ABSTRACT
BACKGROUND
While statin drugs are recommended for secondary prevention of coronary heart disease (CHD), there is no medical consensus on whether or not a statin should be added to lifestyle change efforts for primary prevention of CHD. Previous research suggests that exposure to direct-to-consumer advertising (DTCA) increases drug demand among those at comparatively low risk. Research has yet to examine whether individual-level DTCA exposure may influence statin use among men and women at high, moderate, or low risk for future cardiac events.
OBJECTIVE
To determine the relationship between estimated exposure to DTCA for statin drugs and two clinical variables: diagnosis with high cholesterol and statin use.
DESIGN
We used logistic regression to analyze repeated cross-sectional surveys of the United States population, merged with data on the frequency of DTCA appearances on national, cable, and local television, between 2001 and 2007.
PARTICIPANTS
American adults (n = 106,685) aged 18 and older.
MAIN MEASURES
Levels of exposure to statin DTCA, based on ad appearances and TV viewing patterns; self-reports of whether or not a respondent has been diagnosed with high cholesterol, and whether or not a respondent took a statin in the past year.
KEY RESULTS
Adjusting for potential confounders, we estimate that exposure to statin ads increased the odds of being diagnosed with high cholesterol by 16 to 20 %, and increased statin use by 16 to 22 %, among both men and women (p < 0.05). These associations were driven almost exclusively by men and women at low risk for future cardiac events. There was also evidence of a negative association between DTCA exposure and statin use among high-risk women (p < 0.05)
CONCLUSIONS
This study provides new evidence that DTCA may promote over-diagnosis of high cholesterol and over-treatment for populations where risks of statin use may outweigh potential benefits.
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REFERENCES
Miniño AM, Murphy SL, Xu J, Kochanek KD. Deaths: final Data for 2008. National Vital Statistics Reports; vol 59 no 10. Hyattsville, MD: National Center for Health Statistics; 2011.
National Heart, Lung and Blood Institute (NHLBI). High Blood Cholesterol: what You Need to Know. NIH Publication 05–3290. Washington, DC: US Department of Health and Human Services. Available at: http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm. Last accessed January 16, 2013.
US Preventive Services Task Force (USPSTF). Screening for Lipid Disorders in Adults: Recommendation Statement. Rockville, MD: US Preventive Services Task Force. Available at: http://www.uspreventiveservicestaskforce.org/uspstf08/lipid/lipidrs.htm. Last accessed January 16, 2013.
Blaha MJ, Nasir K, Blumenthal RS. Statin therapy for healthy men identified as :“increased risk”. JAMA. 2012;307(14):1489–90.
Redberg RF, Katz MH. Healthy men should not take statins. JAMA. 2012;307(14):1491–2.
National Cholesterol Education Program (NCEP). Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (adult treatment panel III). Washington, DC: US Department of Health and Human Services. Available at: US Department of Health and Human Services. Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm. Last accessed January 16, 2013.
Donohue J. A history of drug advertising: the evolving roles of consumers and consumer protection. Milbank Q. 2006;84(4):659–99.
Donohue JM, Cevasco M, Rosenthal MB. A decade of direct-to-consumer advertising of prescription drugs. N Engl J Med. 2007;357(7):673–81.
Holmer AF. Direct-to-consumer advertising—strengthening our health care system. N Engl J Med. 2002;346(7):526–8.
Liu Q, Gupta S. the impact of direct-to-consumer advertising of prescription drugs on physician visits and drug requests: Empirical findings and public policy implications. Int J Res Market. 2011;28:205–17.
Frosch D, Grande D, Tarn DM, Kravitz RL. A decade of controversy: balancing policy with evidence in the regulation of prescription drug advertising. Am J Pub Health. 2010;100(1):1–32.
Macias W, Pashupati K, Lewis LS. A wonderful life or diarrhea and dry mouth? Policy issues of direct-to-consumer drug advertising on television. Health Comm. 2007;22(3):241–52.
Woloshin S, Schwartz LM, Tremmel J, Welch HG. Direct-to-consumer advertisements for prescription drugs: what are Americans being sold? Lancet. 2001;358(9288):1141–6.
