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For anyone who watches television or reads magazines, where ads
for prescription drugs have become commonplace, the results of a
new study will come as no surprise.
Since the mid-1990s, pharmaceutical companies
have tripled the amount of money they spend on advertising prescription
drugs directly to consumers.
Despite the huge increase, drug companies continue to direct the
overwhelming majority of their advertising spending toward physicians,
not consumers. And most direct-to-consumer advertising is concentrated
on a few medications.
Still, some physicians and health professionals are concerned that
advertising drugs and medical tests directly to consumers interferes
with the doctor-patient relationship and may raise medical costs
by trumpeting expensive new medications.
Spending on prescription drugs is on the
rise and is now the fastest growing portion of healthcare spending
in the US.
This increase is due no doubt in part to a rise in the number of
effective medications, but "there is widespread concern"
that part of the increase is due to advertising of drugs that do
not provide better care.
Though broadcast advertising of prescription drugs has been legal
for years, guidelines released by the Food and Drug Administration
(FDA) in 1997 clarified the rules for advertising directly to consumers.
According to these guidelines, drug companies can fulfill their
obligations for informing consumers about prescription drugs by
referring in advertisements to four sources of additional information:
their doctor, a toll-free number, a magazine or newspaper ad and
a Web site.
From 1996 to 2000, spending on these ads more than tripled, rising
from $791 million to nearly $2.5 billion.
There has been a dramatic growth in advertising of prescription
drugs. Most advertising dollars are spent on television ads.
The big question, of course, is whether advertising leads to improvements
in health or unnecessary spending and inappropriate treatment. Unfortunately,
according to the Harvard researcher who did the study, there is
no solid evidence on the appropriateness of prescribing that results
from consumers requesting an advertised drug.
Despite claims by the pharmaceutical industry that direct-to-consumer
advertising is educational, the public is often misinformed about
these ads, according to Dr. Sidney M. Wolfe, of the Public Citizen
Health Research Group in Washington, DC.
He points out in an accompanying editorial that one study found
that a substantial proportion of people
mistakenly believe that the FDA reviews all ads before they are
released and allows only the safest and most effective drugs to
be promoted directly to the public.
Though a ban on direct-to-consumer advertising would be unconstitutional,
Wolfe urges the FDA to increase its control over such ads. He points
out that FDA actions to enforce advertising rules have decreased
as direct-to-consumer pharmaceutical advertising has mushroomed.
The education of patients -- or physicians -- is too important
to be left to the pharmaceutical industry," whose primary aim
is to promote drugs.
Public Health Service agencies such as the National Institutes
of Health and the FDA, along with medical educators in schools and
residency programs, must move much more forcefully to replace tainted
drug company 'education' with scientifically based, useful information
that will stimulate better conversations between doctors and patients
and lead to true empowerment.
Direct-to-consumer medical advertising is not limited to pharmaceutical
industry.
Two commonly advertised tests are electron-beam computed tomography
(CT) to screen for undetected coronary artery disease and low-dose
spiral CT to screen for lung cancer and other malignancies.
For people thinking about paying to have one of these screens,
this is not a good way to spend your money."
These tests are perfectly legal, but their benefits for detecting
these diseases in low-risk people who have no symptoms have not
been proven.
In the meantime, there is a pretty good chance that an abnormal
test will be needlessly frightening to you and a negative test will
be giving false reassurance.
Doctors do not know what to do with the information these tests
provide. This uncertainty is normal, he said, and will be resolved
within a few years. In the meantime, there is no reason to throw
away your money to enrich entrepreneurs.
What is even more troubling than the unconfirmed accuracy of these
tests is that patients must undergo invasive diagnostic procedures
to confirm the results. These tests have high false-positive rates,
so the results have to be confirmed.
The New England Journal of Medicine
February 14, 2002;346:498-505,524-531
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