Prolia is an injection medication for post-menopausal osteoporosis, plugged by actress Blythe Danner, 70, who says the stage phrase “Break a leg” has new meaning for her. The ad advises: “Ask your doctor if Prolia is right for you.”
That sounds like good advice, since everyone knows that TV ads are designed to entice us to use a product. But new research shows that ads also have influence in the doctor’s office — and to a degree that may subject patients to more harm in the form of side effects than good.
A 2013 study of 100,000 adults surveyed between 2001 and 2007 found that men and women who had more exposure to direct-to-consumer advertising for statin drugs were 16 to 22 percent more likely to receive a diagnosis of high cholesterol — and were also more likely to be prescribed statins.
The people who saw the most ads for statins may have asked for the drug by name or scheduled a doctor’s visit to talk about symptoms mentioned in commercials. Doctors may also be influenced by the ads, says the study’s lead author, Jeffrey Niederdeppe, an assistant professor of communication at Cornell University who specializes in the effects of mass media campaigns and health news coverage on health behavior and social policy.
The rates of diagnoses and prescriptions were highest among those who had the fewest risk factors for cardiac events: They did not have coronary heart disease or diabetes and had never experienced a heart attack.
So, do statin ads promote over-diagnosis and over-treatment, especially as research on the usefulness of statins in low-risk populations is still a subject of debate?
“The first step in addressing high cholesterol is always diet and exercise,” Niederdeppe says. “So this increase in prescription rates — are these appropriate? Or are they at the expense of diet and exercise, which have no side effects?”
The findings add to a large body of research characterizing how ads influence interactions between doctors and patients, including studies that use actors to role-play patient behavior. Not only do patients walk in requesting a particular brand name medication, doctors feel pressure to accommodate these requests.
“I’ll be candid — and I’m a practicing internist — it’s something of a hassle for a busy clinician to have to invest half the visit or more going over this with a patient,” says Molly Cooke, president of the American College of Physicians, which is opposed to direct-to-consumer advertising.
“In markets with heavy advertising, more medicine is sold; that’s been shown before,” says Joseph Ross, a physician at Yale University. “The new paper showed that marketing affected prescriptions in people who were at very low risk, where there’s not much benefit and it exposes them to risks.”
The risks are related to side effects, sometimes common and annoying, other times rare and serious. All drugs have the potential for side effects.
Proponents of the ads say that, contrary to being problematic, they “foster an informed conversation about health, disease and treatments between patients and their health care practitioners,” according to the Pharmaceutical Research and Manufacturers of America, a trade organization for the industry.
The ads do increase awareness, informing Americans about illnesses, symptoms and treatments that they may know little about. The fact that ads for depression play on TV may have helped reduce the stigma of the mood disorder and led people who might not have otherwise sought help to do so.
The TV ads “inform people that their symptoms may in fact be depression,” says David Bradford, a public policy expert at the University of Georgia who has done research on direct-to-consumer advertising. “They do provide information to people and get them in front of a physician.”
According to numerous studies, the ads increase prescriptions — no surprise, since that’s the goal of advertising.
The content of direct-to-consumer drug ads is regulated by the FDA. That doesn’t mean a government official watches each ad and says yay or nay. Rather, it means that the ads have to abide by guidelines for accuracy, which include stating major side effects and contraindications (people who shouldn’t take the drug) and be balanced in terms of describing benefits and risks.
Not surprisingly, the ads tend to have a positive overall spin, says Niederdeppe, who notes that there is no good way to balance the visuals with the spoken words. “Imagery is a very powerful part of these ads,” he says.
The path between seeing a prescription-drug ad and buying the product is more circuitous than for most TV ads. Consumers still must see a physician, who must write a prescription for that drug. “We trust physicians to help diagnose and help treat,” Bradford says. “We have to be careful about second-guessing what goes on in the examination room.”
The takeaway for those of us who see the ads and recognize some ailment in ourselves?
The experts say the same thing as the ads do: “Talk to your doctor.” But they add a few caveats.
“Be skeptical. Remember, the ads paint a rosy picture,” says Ross, who notes that not everyone benefits from drug treatment.
“Be open-minded about the treatment options your doctor suggests,” Bradford says, even if it does not include the drug you saw advertised on TV.
“If someone is worried about their poor sleep, they absolutely should have a conversation with a doctor about it,” Cooke says. “But starting the conversation with ‘I’d like Lunesta’ is not a good thing.” She says the vast majority of people with sleep complaints should not get sleep medications.