Consumer advertising influences doctors' prescribing, study finds
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《英国医生杂志》
Drug advertising that is aimed directly at consumers can have important effects on treatment decisions. This is the conclusion of new research that tested doctors' responses to specially briefed patients who were sent to their clinics.
Patients asking for a specific drug, such as one of those in the direct to consumer advertisements shown above, are more likely to leave with a prescription than those patients who don't ask for a drug
Dr Richard Kravitz of the University of California's Department of Internal Medicine and colleagues created six standardised patients by crossing two conditions (major depression or adjustment disorder) with three different typical requests that patients might make of their doctors (a request for a specific brand of drug, a general request for a class of drugs, or no request for any drug) ( JAMA 2005;293: 1995-2002). These standardised patients, who were played by actors, were then randomly assigned to make 298 unannounced visits to primary care doctors.
The overall rates of prescribing of antidepressants were highest for visits in which patients made general requests for a class of drug (76%), lowest for visits in which patients made no requests for a drug (31%), and in between for visits in which patients asked for specific brands linked to direct to consumer advertising (53%).
Minimally acceptable initial care, which the authors regarded as any combination of an antidepressant, referral to mental health specialists, or follow up within two weeks, was offered to 98% of the patients in the major depression role who made a general request, 90% of those who asked for a specific brand, and 56% of those who made no request (P<0.001).
The drug that some patients were told to ask for, paroxetine, was rarely prescribed unless specifically requested. For example, among the patients portraying major depression, paroxetine was prescribed to 3% of patients who made no specific request but was prescribed to 27% of patients who asked for the drug by name. In the adjustment disorder group, paroxetine accounted for two thirds of all antidepressant prescriptions to patients who asked for a specific brand but about a quarter of prescriptions given to those who made general requests.
"These results underscore the idea that patients have substantial influence on physicians and can be active agents in the production of quality," the authors wrote. "The results also suggest that DTC advertising may have competing effects on quality, potentially averting underuse, while also promoting overuse."
In an accompanying editorial Dr Matthew Hollon, from the University of Washington, Seattle, wrote, "Relying on emotional appeals, most advertisements provide a minimal amount of health information, describe the benefits in vague, qualitative terms, and rarely offer evidence to support claims."(Scott Gottlieb)
Patients asking for a specific drug, such as one of those in the direct to consumer advertisements shown above, are more likely to leave with a prescription than those patients who don't ask for a drug
Dr Richard Kravitz of the University of California's Department of Internal Medicine and colleagues created six standardised patients by crossing two conditions (major depression or adjustment disorder) with three different typical requests that patients might make of their doctors (a request for a specific brand of drug, a general request for a class of drugs, or no request for any drug) ( JAMA 2005;293: 1995-2002). These standardised patients, who were played by actors, were then randomly assigned to make 298 unannounced visits to primary care doctors.
The overall rates of prescribing of antidepressants were highest for visits in which patients made general requests for a class of drug (76%), lowest for visits in which patients made no requests for a drug (31%), and in between for visits in which patients asked for specific brands linked to direct to consumer advertising (53%).
Minimally acceptable initial care, which the authors regarded as any combination of an antidepressant, referral to mental health specialists, or follow up within two weeks, was offered to 98% of the patients in the major depression role who made a general request, 90% of those who asked for a specific brand, and 56% of those who made no request (P<0.001).
The drug that some patients were told to ask for, paroxetine, was rarely prescribed unless specifically requested. For example, among the patients portraying major depression, paroxetine was prescribed to 3% of patients who made no specific request but was prescribed to 27% of patients who asked for the drug by name. In the adjustment disorder group, paroxetine accounted for two thirds of all antidepressant prescriptions to patients who asked for a specific brand but about a quarter of prescriptions given to those who made general requests.
"These results underscore the idea that patients have substantial influence on physicians and can be active agents in the production of quality," the authors wrote. "The results also suggest that DTC advertising may have competing effects on quality, potentially averting underuse, while also promoting overuse."
In an accompanying editorial Dr Matthew Hollon, from the University of Washington, Seattle, wrote, "Relying on emotional appeals, most advertisements provide a minimal amount of health information, describe the benefits in vague, qualitative terms, and rarely offer evidence to support claims."(Scott Gottlieb)