How Pharmaceutical Ads Distort Healthcare Markets
April 14, 2013 1 Comment
It probably doesn’t strike you as strange to see advertisements for prescription drugs. By now, everybody knows that you should “talk to your doctor about Levitra” while “doing more with Lipitor” and getting “Claritin clear.” But if you think about it, it’s odd for an actor being paid by a pharmaceutical company to tell you what medicine to take. The implication is that despite having no medical experience, you should be giving medical advice to your doctor. Granted, there are times when patients should have a strong voice in the specifics of their treatment, but those times are not when patient desires are strictly based on positive branding from a TV commercial.
Given that doctors are likely to frequently deny the ad-induced requests of patients, it’s worth asking how these ads impact the patient experience. For example, does the effect of a pharmaceutical ad persist beyond a patient’s initial request for a drug?
A new study by Benjamin Lewin of the University of Puget Sound suggests that it does. Lewin examined what factors influenced patient satisfaction among people who had gone to the doctor after seeing a form of “direct to consumer advertising” (DTCA). He found that the advertisements had a significant impact on a patient’s experience:
Results indicate that patients who do not receive a prescription when mentioning a DTCA drug are significantly less likely to be satisfied with their physician visit. In contrast, the receipt of a diagnosis has no significant impact on patient satisfaction. Other factors associated with patient satisfaction were whether or not the patient received the exact drug that he or she requested or a different drug, and the specific reason for denial of a prescription for the requested drug. Instead of accepting a doctor’s recommendations and complying without question, patients are now unhappy with their physicians’ decisions when these decisions do not adhere to the patient’s expectations, which are formed by DTCA.
If advertising is influencing patient satisfaction it’s bad news for the healthcare system. First and foremost, it means patient satisfaction is increasingly reliant on outcomes that have nothing to do with patient health. Somebody who ends up less healthy, but who got the drug they asked for, could end up more satisfied than a healthier person who didn’t get what they asked for. Even if it initially leads to more satisfaction, in the long run it’s not beneficial to accept a marginally inferior health outcome in return for the warm feeling you get from doing what the TV said.
When satisfaction becomes disconnected from health outcomes patients may also begin “doctor shopping” for a doctor who will give them what they want. In effect, you have people moving away from doctors who will provide the best medical treatment and toward doctors who will provide the most overall satisfaction. This incentivizes doctors to focus on patient satisfaction at the expense of better health outcomes. If a doctor wants to keep a patient, it might be better for the patient to be 99% cured and get the drug they want than to be 100% cured and not get the drug they want. Obviously doctors aren’t pushovers who do whatever they’re told, but doctors do want to please patients, and at the margin patient desires will influence treatment decisions. The end result is a distortion in the market for doctor services that leads to a decrease in the supply of superior treatment.
Is there anything that can be done about the detrimental effects of pharmaceutical ads? In the U.S. ads are already regulated by the FDA, and though many countries have banned them, you don’t have to be Rand Paul to think that preventing somebody from advertising a medicine is a serious violation of the first amendment. Banning pharmaceutical ads could also be unwise, as they surely allow some people to gain valuable information.
The best solution may actually be what’s already present in Levitra’s ubiquitous ads. The ads say to ask your doctor “about” Levitra, not “for” it. One thing Lewin found was that out of ten different reasons doctors gave for denying a requested drug, “it was’t the right drug for you” led to the most satisfaction. By creating ads that insinuate a drug isn’t for everybody pharmaceutical companies can increase the degree to which people are open to that explanation.
There is one final thing patients can do. Next time you see a TV commercial for a prescription drug, remind yourself that you know nothing about medical treatment and that everybody who made the commercial has a financial interest in your future behavior.
Lewin, B. (2013). Patient satisfaction with physician responses during interactions prompted by pharmaceutical advertisements The Social Science Journal DOI: 10.1016/j.soscij.2013.03.002