Direct-to-consumer pharmaceutical advertising (DTCA) does not appear to result in widespread adverse health effect, as reported by a nationwide survey of patients' experiences with these ads. Such ads actually appear to have promoted discussions with doctors resulting in diagnoses that may not have been made otherwise, according to the survey published online in the February 26 Health Affairs. Yet these results are under attack from others who think the survey is (among other things) a "little more than an advertisement for drug advertisements."

"We found that direct-to-consumer advertising is a factor causing a lot of people to seek a physician to talk about problems they hadn't talked about before," said Robert Leitman, M.A., an author of the report. Leitman is also division president for health care research at Harris Interactive, a survey research firm known for conducting the Harris Poll.

In the survey, more than 85% of people said they had seen a direct-to-consumer pharmaceutical advertisement, and 35% discussed the ad with their doctor. 25% of patients received a new diagnosis, and one of the most common was depression. In response to the latter results, "That tells us, and should tell physicians, that there is a pool of people out there who are depressed but undiagnosed," said Leitman.

When a patient discussed a DTCA with their doctor, it most commonly resulted in the doctor prescribing a medication - 72.9% of the study's participants reported being prescribed any drug by the doctor. Approximately 43% were prescribed the advertised drug. And in 32.6% of cases, patients were referred to a specialist-"One of the most common things we see is that when patients go to a physician [about a condition related to advertising they had seen], they are referred to a specialist," explained Leitman.

Mary Helen Davis, M.D., chair of APA's Committee on Public Affairs, said she believes much of the impact of DTCA occurs at the primary care level. She agrees that DTCAs have had an effect on patients, doctors, but says that the impact the healthcare system in general in both positive and negative ways. "Obviously, anything that reduces stigma and provides useful information can have a positive impact. But there has also been a concern about overdiagnosis, raising the cost of health care by prompting patients to go to a physician seeking the newest, most expensive designer drug when there are other fully efficacious drugs that are less expensive."

Davis believes that DTCA is just one component of a phenomenon that is impacting both primary care physicians and specialists - the increasing sophistication of patients in their own health and medical care. According to Davis, the Internet has an even greater impact than DTCA. "What I see more of in my own practice is Internet exploration and many more questions about something someone found on the Net. People are becoming more knowledgeable in general about their medical care. That has been a major change in the last few decades, from an authoritarian medical model to a more collaborative model. Patients have taken more responsibility and have the capacity to do research at their fingertips."

Leitman and fellow colleagues also found that DTCA was only one of the many health information sources that are currently influencing people. 51% of survey participants said they were influenced by family or friends; 40% by broadcast media, 34% by print media, 33% by pamphlets in doctors' offices, 33% by another doctor; 16% by the Internet; 17% by a pharmacist.

Researchers from Harvard University, Massachusetts General Hospital, and Harris Interactive conducted the telephone interviews. Approximately 86% of the sample had seen or heard DTCAs in the previous year, and about 35% of the sample had a physician visit during which DTCA was discussed. 25% of the sample received a new diagnosis and more than half reported actions taken by their physician other than prescribing the advertising drug.

The most common new diagnoses were allergies (9%), high cholesterol (6%), arthritis (6%), hypertension (6%), diabetes (5%), and depression (5%).

Others sighted problems with the study, such as failing to ask respondents about the cost of drugs. One critic, Thomas Bodenheimer, M.D., said that between 1997 and 2000, 28% of the increase in drug spending "resulted from newer, higher-priced drugs that were replacing older, less-costly drugs, and 48% came from the increasing number of prescriptions written." He said that TV drug advertising "is a strategy used by the pharmaceutical industry that covers up the astounding statistic that over the past 10 years, only 15 percent of the newer, expensive drugs arriving on the market offer significant improvements over already existing, lower-price medications."