Is Prescription Drug Advertising Good or Bad for Patients?

In recent years pharmaceutical companies have taken to the airwaves in force. But some doctors at this year's meeting of the American Medical Association (AMA) want to stop this kind of drug advertising and have introduced a resolution calling for them to be banned.

Interview with Dr. Angelo Agro, the president of the Medical Society of New Jersey (an ear, nose and throat doctor), who is also an AMA delegate and is against the ads.

Can you tell me about the resolution the New Jersey delegation has floated regarding these pharmaceutical ads called direct-to-consumer ads?

Out of the various proposals floating at the conference, the New Jersey resolution is the most radical and calls for the AMA to petition the FDA and the FTC to ban direct-to-consumer pharmaceutical advertising.

I think there are about four other resolutions, each of which takes a bit of a different approach to the problem. But the fact that at least five states think that something has to be done tells us we are on the right track. We took a radical stand, primarily to encourage debate and to bring our concerns to the front burner.

The AMA does have a policy that says it continues to work and follow the FDA on this matter to ensure balance and accurate ads, etcetera, but over the past year or so it seems to us that things are getting out of hand.

Any particular ads that get you crazy?

I won't name names, but there is an antihistamine that is the focus of one ad and the ad says this is good for both indoor and outdoor allergies. Guess what? That is no more special than other antihistamines. The biology is the same. But by saying that, the ad has some greater power, some newer advantage, that borders on deceptive--and then making it out to be more than it really is confuses the public, makes them look at other, less-expensive brands less favorably for no good reason.

But isn't it good that people are attempting to be proactive about their health?

Yes, and we in medicine in general have to come to grips with the fact that the public will ultimately take a greater part in determining and exploring their care. The Internet has already been a major influence on this, and the more that managed-care companies keep pulling back treatment options, the more patients have to be proactive and make more decisions for themselves.

We feel that often patients make their decision based on biased and incorrect information that is limited or poor, such as these ads, and then that puts them in a position where they can become confused and even more poorly informed. Unfortunately, these ads are a case of where a little bit of knowledge can be a dangerous thing.

The bottom line to remember is that, truly, the most impartial and personal advice a patient can get regarding what will be good for your condition comes from your doctors, not an ad.

Is that really true? What about when doctors may be limited to what thecan prescribe because of the HMO the patient is in? Is that, therefore, all the more reason for a patient to demand a certain drug?

Listen: What most people are asking for is the latest that is being advertised. Well, those are the drugs that are the most expensive because they are still in pending patent mode. They have the highest prices because the patent is not yet passed and it can't be made into a generic, which will happen eventually. So, by asking for the highest-priced new drug, the patient is also causing everyone's healthcare costs to rise, which feeds into limitations by care companies.

Also, remember, oftentimes things like allergies can be treated without drugs at all and that is also lost in the ad wars.

Explain to me about how some doctors complain that these ads undermine the doctor's credibility.

It is more that these drugs undermine the doctor-patient relationship. They erode it when they set the physician's role of managing care versuwhat the patients think they should be having simply because they saw an ad they liked.

We just feel that the 15- to 60-second commercial has two characteristics: It is by necessity biased and that is just not enough time to present a fair, balanced view of the drug. I mean, the disclosures at the end go by so fast: Who can take those in? But the ads are good, and leave you thinking they [the drugs advertised] are just great.

But the FDA screens them, each and every one, so how can they be biased?

Yes, they are considered balanced because there is that disclaimer at the end. All the warnings are either listed or read out in a list quickly. But, after a while the general public tends to be so numb to those that they do not pay too much attention. So what comes through is that Brand X is simply marvelous--not that long list with side effects that is read out quickly at the end. That is not balance.

Finally, people will be watching this: What is your message to our viewers?

Please be aware of alternatives to what is being advertised, equally good but less expensive drugs, nondrug therapies. Be aware of the fact that you are not seeing all the alternatives in those ads and please talk to your physician about your specific needs. Beware of your own self-diagnosis: Just because you think you need Allegra does not necessarily mean that you do. That's why the professional should be involved. So, go ahead and listen to the ads, but there is a lot not being said, and you have to find out before you simply decide on it if it is what you really should be taking, so listen to your doctor.

