For more than a decade, pharmaceutical companies have been pitching their drugs to the American public via so-called direct-to-consumer (DTC) advertising. Before this DTC era began, new medications were introduced to prescribers at conferences, in professional journals, and through personal visits by pharmaceutical company representatives (known in the business as “detailing”). The choice of which brand of drug to recommend was made solely by the prescriber. Times have certainly changed.
In 1997, the FDA relaxed its regulations regarding DTC advertising, and in the ensuing years there has been an exponential increase in the amount of money spent by drugmakers on television, radio, electronic, and print advertising aimed directly at consumers. Today, an estimated $4 billion is being invested each year in this type of advertising. It is an effective and profitable marketing strategy that has become part of our national culture.
Many issues have emerged as a result of the direct marketing of pharmaceutical products to consumers. Not the least of these are the problems encountered by NPs and PAs because of their exclusion in the language used in DTC advertisements. The phrases “Ask your doctor” or “Only your doctor” that are the hallmark of many of these ads effectively limit patient access to PAs and NPs, whose services are sorely needed in our current health care system. Most ads encourage people to seek help from their physician for such conditions as dry eye, allergic rhinitis, high blood pressure, urinary incontinence, erectile dysfunction, asthma, attention-deficit/hyperactivity disorder, diabetes, and cancer. All of these conditions are diagnosed and managed by NPs and PAs every day, but you would never know it to listen to these ads.
When people are repeatedly told that only their physician can manage such common health problems, they are being given false information. This erroneous message creates confusion in the minds of patients who are seeing or may wish to see an advanced practice clinician and not a physician. In addition, it encourages the public to seek health care from just one type of provider. This undermines the positive movement toward diversifying our approach to health care in this country by using all qualified providers to their maximum capacity.
It’s hardly surprising that PAs and NPs have become frustrated by DTC advertising. We are questioned by patients about our qualifications for diagnosing and treating common health problems based solely on information obtained through such advertising. There can be no doubt that these questions regarding our professional abilities and responsibilities have increased since the advent of DTC ads.
In a recent national survey of NPs and PAs conducted by the American College of Clinicians about this issue, 66.4% of the respondents stated that patients have questioned their ability to prescribe medications based on a television advertisement. For me, this is an especially troubling statistic, having cut my professional teeth on the struggle to gain prescriptive authority in the early 1980s. But the implications are felt on a day-to-day basis by advanced practice clinicians across the country. In the context of any given patient encounter, it means that precious office time must be spent explaining legal and regulatory reasons for why it is OK for patients to be sitting across from a PA or NP and why they should trust what we say.
As reported in last month’s issue of Clinician Reviews (see “Trends in Health Care,” page 3), the study also revealed that some NPs and PAs have changed their prescribing patterns in response to DTC advertising. For example, 41.1% of respondents stated that they would use a comparable drug whenever possible if the medication requested by a patient was marketed with phrases such as “Only your doctor” or “Ask your doctor.” While this is not to be construed as a coordinated effort to boycott certain medications, it is certainly a trend worth monitoring.
For all clinicians, DTC marketing strategies have increased the need for more counseling and education of the patient and family. This has both positive and negative effects. As one survey respondent wrote, “DTC advertising gives patients permission to bring up sensitive issues or problems.” Another said that patients are “more educated and prepared to discuss their concerns” because of DTC ads.
But while patients may come to us with an increased awareness of certain health issues, their information is often incomplete or incorrect. Rarely (less than 10% of the time, according to the survey) do patients bring information obtained from nationally recognized, evidence-based sources such as the NIH, American Diabetes Association, or American Cancer Society. Rather, they quote the sound bite or celebrity in the latest television commercial.
Clearly, there is a need for balance in the type of health care information that is disseminated to the American public. Many consumer groups agree. A recent report by AARP stated, “Direct-to-consumer advertisements should inform the consumer and provide clear, accurate information. They should also encourage the consumer to have a productive dialogue with their provider about their treatment options, including prescription and nonprescription medicines, generic alternatives, and lifestyle changes, if applicable.” (See www.medicalnewstoday.com/articles/107076.php.)
Much more is being learned about the issues created by DTC advertising. We must continue to participate in the dialogue on consumer protection, regulatory oversight, and fair market practices. Our response must be conducted on several levels. While it may be difficult to counter misinformation within the context of a typical patient interaction, we know that the personal relationships we forge with our patients are our best defense. We must continue to support our respective organizations in their attempts to enlighten the pharmaceutical industry about the realities of the current health care system. And we must use the lessons learned from the advertising sector itself—namely, to keep our message brief, consistent, and repetitive.
I welcome your comments on this issue. Please e-mail me at ElayneD@gmail.com.
M. Elayne DeSimone is a Clinical Associate Professor at Stony Brook University School of Nursing in New York and an adult nurse practitioner at Community Volunteers in Medicine, a free primary care clinic for the uninsured in Westchester, Pennsylvania. She is also the incoming president of the American College of Clinicians.