Direct-to-consumer advertising

Barbara Mintzes and colleagues1 conclude that if a patient brings up a DTCA drug with a physician, a prescription is likely to result. This conclusion might lead us to think that doctors feel pressured into prescribing medication. However, other studies have demonstrated that this is not the case. Spurgeon2 reported that doctors said they felt “little” or “very little” pressure from their patients related to DTCA. In fact, only 6% of the 200 general practitioners surveyed felt strongly pressured to prescribe medication that the patients had learned about through advertising. All of the doctors who opted for the medications that patients had requested (instead of their usual choices) agreed that the prescriptions were acceptable for the diagnosed conditions.

In a recent personal communication with Mintzes (Barbara Mintzes, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC: personal communication, 2003) I learned that physicians in the published study1 judged a total of 92% of new prescriptions for requested DTCA drugs to be “very likely” (50%) or “possible” (42%) choices for similar patients with the same condition. It would seem that both these options indicate some degree of confidence in the medications, since the word “possible” means that a thing may occur under appropriate conditions (such as a similar patient with the same condition). This perspective on the data is quite different from that presented by Mintzes and colleagues,1 who judged physician confidence in treatment choice in much more limited terms (they defined physician confidence on the basis of drugs that would be a “very likely” choice, i.e., 50%).

Moreover, DTCA was shown to be informative. Close examination of the results1 reveals that the patients who were most exposed to the advertising of prescription medicines were the ones that physicians considered the best informed. For 71.4% of prescriptions requested by patients in Sacramento, where advertising is more common, the physician considered the patient to be knowledgeable about the medicine; in Vancouver, the proportion was 53.3% (these data are for any drug, not just DTCA drugs).

These findings are congruent with those of a previous study3 involving 454 family doctors, who agreed that DTCA encouraged patients to take an active role in managing their health and led them to seek advice about problems that would otherwise have gone untreated.

Opponents of DTCA have never succeeded in demonstrating that the costs generated by an increase in the number of patients obtaining prescriptions for a drug that has been promoted by advertising are greater than the savings achieved by associated reductions in health services fees (e.g., hospital costs).

Marc Lacroix President and CEO LXB Communication-Marketing Montréal, Que.