Patient Requests for Asthma and Allergy Medicine
There are occasions in my Allergy/Asthma practice when patients ask about a medication by name. I bristle a bit when I suspect that this inquiry was driven by an advertisement on television or in print. In an unconscious way, I feel that my control over the "menu of care" that I have crafted for my patient is being intruded on by an outsider. In general, and perhaps in a selfish way, I prefer that patients trust that I have made the best recommendations for controlling their asthma or allergies (or both).
Yet it is just that kind of reaction that brings up a benefit of patients inquiring about specific treatments - whether they saw it on TV or heard about it from an acquaintance. Keeping up to date, reevaluating treatment plans, and occasionally seeking counsel from colleagues are essential to professional growth and maintaining expertise as a doctor. And I benefit from patients providing that spark for me to reconsider treatment options. Their suggestion may pose a reasonable alternative; if not, it gives me the opportunity to explain in detail why I think this would not be. More importantly, it enhances the dialogue with patients about their disease and treatment.
To put this into perspective, I think it is informative to look at a little bit of the ‘history' of direct-to-consumer marketing of prescription drugs - both for patient and physicians.
Background on direct-to-consumer advertising for prescription medications
Much like advertising about alcoholic beverages and tobacco products, there is a long history of regulation of prescription drug marketing. Prior to 1997, advertising for prescription medications was only permitted in professional medical publications. Federal regulators, with support from the medical profession (though not necessarily unanimous) felt that consumers would not be able to interpret ads for prescription medications. This limitation was essentially unchallenged for most of the past 50 years.
In the mid 1990's, there was a movement, which included large pharmaceutical companies, to allow direct-to-consumer advertising of prescription drugs. The main argument was that patients should be informed about which medications may help them. This thinking supported a certain advocacy role on the part of patients to take a greater stake in their health care decisions, encouraging them to "ask your doctor" about whether they may have a certain disorder and whether a medicine could be good for them. While there is no doubt that an important objective for pharmaceutical companies was more sales, this change paralleled a broader shift in the culture of medicine toward greater patient autonomy as a reaction to medical profession "paternalism." In 1997, direct marketing of prescription medications to consumers was allowed. We saw advertisements for antidepressants in magazines and commercials for medications to improve erectile dysfunction on television, among others.
There is no disagreement about whether it ‘worked'. Beyond the results of the Kaiser/Harvard/USA Today poll, the ranking of top-selling drugs in the U.S. reflected those products which for which there had been heavy investment in direct-to-consumer marketing. The recent poll looks into the perceptions, behaviors, and physician responses to this issue in detail. It is very informative and confirms the fact that not only are consumers ‘listening' to the recommendation to ‘ask your doctor', but that physicians are responding to those inquiries by pulling out the prescription pad.
To paraphrase the President of the Kaiser Family Foundation, while we can't say whether this is good for patients or not, it will increase overall health care costs. Perhaps it is worth it, as patients feel that they have greater control of their health care decisions. And they may feel better that physicians are responding actively to their questions and requests. For the time being, it is unlikely that we will put the genie back in the bottle.
Both patients and physicians need to think critically about how they respond to prescription drug advertising, and whether prescribing medication remains clearly in the interest of patient health in some cases over patient satisfaction.