Ever since direct-to-consumer (DTC) drug ads started airing on television, advanced practice nurses and physician assistants have been trading stories about confused patients.
Mary Jo Goolsby, EdD, MSN, NP-C, Director of Research and Education for the American Academy of Nurse Practitioners (AANP), recalls, with chagrin, the handful of patients who walked into her Florida primary care practice and asked for a referral to a physician. Despite the fact that Goolsby had been diagnosing their ailments and legally prescribing medication for them for years, they had seen an ad that said “only your doctor can prescribe.” And so, they wanted to switch their care to a physician.
But what might have started out as mildly exasperating has grown troublesome: A new study by the American College of Clinicians (ACC) shows PAs and NPs are fielding similar questions regarding their ability to prescribe from about one-third of their patients.
This problem, which AANP President Mona Counts, PhD, CRNP, FNAP, FAANP, describes as “a most troubling issue,” has been around for more than a decade. But it’s one that NPs and PAs are getting increasingly tired of dealing with. As the number of ads increases—a report by the American Academy of Physician Assistants (AAPA) shows pharmaceutical companies increased their spending on DTC television ads from $791 million in 1996 to $3 billion in 2001—clinicians are starting to take increasingly aggressive action to make the language in the ads more “provider neutral.”
The recent survey by the ACC indicates that nearly half of PAs and NPs are starting to rebel: They are actually boycotting drugs whose ads use the “only your doctor” language. To be specific, 41% of those who responded to the survey said they would choose to prescribe a similar drug that does not have the “offensive” DTC wording if such an alternative exists.
“It demonstrates that people are starting to express their dismay with their prescription pad,” says ACC President-Elect Elayne DeSimone, PhD, PA, NPc, FAANP.
Not all efforts at change are so extreme (officials from the AAPA specifically stated that they do not condone the boycotting of certain drugs). Leaders from both AANP and ACC are actively submitting petitions to pharmaceutical companies; AANP alone has gathered more than 12,000 signatures. Both groups, and the AAPA as well, have also been meeting regularly with pharmaceutical companies about this issue. Many individual clinicians also raise their concerns about DTC language on a daily basis when drug reps stop by with samples.
And progress is being made, even if it’s not as quickly as advocates would like. For example, Sanofi-Aventis has already agreed to use provider-neutral terms in their new ads for Lunesta® CR. After meeting with NPs and PAs last fall, GlaxoSmithKline now alternates between “only your doctor” and “only your health care provider” when the company airs television ads for Avodart®, a popular prostate drug. Reportedly, Pfizer executives are considering using health care provider instead of doctor in some of their newer DTC ads. (Representatives from these companies were not available for comment.)
Why the Fuss?
DeSimone explains why clinicians from her group felt strongly enough to pick this battle. Put simply, she says, advertisements that say “only your doctor can prescribe” are insulting to the 200,000 PAs and NPs who are out there, actively caring for patients and writing, on average, more than 50 prescriptions each per week.
Clinicians who sought an active leadership role in this area argue there’s a lot at stake for NPs and PAs, both professionally and financially. They contend they have spent years fighting for the right to prescribe in their home states. And they have spent even more time trying to educate consumers about their key role in the health care marketplace. When those physician-centric ads come on, they threaten to undo all of that progress.
“To say, ‘only your doctor can diagnose’ and ‘only your doctor can prescribe,’ that’s a lie,” says ACC President Bob Blumm, RPA-C. “It’s false advertising.”
That’s How It’s Always Been
Despite all of this awareness and activity, why do drug companies still persist in saying “only your doctor can prescribe”? Some of the companies told ACC co-founder and PA Dave Mittman they thought this phrasing was required by the FDA. (It’s not.) Others felt it was obvious that PAs and NPs were naturally included under the term doctor because so many work collaboratively with a physician. (In a related story, the American Medical Association is actively pursuing this issue, trying to limit the use of doctor to MDs, DOs, and podiatrists.)
Pharmaceutical company consultant Carla Duryee, who is based in North Carolina, offers perspective on why this dilemma continues to exist. In her opinion, it’s a financial and bureaucratic issue. The companies started out using doctor. To change the terms, they have to get approval from the FDA (a long process), and it would cost a lot to change all of the ad materials. Duryee feels upbeat, however. She believes the industry will eventually change the language.
PA and NP groups say their ultimate goal is to persuade all of the pharmaceutical companies to adopt provider-neutral terms, such as provider, health care professional, or prescriber, across the board in all of their advertising materials.
That is a fine goal, Goolsby says. But it will require finesse and patience. “We have a lot of partners in the pharmaceutical industry, and we need to keep working with them,” she relates. “We don’t expect things are going to change overnight, so we keep at it.”
Change will come, Duryee predicts, and it will be good for NPs and PAs. “The positive impact to PAs and NPs would be, I believe, better relationships with the pharma industry, solidifying their place in the medical community, and a positive perception of their profession with patients,” she adds.