ATLANTA — Direct-to-consumer (DTC) advertising should be banned in order to reduce the demand for expensive, unnecessary drug treatments, the American Medical Association’s (AMA) House of Delegates voted on Tuesday.
“Today’s vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices,” AMA board chair-elect Patrice A. Harris, MD, MA, said in a statement issued after the vote at the association’s interim meeting here. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”
The policy also advocates for a campaign to urge prescription drug affordability — including demanding more competition in the drug industry — and for urging more transparency in drug costs; it also calls for convening a physician task force on the issue.
“Physicians strive to provide the best possible care to their patients, but increases in drug prices can impact the ability of physicians to offer their patients the best drug treatments,” said Harris. “Patient care can be compromised and delayed when prescription drugs are unaffordable and subject to coverage limitations by the patient’s health plan. In a worst-case scenario, patients forego necessary treatments when drugs are too expensive.”
Banning DTC advertising would be a really good idea, said Sunny Linnebur, PharmD, associate professor of clinical pharmacy at the University of Colorado Skaggs School of Pharmacy, in Aurora. “I can see the potential risks that occur when patients watch commercials and immediately think they need to be on that medication,” she said in a phone interview.
“Number one, it puts pressure on providers — doctors, nurse practitioners, and physician assistants — to prescribe those medications. Number two, patients are not always in the best place to make decisions about which medications they should and should not take, and commercials are targeting patients and can make them think that medicine is for them, when it’s not safe for them.”
In addition, such ads can increase providers’ workloads because “we [may] have to discuss medications that were never going to be on the table to begin with,” said Linnebur.
David Holdford, PhD, professor of pharmacotherapy and outcomes science at Virginia Commonwealth University, in Richmond, said that although too much money is being spent on marketing and too little on drug research and development, it’s doubtful that banning DTC ads will serve to either increase spending on drug research or bring down the price of drugs.
“DTC spending is approximately $3 billion per year — 11% of all promotional spending,” he said in an email, citing a report by the Pew Charitable Trusts. “Direct-to-provider [advertising] is the other 89%.”
“MDs are still in control of the prescription pad,” Holdford said. “They do not have to prescribe for heavily promoted DTC drugs, but they do. In fact, studies consistently show that physicians are not cost-effective in their prescribing behaviors.”
The AMA has grappled with the DTC issue before. In April, the association wrote to the Centers for Medicare and Medicaid Services complaining about the misuse of Medicare’s annual wellness visit by commercial firms that promote whole-body scans as a means of disease prevention.
“We note that some consumer groups have asked the Federal Trade Commission to investigate the direct-to-consumer marketing of some of these commercial entities on the grounds that their advertisements contain false or misleading representations or material omissions,” wrote the AMA along with several other physician organizations. “This raises serious concerns for us about potential program integrity threats that these entities may pose to Medicare.”
The FDA also has been studying the issue for some time. In 2003, the agency presented results from surveys of patients and physicians, which found that of 500 doctors surveyed, 60% said that when they discussed a medication with a patient who had seen an ad for it, the ad had no beneficial affect on the discussion. And fewer than 20% said their patients understood how to get more information about a drug as a result of seeing an ad for it.
In other meeting news, the House of Delegates also passed resolutions in support of:
- Revising quality standards and Meaningful Use requirements to make the program more streamlined and less burdensome.
- Passing federal, bipartisan legislation to speed up paramedic training for returning veterans who received emergency medical training while in the military.
- Developing model state legislation to increase use of prescription drug monitoring programs (PDMPs). “The AMA strongly supports ensuring patient privacy protections, interstate interoperability of PDMPs as well as improving the functionality and workflow of these tools to help physicians make informed prescribing decisions,” the association said in a statement.
- Lifting a Congressional ban on coverage of in vitro fertilization treatment by the Department of Veterans Affairs. Current law prohibits the department from covering this service, even though it is covered for active-duty military.