Damned if we do – damned if we don’t. Should patients have greater access to prescription drug information?

Damned if we do – damned if we don’t. Should patients have greater access to prescription drug information?

The last decade has seen a sharp increase in the number of television ads for prescription drugs. They have become so common that we might assume that these commercials are legal in Canada. In fact, Canada prohibits direct-to-consumer drug advertising but because so many of our available television stations are based in the US we are subjected to these ads every day. Currently, only the United States and New Zealand allow drug ads.

Drug advertising directed at consumers is still prohibited in most countries because there has been a fear that these ads might alter the way that drugs are prescribed – possibly compromising the quality of health care and increasing the incidence of unnecessary prescriptions. Until now, however, most of these concerns have been conjecture on the part of health care professionals. Today we have proof not only that these concerns are valid, but also that the damage done by these ads may be more serious than first feared. This week the British Medical Journal (http://bmj.com/cgi/content/full/324/7332/278?lookupType=volpage&vol=324&fp=278&view=short)published a study by a Health Canada research team headed by Barbara Mintzes that shows the extent to which drug advertising alters the prescription patterns of doctors in both the United States and Canada.

The cross-sectional survey data showed that during the test period, 12% of patients requested prescriptions and that 42% of the drugs requested were advertised to consumers. “The prescribing rate was similar for [both] advertised and non-advertised drugs (about 74%).” However, the statistics also showed that “patients who requested a prescription were more likely to receive one” than those who did not.

Most importantly, the prescribing doctors were asked if they would, in the future, prescribe the same drug for patients with the same condition. In cases where patients specifically requested (and got) certain drugs, doctors were “ambivalent about the choice of treatment” 40% of the time. This number rose to 50% when the requested drugs were advertised to consumers. By contrast, doctors were only ambivalent about treatment in 12% of cases where the doctor had not recommended the drug.

Given this data, the researchers concluded, “patients’ requests for medicines are a powerful driver of prescribing decisions.” This could lead to doctors prescribing drugs that are not required, or even prescribing drugs that are not appropriate for the condition being treated.

An example of this type of inappropriate prescribing has been prevalent on the news the past few months. During the peak cold and flu season, people flock to their doctors asking for antibiotics to cure the pesky viruses, though antibiotics are known to have little or no effect on colds and flu’s. Doctors, through local news stories, have advised patients not to request antibiotics for the flu, but this has done little to quell the problem because it is a common notion that antibiotics are necessary for overcoming the virus. Studies into the “abuse of antibiotics … have shown that doctors don’t like to say no to their patients (Canadian Press),” even though they may not feel that the drugs are needed. This has been shown to increase illness in many cases, as patients who frequently use antibiotics develop a resistance to them.

Despite the risks, drugs are already being advertised in Canada through a loophole that allows drug ads so long as the condition that is being treated is not mentioned. Imitrex, a migraine medication, has just begun advertising here. A recent ad urges viewers to ask their doctor if Imitrex is right for them, but the ad does not even give a clue as to what condition the product treats. In a similar vein, Viagra has been running television ads masked as public service announcements on the importance of seeking treatment for erectile dysfunction.

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