Patient requests for specific medications — including brand-name drugs that are heavily advertised — have a substantial impact on doctors’ prescribing decisions, according to a novel study published in the journal Medical Care.
“Decisions about whether to prescribe a medication, and which medication to prescribe, were traditionally made by physicians, with patients assuming a more passive role. This has changed dramatically in recent decades as patients have become more active participants in their medical care,” said John McKinlay, PhD, who led a team of researchers at the New England Research Institutes in Watertown, Mass.
Much of that change is due to direct to consumer (DTC) advertising, which only became legal in the U.S. in 1985. By 2011, drug makers were spending $4 billion a year targeting consumers with “Tell Your Doctor” advertising campaigns. It was money well-spent; for every dollar invested in DTC advertising, the average return to drug makers was $4.20.
“Patients are more likely to come to a clinical encounter with a desired therapeutic plan already in mind, such as a prescription for a specific agent,” says McKinlay.
To see how influential patients can be on their doctor’s treatment plans, researchers made videos in which professional actors played the role of patients with two common painful conditions: sciatica causing back pain or osteoatrthritis causing knee pain.
Half of the “patients” with sciatica requested oxycodone, an opioid painkiller; while half of the patients with knee arthritis requested the prescription drug Celebrex. The other half of patients requested “just something to make it better.”
The patients requesting oxycodone said they had tried their spouse’s leftover medication. Those requesting Celebrex said they saw it advertised, and that a co-worker took it and said it really helped.
The video scenarios were shown to 192 primary care physicians, who were then asked a series of questions about diagnosis and management, including what treatment they would recommend.
The results suggest that patient requests for specific drugs had a strong effect on what the doctor recommended. Nearly 20% of sciatica patients requesting oxycodone would receive it, compared to just 1% of those making no specific request. Narcotic pain relievers such as oxycodone are generally not recommended for sciatica.
Over half (53%) of osteoarthritis patients requesting Celebrex would receive that drug, compared to 24% of those requesting no specific medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Celebrex are recommended for treatment of knee arthritis, but Celebrex is much more expensive than other NSAIDs.
“A patient request for a specific medication dramatically increases the rate at which physicians prescribe that medication,” said McKinlay. “These results highlight potential negative impacts of DTC advertising and other forms of activation in medication requests.”
The findings add to concerns over the potential safety and economic impact of prescription drug requests driven by DTC advertising. The United States and New Zealand are the only two countries that permit DTC advertising for prescription drugs.
“Supporters defend the practice as a way to empower consumers, while opponents argue that commercially motivated messages leads to inappropriate patient requests for medication,” said Dr. G. Caleb Alexander, Deputy Editor of Medical Care in an editorial.
“In order to resolve this debate, more research is needed to determine the effects of DTC advertising on patient and physician behavior, especially how it affects prescribing decisions and health outcomes.”
Since DTC advertising is generally used for expensive medications, researchers say patient requests for advertised drugs are likely to increase medication costs. Some requests may also lead to suboptimal care — patients receiving oxycodone for sciatica or Celebrex for arthritis might have more side effects, compared to other medications.