Are Patients Getting The Right Drugs?

Miss Aruba 2007, Carolina Raven, poses for photographers on the runway clad in traditional dress on Reforma Avenue in Mexico City, Sunday, May 20, 2007. Raven will compete for the title of Miss Universe 2007 during the 56th annual Miss Universe competition in Mexico City, on Monday, May 28, 2007. ALFREDO ESTRELLA/AFP/Getty Images

Ask a doctor for a prescription drug you saw advertised on TV, and 69 percent of the time you'll go home with it.

That's what the Food and Drug Administration just discovered in a survey that illustrates how big a role advertising plays in the doctor's office.

Is that necessarily bad? Critics bemoan the findings while proponents say drug ads help more sick people find treatment — but the FDA still is struggling to uncover the true public health impact of the nation's barrage of drug commercials.

"The question is: Are people getting drugs that actually aren't appropriate?" says FDA drug chief Dr. Janet Woodcock.

She doesn't yet know. But the FDA now is studying why doctors prescribe the way they do, a first step toward answering that question. And the agency is considering if some of the rules that govern how powerful medications are advertised need changing to ensure consumers better understand a drug's pros and cons.

It's a complex issue. Doctors have to decide more than yes or no when a patient demands a drug by name. Does the patient expect a miracle because the ad overpromised a pill's benefits? Is there an alternative that works better, more safely or is cheaper? Cheaper drugs typically don't rate a commercial, while the hottest-selling newer drugs — like arthritis treatments Vioxx and Celebrex or heartburn medicine Prilosec — are among the most heavily advertised.

Then there's the trickier question of who an ad targets. The National Medical Association, which represents black doctors, says direct-to-consumer drug ads can prod people reluctant to visit a doctor to do so — especially black Americans, who are less likely to get appropriate care for a host of diseases.

But today's ads aren't living up to that potential, the NMA said this month as it issued what is for a health group a startling call for more drug ads — in media outlets that target minorities, and with more culturally diverse commercials.

How important is advertising to a patient's perception of disease? Consider the middle-aged black woman who looked shocked when NMA member Dr. Sharon Allison-Ottey ordered a test for bone-thinning osteoporosis. "I can't get that — white women get that," the patient said, citing TV commercials and ads in Allison-Ottey's own Baltimore waiting room that featured only white women swallowing pills for the ailment.

Manufacturers once advertised prescription drugs mainly to doctors. Then in 1997, the FDA loosened its drug-promotion rules and suddenly advertising aimed at ordinary people tripled to nearly $2.5 billion a year.

Critics argue the ads encourage patients to badger doctors into prescribing more expensive drugs than they really need, sometimes unnecessary ones, by making a pill seem a panacea while downplaying side effects. Dr. Sidney Wolfe of the consumer advocacy group Public Citizen charges that FDA's efforts to curtail misleading ads has plummeted even as drug advertising climbs, partly because of lack of staff.

The drug industry argues there's a good side, and a recent survey of the National Medical Association's members found many agree. Half of the black physicians said ads can benefit patients by educating them about troublesome symptoms or new treatments developed since they last saw a doctor — even though a third of the doctors admitted they've felt pressure to prescribe a particular brand.

Now the FDA's new survey of 943 people who saw a doctor in the last three months adds to the debate: Only 5 percent said a drug ad spurred them to go to the doctor. Once there, 69 percent who asked for a particular drug got it.

Of those who saw a drug ad in a newspaper or magazine, 41 percent didn't read the required side-effect warnings, calling them hard to understand. Warnings on TV ads apparently were confusing, too: 12 percent recalled hearing what to do if they overdosed, something ads don't discuss.

A consumer survey can't tell if patients got the right or wrong drug thanks to an ad, FDA's Woodcock stresses. Asking for a cholesterol-lowering drug, for example, "might not be a bad health outcome," she notes.

Stay tuned: FDA hopes to shed more light on the controversy by asking 500 doctors about how they prescribe. Results are due this summer.
  • Jaime Holguin

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