Clinical Inquiries

Does DTC advertising affect physician prescribing habits?

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References

Advertising for acid-peptic disorder medications was inversely associated with Zantac prescriptions (-59 prescriptions/$1000, P=.004). This finding may be related to the emergence of, and advertising for, proton pump inhibitors during this time.

No relationship between advertising and prescribing was found for antihypertensives or medications for benign prostatic hypertrophy.

More frequent advertising doesn’t necessarily mean more prescriptions
Another time-series analysis examined the relationship between the frequency of local DTCA for cyclooxygenase-2 (COX-2) inhibitors and prescriptions for COX-2 inhibitors in the corresponding months. DTCA was not significantly associated with Celebrex prescriptions, but was slightly associated with Vioxx prescriptions (P=.04, 10-fold increase in DTCA associated with a 0.5% increase in prescriptions; P=.04). Practices farther than 100 miles from a media market and those that prescribed Vioxx infrequently were excluded.6 (In 2004, Vioxx was withdrawn from the US and worldwide markets.)

But patient questions about a specific ad get results
A survey of 2929 patients regarding the appropriateness of COX-2 inhibitors showed that 78% of patients who asked their physician about a COX-2 advertisement received a prescription for a COX-2 inhibitor (instead of a nonsteroidal anti-inflammatory drug) compared with 43% of all other patients.7

Recommendations

The American Medical Association (AMA) encourages physicians approached by patients about advertised medications to initiate a dialogue in order to enhance the patient’s understanding of the underlying condition. Request ed medications should be prescribed only if indicated and cost effective relative to other options.

The AMA also recommends that physicians report (to the pharmaceutical company or the US Food and Drug Administration) ads that are inaccurate, incomplete, or imbalanced, and ads that don’t enhance patient education or encourage patients to have a discussion with their physician.8

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