How to Combat Pressure from Patients to Prescribe the Drugs They See on TV

If you feel like your TV advertisements increasingly include more prescription drugs, you’re right. Pharmaceutical companies are pouring money into their consumer marketing campaigns, spending $4.5 billion in 2014, $3.5 billion in 2012, and $2.5 billion in 2000. The drugs advertised most to consumers include Viagra (a Pfizer product) and Cialis (an Eli Lilly product) – both of which treat erectile dysfunction. Those two drugs saw marketing expenditures of $232 million and $272 million in 2014, respectively. These numbers, of course, pale in comparison to spending on physician advertising: while consumer marketing reached $3.5 billion in 2012, doctor marketing hit $24 billion that year.

In a 2010 survey, nearly two-thirds of Americans reported seeing, hearing, or receiving some form of prescription drug advertising in the previous 6 months. Overall, about 8% of the people who were exposed to ads then asked their doctors for specific drugs, and 36% of those people actually received prescriptions for the drugs they requested.

The direct-to-consumer ads are a relatively new phenomenon, becoming more prevalent in 1997 after the FDA loosened their restrictions on TV advertising of prescription drugs. Before that, drug ads were targeted to doctors and pharmacies.

“Talk to your doctor.”

These TV ads aren’t without benefits. Patients get better information about what’s available to them, and the phrase “Talk to your doctor” has led to more conversations about topics that may have been hard for patients to bring up. By broadening patients’ awareness of existing medications and treatments, patients become more involved in their healthcare decisions and ask more informed questions about potential risks.

However, these ads also carry a slew of downsides. While a TV ad doesn’t turn every viewer into a hypochondriac, omnipresent drug ads can make us worry that we’re suffering from an ailment even when we’re perfectly healthy. Also, exciting new medications advertised on TV tend to be pricey and often have no generic equivalent. These drugs and their side effects may also be less familiar to prescribers than drugs with longer histories on-market – thus making patients more likely to suffer unexpected side effects or requiring more trial-and-error in identifying the appropriate dose for each patient population. Physicians also report that their patients understand the benefits of advertised drugs better than they understand the risks, and one study reported that 75% of physicians believe that these ads cause patients to believe that a drug works better than it does. And as a corollary to patients’ heightened involvement in their medical decisions, many physicians felt pressured to prescribe something because of patients’ requests sparked by the ads.

Side effects include…. Shortnessofbreathheadachesbodyachenauseavomitingcomaincapacitationandpotentialdeath

Ever listen to the chatter at the end of a drug commercial? The fast-as-lightening pace at which the side effects are mentioned is often unintelligible. As the camera pans to show someone walking along the beach or doing yoga, the narrator chatters about potential risks like punctured uterine walls, erections lasting longer than four hours, and death. How do these ads increase, rather than decrease, the public’s interest in consuming these drugs?

In 2014, the FDA proposed a study to consider shortening the “major statement” (i.e., the long list of risks. An FDA spokeswoman pointed out that the precautionary narrative is “often too long” or may not “include adequate risk information or leave out important information.”

The FDA encourages doctors to report bad drug ads or marketing techniques, but Liza Schwartz of the Dartmouth Institute for Health Policy and Clinical Practice says that’s insufficient.

By the time there are any complaints about an ad, it’s already run its course and it seems like we don’t have a very good monitoring system for this information … It relates to this general problem [of] a reactive rather than a proactive situation around direct consumer advertising.

Reactive (rather than proactive) providers isn’t anyone’s goal. How do you manage patients’ requests for medications or modalities?

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

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about the author

Erin Jackson is Jackson LLP’s Managing Partner. She is responsible for all aspects of firm management, is a sought-after speaker for healthcare conferences, and is a published author. She is specifically focused upon the intersection of the patient experience in healthcare with the legal and ethical responsibilities of providers.