, which include an increase in expenditures, improper use of drugs and harm from adverse events. Unlike many products, the use of prescription drugs can have serious consequences. For example, the improper use of antibiotics in humans is one of the major factors accelerating antimicrobial resistance, according to Dr. Hollon.

“Neither physicians nor patients are immune to the effects of marketing,” writes Hollon. “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 cautions, “Until well-designed, independent studies based on available observational 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.”

In the early 1980s, the pharmaceutical industry began marketing prescription drugs directly to patients. The Food and Drug Administration imposed a moratorium on this marketing strategy in 1983, then lifted it in 1985.