Whether they know it or not, patients and prescribers are influenced by pharmaceutical marketing. The widely held beliefs that “newer drugs are better” and “any drug is better than no drug” are byproducts of direct-to-consumer advertising that impact the health care system in subtle but significant ways, illustrated in a pair of recent studies.
Antidepressants in demand
Pharmacy Times reported the findings of the first study in the September 2011 “News and Trends” column. Published in the journal Health Affairs, it showed that more patients are being prescribed antidepressants without a psychiatric diagnosis. Among the factors driving the trend is advertising, which, Health Affairs blogger Chris Fleming explains, “contributes to patients demanding antidepressants” for problems that don’t necessarily warrant a prescription.
Fleming offered the example of a patient who has trouble sleeping—a symptom that may or may not be linked to depression. “There are good ways to improve sleep that patients should try before assuming that medication is the best solution,” wrote Fleming in a blog post on the findings. Educating patients to ask physicians for clinical evidence of a drug’s benefits for their diagnosis is one way to break down that assumption, said the study’s lead investigator.
Primary care physicians should also be educated about the drugs’ long-term benefits and limits and the effectiveness of nonpharmacologic alternatives. In general, communication between patients and physicians is critical to ensure antidepressants are used appropriately. “It may be beneficial for a patient and physician to discuss these other solutions before turning to antidepressants,” the study author wrote.
The “new drug” halo
The second study tackled a more pervasive misconception: that newly approved prescription drugs are always safer and more effective than older ones with proven track records. Driven by “aggressive promotion” of new drugs, these broad assumptions fail to account for side effects that often don’t surface until a drug has been widely used, according to the research.
They also shape the decisions patients make about prescriptions, said lead author Dr. Woloshin, a professor of medicine and codirector of the Dartmouth Institute’s Center for Medicine and the Media. “They may not get the benefit from drugs they think they’re getting, or they may expose themselves to more harm than they think,” the researcher told the Associated Press.
In a national Web-based survey of nearly 3000 adults, researchers found that 39% believed only “extremely effective” drugs win FDA approval. A total of 25% believed the FDA only approves drugs that don’t have serious side effects, study coauthor Steven Woloshin, MD, and colleagues reported in the September 12 issue of the Archives of Internal Medicine.
When presented with 2 fictional drugs for heartburn—one approved in 2009 and the other approved in 2001—just 34% said they would use the older drug. The percentage increased to 53% when patients were given this warning: “As with all new drugs, rare but serious side effects may emerge after the drug is on the market— when larger numbers of people have used the drug.”
Dr. Woloshin suggests new products be packaged with drug facts labels that briefly explain uncertainties about their safety and efficacy. Like the authors of the Health Affairs study on antidepressants, he said education that targets both patients and physicians is key to counteracting myths that could steer drug therapy decisions in the wrong direction.