New Study Links DTC and Increased Statin Use
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?Society makes an economic and risk/reward decision on all such preventive care.? |
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A study published in the Journal of General Internal Medicine concluded that statin DTC ads raised diagnosis of high cholesterol by 16-20% and statin use by 16-22%. The study authors, from Cornell University, concluded that DTC may promote over-diagnosis and drug use. Their reasoning is based on the fact that the medical community is divided on whether statins should be used for everyone with high cholesterol rather than the highest risk populations.
I am not here to debate the issue of whether statins are overused. Physicians make their own determinations on a case by case basis whether statin therapy is needed. The fact that advertising led to more diagnosis should not be a cause for concern. Is it a bad thing that more consumers were motivated by the advertising to get cholesterol screenings?
Is it bad that once diagnosed physicians prescribed these drugs? Are the study authors implying that DTC caused the physicians to over-prescribe? It seems they are blaming DTC for increases in statin use. I am aware that most people using statins would not have a heart attack if they did not take them. That is the unfortunate fact of prevention. We do not know who will get the heart attack so we treat the many to prevent a few heart attacks. It is true that some of those people who would not benefit get side effects from the statins.
This is an issue with all prevention efforts. Society makes an economic and risk/reward decision on all such preventive care. DTC may raise the number treated and in fact that is the goal of advertisers. We rely, however, on the physician community to decide the risk/benefit of such a preventive medicine.
There is no doubt drug companies sell more pills when they treat a wide population of sufferers and there is no way to predict in which patients they will truly prevent disease. That is true with many medications for chronic disease such as high blood pressure, stroke prevention, and obesity. We just do not know who would have survived without incident if they did not take the pills. We do know, however, the huge costs of treating a heart attack and stroke. Therefore we all make a calculation whether the drugs are worth it to us even if the percent benefiting is low.
DTC marketers expect more people to use their advertised drug than they would without the media investment. The conclusion that about 20% more people responded to the DTC effort is further confirmation that DTC works. Critics of DTC have every right to debate the societal impact of DTC in terms of cost and side effects. In this case, the study conclusion, that these increases may prove over prescribing, is a stretch. Much more study is needed to decide cost/benefit of widely used drugs. The fact that DTC ads do what they are supposed to do in terms of disease awareness and eventual use is no surprise.
Over time we as a society will determine how to spend their budget allocation to health care. Effectiveness panels will be increasingly used and drug makers will be under intense pressure to compare their drug with other lower cost therapies. In fact DTC will be a great tool for lower cost and equally effective pills to make their case to consumers.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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