Wednesday, April 27, 2005
This week's edition of the Journal of the American Medical Association contains an article entitled, " Influence of Patients' Requests for Direct-to-Consumer Advertised Antidepressants: A Randomized Controlled Trial" by Richard L. Kravitz; Ronald M. Epstein; Mitchell D. Feldman; Carol E. Franz; Rahman Azari; Michael S. Wilkes; Ladson Hinton; Peter Franks. Not surprisingly, they conclude that patient requests for medication has a important impact on the physician-patient relationship and that the advertising that occurs to encourage such discussion has both positive and negative effects.
There is further discussion of this topic in an editorial by Dr. Matthew Hollon in the same edition of JAMA in which he writes about the impact of direct-to-consumer ads on the public's health. Dr. Hollon concludes,
As Bodenheimer - asked, "What if millions of parents were prompted by a TV spot to ask their physicians about asthma action plans to help in the self-management of their children’s asthma, an intervention shown in a Cochrane review to improve outcomes?" The answer seems clear. Concise, coherent, evidence-based messages, delivered using the most sophisticated techniques of Madison Avenue, unbiased by the motivation to turn a profit, and funded by either a tax on DTCA or an alternative financing scheme will benefit the public’s health. These public service messages could supplement the haphazard approach to health promotion that relies on occasionally helpful and intermittently harmful advertisements that play to a patient’s vulnerability and appeal to the desire to assert control over a potential outcome—advertisements that, first and foremost, sell prescription drugs.
If such a strategy proves untenable, then at a minimum, the FDA should expect that pharmaceutical companies improve the educational nature of DTCA by further developing and adhering to appropriate standards to facilitate regulatory efforts. In addition, the FDA should be adequately funded to accomplish its regulatory function. Last, because the safety of a new drug cannot be known with certainty until it has been on the market for several years, and since drug withdrawals occur more than two thirds of the time within 3 years of release, the FDA should consider a moratorium on advertisement of drugs directly to consumers for 3 years after initial market release.
Update: The Washington Post has a further discussion of the study discussed in JAMA as well as reactions from lawmakers and physicians.