"Spending on direct-to-consumer (DTC) advertising of prescription drugs in the United States totaled $3.2 billion in 2003," the authors provide as background information. "Critics charge that DTC advertisements lead to overprescribing of unnecessary, expensive, and potentially harmful medications, while proponents counter that they can serve a useful educational function and help avert underuse of effective treatments for conditions that may be poorly recognized, highly stigmatized, or both." The authors add that "antidepressant medications consistently rank among the top DTC advertising categories."
Richard L. Kravitz, M.D., M.S.P.H., from the University of California, Davis, and colleagues conducted a randomized trial using trained actors as standardized patients to determine the effects of patients' DTC-related requests on physicians' initial treatment decisions in patients with depressive symptoms. The patients were middle-aged, white, non-obese women, most with professional acting experience. They were trained to portray six roles. They were representing two clinical conditions: symptoms consistent with major depression or adjustment disorder, and three request types: a brand-specific drug request, a general drug request, or no request (control condition). The patients made appointments for office visits with 152 primary care physicians in Sacramento, Calif., San Francisco, and Rochester, N.Y., between May 2003 and May 2004. The scenarios included patients telling their doctor that they had seen an advertisement for Paxil on TV and asked for that drug by name; or patients saying they had watched a program on TV about depression and asking the physician if medication might help them. The researchers chose Paxil, a selective serotonin reuptake inhibito
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