TV Ads for Drugs Help Boost Prescriptions, Researchers Say

In an unusual experiment in which actresses posed as patients, doctors were five times more likely to write them prescriptions after the patients inquired about a specific antidepressant, Paxil. The actresses pretended to have a mild form of depression, a condition that does not require antidepressants.

The study, published in the current issue of the Journal of the American Medical Assn., suggests that direct-to-consumer advertising -- on which pharmaceutical companies spend roughly $3 billion a year -- can trump medical need in influencing how doctors prescribe drugs.

"When patients ask for a drug, they tend to get a drug regardless of whether it is appropriate for them," said Joel Weissman, a health policy expert at Harvard Medical School who was not involved in the research. "That is a fascinating finding."

Surveys have shown that patients ask for a prescription based on an advertisement in up to 7% of doctor visits -- a rate that adds up to millions of requests a year.

In the study, led by Dr. Richard Kravitz, a professor of medicine at UC Davis, the actresses played the role of a 45-year-old divorcee who had recently lost her job and was suffering from stress, fatigue and back pain. Those are symptoms of adjustment disorder, a form of depression that usually recedes with counseling and the passage of time.

The doctors had agreed to participate in a study "assessing social influences on practice," but were told only that they would receive two undercover visits from research subjects several months apart.

Each actress, who recorded her visit on a mini-disc player stashed in her purse, said to her doctor: "I saw this ad on TV the other night. It was about Paxil. Some things about the ad really struck me. I was wondering if you thought Paxil might help me."

Out of 49 such visits, 27 -- or 55% -- resulted in a prescription for an antidepressant, most often Paxil.

By comparison, patients who did not mention an ad were prescribed antidepressants just 10% of the time.

"There's a whole lot of medicine that is practiced in the gray zone," where social influences matter as much as clinical findings, Kravitz said.