Interview with Dr. Richard Dolinar, who is not opposed to drug advertising

What do you say to one of the leading concerns expressed by the AMA--that these ads leave consumers inadequately educated and demanding a drug that they do not need or that may not be quite the right one for the medical complaint being expressed?

think the educated patient is the best patient to work with. For example, I specialize in diabetes and I have patients coming in educating themselves about options in insulin treatment and being aware of new drugs and wanting to know if those drugs are available and good for them. That's great. I know they are being proactive and it benefits the doctor-patient relationship.

But the AMA is not talking about the educated consumer, but perhaps the not-so-well-medically-educated consumer who is demanding that, which may be incorrect, or who may be deluded into thinking the drug in the ad will fix all their ills.

Look, there is something bigger going on here. One has to realize that the doctor-patient relationship is changing dramatically and has already changed when it comes to managed care environments.

Historically, the doctor has been the patient advocate, but now, with managed care, unfortunately the doctor is the patient's adversary in that kind of situation. You do need educated patients. Patients have to be their own advocates in order to demand care in healthcare systems that fight them for it. We all have heard the stories from the HMO wars. The better educated the patient, the better chance they have to get care.

Let me give you one example. A few years ago, a new diabetes pill came out that allowed some diabetics on insulin to stop taking their insulin shots and to instead just take the pill to manage their disease. I lectured a managed care association on the drug but what I found out from those HMO doctors was that this drug was not in the choices they were allowed to prescribe.

In other words, if those doctors wrote out a prescription for the new drug, then their own pay was docked, or reimbursements from the HMO. In other words, the way they pay for their office, workers, rent, etcetera.

In a situation like that, how many doctors are really in a position to step up and say to a patient: You don' t have to take insulin hots. I have this pill instead. A lot of doctors are in a bind. So that is what I mean about doctors being put in position to be a patient's adversary.

And frankly, we are seeing a world where patients do realize more and more that they need to be educated to get the best care for themselves, which is a good thing considering what some are up against in some insurance plans.

But again, I don't think the AMA is against an educated consumer, but more the fact that these ads do not fully educate, leave people with incomplete education. I mean, we are talking about commercials, not a lecture.

I am a member of the AMA myself, I just could not make it to this year's meeting and I appreciate the AMA delegates' concern. But, as far as being incomplete, you know those ads are filtered through the FDA, which is far better than the unregulated Internet ads or unregulated information being bandied about on the street.

But the most important point is that often these ads brig people into the doctor's office, which gives the doctor the opportunity to assess the patient demanding a certain drug--find out exactly what is wrong with the patient, and then provide the appropriate treatment. These ads help bring in the undertreated and those that have not come in for diagnosis before.

The AMA has also brought up the issue that these ads, in some cases, seem to reduce a doctor's credibility?

I think the real issue is this: In a managed care or an HMO setting that particular doctor's paycheck is at risk. If he has a patient demanding a drug, that doctor is finding it uncomfortable to say no. In other words, there might be a generic drug that the HMO will pay for but not the newly advertised one and if that doctor prescribes the new "ad" one, and then his paycheck is impacted. No one likes being in that position.

Often in HMOs, if the doctor orders this brand new drug the HMO may make him take a financial hit for it. The financial incentive is not there.

Do you have a message to consumers about these ads?

This allows for health information to be imparted to the public, the ads have been filtered through the FDA, and I think the information helps stimulate patients to come in and talk to their doctor about health options and what are appropriate drugs for their needs.

Many times, I have type 1 diabetes patients who come in demanding the new pill that he saw on TV, and I have to explain to them that it does not work for type 1 diabetes, but only other types. They cannot have it and have to continue with insulin shots. That is not undermining my credibility, but is a situation that can improve a doctor-patient relationship.
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