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Studies Show Drug Ads Influence Prescription Decisions, Drug Costs

Donna Young

Four separate studies released in November 2001 about prescription drug advertisements aimed at consumers add to the debate of whether the commercials inform the public about health conditions and available treatments or if the ads contribute to rising drug costs and lead people to demand prescriptions for unnecessary or inappropriate medications.

In 1997, FDA issued a draft guidance document that allows pharmaceutical companies to use television and radio commercials to promote specific drugs and provide less detailed information about possible adverse effects and other precautions than is required of print ads. The agency issued its final rule in 1999.

The next year, the pharmaceutical industry spent $1.6 billion on television drug ads and $2.5 billion overall for advertising targeted at consumers, researchers determined.

A relatively small number of prescription drugs that were widely advertised to consumers in 2000 contributed significantly to the increase in pharmaceutical spending in the United States from 1999 to 2000, according to a study by the National Institute for Health Care Management Research and Educational Foundation (NIHCM Foundation), a nonprofit organization in Washington, D.C.Increases in the sales of the 50 drugs most heavily advertised to consumers in 2000 were responsible for 47.8% of the $20.8-billion one-year increase in retail spending on prescription drugs from 1999 to 2000, the study found.

The study's finding, according to a statement from the NIHCM Foundation, adds to the "circumstantial evidence" that drug ads directed toward consumers "may be an increasingly important factor in the recent trend to the expanded use of new (and usually more expensive) prescription drugs."

Nearly one in three adults has talked to a physician, and one in eight has received a prescription in response to seeing an advertisement for a prescription drug, according to a survey report funded by the Henry J. Kaiser Family Foundation. But while the ads may prompt viewers to ask physicians about the drugs, few viewers retain information from the commercials about possible adverse effects and where to obtain additional information, according to the report.

The report provides information about how consumers react to seeing various ads for prescription drugs, said Mollyann Brodie, vice president and director of public opinion and media research for the Kaiser Foundation.

At a news conference announcing the results of the survey, Brodie said Knowledge Networks Inc., a marketing and research firm in Menlo Park, California, conducted the Web-based survey using a nationally representative random sample of adults.
Knowledge Networks selects U.S. households at random and offers them free computer hardware and technical support, Web TV, Internet access, and e-mail accounts in exchange for their agreement to participate in weekly surveys. Participants receive the surveys by e-mail and view video over Web TV.

For the survey, respondents were divided into two groups: viewers and nonviewers.
The 1872 viewers were divided into three groups and shown three ads: a public service message that discourages juvenile smoking, a new car ad, and a prescription drug ad. Because the respondents were not told the subject of the survey before viewing the commercials, they had no reason to pay particular attention to the drug ad, according to the researchers.

The first group of 623 participants viewed an ad for the lipid-lowering agent Lipitor, manufactured by Pfizer. The second group of 627 respondents watched a commercial for the oral leukotriene-receptor antagonist Singulair, manufactured by Merck & Co. The third group of 622 viewers saw an ad for the proton-pump inhibitor Nexium, manufactured by AstraZeneca Pharmaceuticals L.P.

The viewers and the 639 nonviewers were asked about their past responses to prescription drug ads, knowledge of the drug products, and the conditions they treat.

The viewers were surveyed about the ads they viewed, and the nonviewers were asked about prescription drug ads in general, according to the report.

The researchers found that the elderly and the infirm were more likely than other people to talk to their physicians about a medication they saw advertised. But these groups, the report said, were not any more likely to have received a prescription.

The survey looked at whether drug ads improve the public's health by creating awareness about conditions and available treatments. Researchers found that the responses to this question were mixed.

In some cases, the respondents already knew about the drug or condition in the ad. For example, when asked whether heartburn and gastroesophageal reflux disease can lead to more serious stomach problems, 79% of those who saw the ad for Nexium and 68% of those who did not see the ad answered yes, according to the report. Because the majority of both groups answered yes to the question, this was not necessarily new information but something the responders already knew, the report said.

With respect to Singulair, researchers found that 71% of those who watched the ad said they learned that people with asthma can take tablets to prevent or limit the number of acute episodes. But 25% of the viewers had the mistaken impression that people can take a tablet during an acute exacerbation of asthma instead of using an inhaler.

When asked about the knowledge gained from the commercials, 70% of the respondents indicated that they learned little from watching the ads, according to the report.

But Christopher Molineaux, vice president of public affairs for the Pharmaceutical Research and Manufacturers of America, argued that drug advertising raises consumers’ awareness "so they would seek additional information about treatment and information about the specific drug."

"People that are armed with information are more active in their health care decisions and participate more," he added.

Molineaux said a large percentage of men were prompted by television ads for Pfizer's Viagra to visit their physician. These men were then found to have a chronic medical condition, such as diabetes mellitus or hypertension, that might have otherwise gone undiagnosed.

"This is not insignificant," Molineaus said.

Commercials for medications to treat osteoporosis have also helped to raise women’s awareness about the disease, he added.

According to Pfizer, a company-funded study found that prescription drug ads help people to be more actively involved in their health care, "which increases the likelihood that they follow their treatment regimen."

In a press release dated November 29—the same day the Kaiser Family Foundation released its report—Pfizer said its study found that patients who were prompted by a drug ad to ask their physician about a medication were more likely to take their medications. According to the press release about the study, "Patients diagnosed with nasal allergies who request a specific drug as a result of seeing a [direct-to-consumer] advertisement are more than twice as likely to stay on their medication. Similar results were found for other conditions."

But Sharon Levine, a physician and associate executive director of the Permanente Medical Group of Oakland, California, said she is skeptical of any drug study that is funded by a pharmaceutical company.

Levine participated in a panel discussion about drug advertising that was hosted by the Kaiser Family Foundation in Washington, D.C.

She said studies that involve medications should be "independent" of companies that make their revenues from marketing drug products.

"Consumers need unbiased information," she said. "We are kidding ourselves if we only rely on the [drug] industry for the information."

Levine said she is concerned that patients pressure their physician into prescribing inappropriate or unnecessary medications because of expectations they have after seeing drug ads.

She noted that the anti-inflammatory drugs Celebrex (Pfizer) and Vioxx (Merck) cost 60–70% more than Motrin. But, she asked, "Are they any better?"

Merck spent $160.8 million promoting Vioxx to consumers in 2000, the most spent on any prescription drug, according to the NIHCM Foundation study.

Levine said about 4% of the population that takes an anti-inflammatory drug have been identified as candidates for the more expensive drugs because of their lower risks of gastrointestinal problems.

But, she argued, "there is an unordinary amount of money being spent on those drugs unnecessarily."

The Kaiser Family Foundation also released Prescription Drug Trends: A Chartbook Update, a report with data on prescription drugs, including coverage, national spending, utilization, promotion, and the pharmaceutical industry.