Pfizer-Funded DTC Study Concludes Physicians Find Ads Beneficial

A Pfizer-funded study concludes that physicians find direct-to-consumer advertising of cholesterol and mood disorder drugs beneficial to the doctor-patient relationship.

The study released Feb. 14 finds that 56% of physicians who treat high cholesterol and two-thirds of those treating mood disorders feel that DTC ads have a beneficial effect on their interactions with patients.

The study was conducted by Hanover, N.J.-based Market Measures/Cozint as part of its "Doctor Dialogue" interview series with physicians from various specialties begun in 1999.

For the cholesterol/mood anxiety study, 417 interviews were conducted with two groups of doctors: primary care physicians and cardiologists treating high cholesterol conditions, and primary care physicians and psychiatrists treating mood/anxiety disorders.

Out of all the physicians surveyed, 68% of physicians in the "High Cholesterol Doctor Dialogue" group and 75% in the "Mood/Anxiety Doctor Dialogue" group said that discussions about medicines initiated by patients who reference a DTC ad were as valuable as other patient-initiated discussions.

The study also found that DTC ads prompt patient requests for medicine. For mood/anxiety drugs, DTC ads boosted patient requests for prescriptions from 68% for those who did not mention ads to 79%. For cholesterol drugs, however, the rate was almost identical among those who mentioned DTC ads and those who did not: 54% versus 53%, respectively.

In 20% of patient requests for cholesterol medicine, doctors had a self-reported negative reaction. Nine in 10 physicians in the mood/anxiety group said their reactions to patient requests were positive.

More than two-thirds of all physicians said they did not feel pressured to grant patients' prescriptions upon request, and mentioning a DTC ad created no statistically significant difference in the percentage of patients receiving a prescription in either the cholesterol or mood/anxiety group.

Data from the study also indicate that doctor-patient discussions in which DTC ads are mentioned are more likely to include topics such as efficacy, side effects, appropriateness, insurance coverage and treatment alternatives than those when an ad is not mentioned.

Of doctors in the cholesterol group, 75% discussed the efficacy of a product with patients who mentioned a DTC ad, versus 58% who discussed efficacy when a patient did not mention an ad.

In the mood/anxiety group, the percentage of doctors who discussed side effects of a product with their patients rose from 50% to 73% for those patients mentioning a DTC ad.

Some physicians interviewed did express negative opinions about the effects of DTC. Fifteen percent of physicians treating high cholesterol and 9% of those treating mood/anxiety disorders felt that their patients' seeing DTC ads had a negative effect on their visits.

Thirty percent and 33% of those physicians, respectively, described this negative effect as having a "major impact" on their overall visit.

Pfizer also funded a recent DTC report by the National Health Council.

The "preponderance of evidence" about DTC ads indicates that "the benefits are viewed as outweighing any negative impacts," a Feb. 11 NHC statement accompanying the report says.

However, "AMA reports that some doctors complain that they must devote increasing amounts of scarce time to dissuading patients from taking drugs that advertising led them to believe are right for them, when the doctors think otherwise," the NHC report says.

The NHC report includes data from a second-quarter 2000 Scott-Levin Advertising Audit that showed that a physician's specialty is a significant predictor of his or her opinion of DTC.

"Specialists who tended to feel the most positively" included psychiatrists (40%), the NHC report says. Podiatrists (60%), orthopedic surgeons (37%), dermatologists (36%), urologists (35%), ob/gyns (35%), and neurologists (34%) were also among the most positive responders.

"Those who felt most strongly negative were specialists in infectious disease (47%), pediatrics (57%), ears, nose and throat ailments (56%), allergy (51%), and internal medicine (50%)."

Unlike the "Doctor Dialogue" findings, the NHC report lists "DTC's advertising impact on the physician-patient relations" as an overall "concern" to "a significant number of doctors."

NHC suggests that additional research on DTC is needed in such areas as "consumer perceptions and comprehension of DTC ads in different media, broken down by age, race, and income"; and "non-physician health care practitioners' opinions and recommendations for DTC advertising (e.g. pharmacists, nurse practitioners, physician assistants)."

The pharmaceutical industry is bracing for debate over DTC in the context of the Prescription Drug User Fee Act reauthorization and Medicare legislation.

House Ways and Means Committee Chair Bill Thomas (R-Calif.) is one key legislator who wants to address DTC issues this year.

FDA is conducting a survey of physicians' opinions on DTC. The agency has completed the consumer response portion of the survey, and expects to release that data in April (¹ (Also see "FDA's DTC Advertising Survey Should Ask Cost, Insurance Questions - FTC" - Pink Sheet, 1 Oct, 2001.), p. 8).

Pfizer published an issue brief in November on the purported relationship between DTC spending and prescription drug prices (² (Also see "PhRMA Offers To Discuss Medicare Rx With NIHCM In Response To DTC Report" - Pink Sheet, 26 Nov, 2001.), p. 11).

Pharmaceutical Research & Manufacturers of America President Alan Holmer cited Pfizer's brief in an editorial appearing in the Feb. 14 issue of The New England Journal of Medicine.

The issue also includes an editorial by Public Citizen Health Research Group Director Sidney Wolfe, MD, and a special article by Meredith Rosenthal, PhD, Harvard School of Public Health, et al., on the effects of DTC.

The NEJM articles suggest another area of concern for industry: scrutiny of DTC could prompt examination of the industry's overall promotion practices.

The Rosenthal article concludes that although the use of DTC "has grown disproportionately to other forms of promotion, it continues to account for a small proportion of total promotional efforts."

Direct promotions to physicians, including the retail value of free samples, accounted for approximately 84% of total spending on drug promotions in 2000, the article, citing data from IMS Health and Competitive Media Reporting, states.

In addition, DTC appears to be concentrated on only a few products. "In 2000, the 20 prescription drugs for which spending on direct-to-consumer advertising was greatest accounted for about 60% of the total industry spending on such advertising," the article says.

Holmer emphasized that the devotion of promotional resources to doctors shows that "pharmaceutical companies recognize" that "physicians should and do remain in control of prescribing medications."

"The purpose of this advertising is to encourage patients to talk to their physicians about their medical conditions and treatment options," the editorial says.

DTC is a "healthy development that helps balance the system," Holmer maintained. Physicians are often influenced by "payment incentives" linked to patterns of prescribing and dispensing of medications and formularies.

"With so many parties using such financial incentives and encouraging patients to assume increased responsibility for their medical care, it is surprising that the transmission of FDA-regulated information to consumers has engendered controversy."

Wolfe, however, disputed that DTC is a reliable form of patient education. "Confusion arises when commercially driven information is represented as education."

Wolfe also suggested that at least as important as closer scrutiny of DTC is a second look at the promotional activities directed at physicians.

"It is important to examine the accuracy of sources of information that physicians use to learn about new drugs," he said. "Duped gatekeepers may not adequately resist patients' exhortations to write a prescription."