TV drug ads influencing patients, doctors

A study that used actors to pose as patients has found that TV ads for prescription antidepressant drugs lead to both proper and over-use of such medicines, researchers reported Tuesday. Either way, they had an influence over which drug was prescribed.

The drug industry spends $3.2 billion yearly advertising prescription drugs directly to U.S. consumers, with products for erectile dysfunction, arthritis and allergies leading the pack.

In the study published in this week’s Journal of the American Medical Association, researchers found that the actors who asked for drugs often got them — leading to what would be considered proper levels of care. However, in some cases drugs were prescribed for a condition that did not warrant them.

“These results underscore the idea that patients have substantial influence on physicians” and can be active agents in promoting quality health care, the study from the University of California at Davis found.

“The results also suggest that direct-to-consumer advertising may have competing effects on quality, potentially averting underuse (by making people aware of drugs), while also promoting overuse,” it added.

The study, conducted in 2003 and 2004, used a group of women who pretended to have symptoms mimicking forms of depression. They made 298 unannounced visits to the offices of 152 doctors.

Some of the actors described symptoms indicating they could have major depression, while others described an “adjustment disorder” — fatigue, stress and some sleeplessness.

All of the actors followed three different scripts at various times. In one they said they had seen an ad for Paxil, an anti-depressant made by GlaxoSmithKline Plc and asked for it. In another they said they had seen a TV program on depression and wondered if a drug would help. In the third scenario they made no request.

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In the group portraying major depression, doctors prescribed antidepressants 53 percent of the time when Paxil was requested, with that drug making up 27 percent of the total. When the actors made a general request for drugs, they were given 76 percent of the time. When they asked for nothing, they received prescriptions 31 percent of the time.

In the less serious adjustment disorder group, antidepressants were prescribed 55 percent of the time when Paxil was mentioned, 39 percent when a general request was made and 10 percent when no drugs were requested.

Paxil accounted for two-thirds of all antidepressant prescriptions given to the second group among those who asked specifically for it.

“We were a bit startled to see the rather high levels of prescribing for patients who made requests for medication in the adjustment disorder condition, because clinical evidence suggests that the benefits of such medication in that situation are really quite minimal,” said Richard Kravitz, the report’s chief author.

The report said the findings “sound a cautionary note for direct-to-consumer advertising but also highlight opportunities for improving care of depression (and perhaps other chronic conditions) by using public media channels to expand patient involvement in care.”