Robinson AR, Hohmann KB, Rifkin JI, et al. Direct-to-consumer pharmaceutical advertising: physician and public opinion and potential effects on the physician-patient relationship. Arch Intern Med. 2004;16(4):427–32.
Weissman JS, Blumenthal D, Silk AJ, Zapert K, Newman M, Leitman R. Consumers’ reports on the health effects of direct-to-consumer drug advertising. Health Aff (Milwood). 2003;W3(Suppl Web Exclusives):82–95.
Rosenthal M, Berndt E, Donohue J, et al. In: Cutler DM, Garber AM, eds. Demand Effects of Recent Changes in Prescription Drug Promotion. Frontiers in Health Policy Research, vol. 6. Cambridge: MIT Press; 2003.
Donohue J, Berndt E. Effects of direct-to-consumer advertising on medication choice: the case of antidepressants. J Pub Policy Mark. 2004;23(2):115–27.
Iizuka T, Jin GZ. The effects of prescription drug advertising on doctor visits. J Econ Manag Strat. 2005;14(3):701–27.
Block A. Cost and benefits of direct-to-consumer advertising: the case of depression. Pharmaeconomics. 2007;25(6):511–21.
Wonsinska M. Direct-to-consumer advertising and the demand for pharmaceutical products. J Mark Res. 2005;42(3):323–32.
Avery RJ, Kenkel D, et al. Public profits and public health: does advertising smoking cessation products encourage smokers to quit? J Polit Econ. 2007;115(3):447–81.
Avery RJ, Eisenberg M, Simon KI. The impact of direct-to-consumer television and magazine advertising on antidepressant use. Health Econ. In press.
Parnes B, Smith PC, et al. Lack of impact of direct-to-consumer advertising on the physician-patient encounter in primary care: aSNOCAP report. Ann Fam Med. 2009;7(1):41–6.
Spence MM, Teleki SS, et al. Direct-to-consumer advertising of Cox 2 inhibitors: effects on appropriateness of prescribing. Med Care Res Rev. 2005;62:544–59.
Kravitz RL, Epstein RM, et al. Influence of patients’ requests for direct-to-consumer advertised antidepressants: a randomized controlled trial. JAMA. 2005;293(16):1995–2002.
Gilbody S, Wilson P, Watt I. Benefits and harms of direct to consumer advertising: a systematic review. Qual Saf Health Care. 2005;14:246–50.
Mintzes B. Advertising of prescription-only medicines to the public: does evidence of benefit counterbalance harm? Annu Rev Pub Health. 2012;33:259–77.
Simmons National Consumer Survey. Available at: http://www.experian.com/simmons-research/consumer-study.html. Last accessed January 16, 2013.
Kantar Media. Available at: http://kantarmediana.com/intelligence. Last accessed Jaunary 16, 2013.
US Centers for Disease Control and Prevention (CDC). Cholesterol: facts. Atlanta, GA: US Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/cholesterol/facts.htm. Last accessed January 16, 2013.
Stagnitti MN. Statin Use Among Persons 18 and Older in the U S: Civilian Non-Institutionalized Population Reported as Receiving Medical Care For The Treatment Of High Cholesterol, 2002. Statistical Brief #95. Rockville, MD: Agency for Healthcare Research and Quality. 2005. Available at: http://meps.ahrq.gov/mepsweb/data_files/publications/st95/stat95.pdf. Last accessed January 16, 2013.
Acknowledgements
The collection of the televised pharmaceutical advertising database used in this study was supported from NIH Grant No. 1 R01 CA113407-01A1 and a grant from the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation. The project was expanded to include ads for other prescription drug products, with support from an unrestricted educational grant to Cornell University from the Merck Company Foundation, the philanthropic arm of Merck & Co. The funders played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Potential Conflict of Interest Disclosure
The project was supported by an unrestricted educational grant to Cornell University from the Merck Company Foundation, the philanthropic arm of Merck & Co.
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Niederdeppe, J., Byrne, S., Avery, R.J. et al. Direct-To-Consumer Television Advertising Exposure, Diagnosis with High Cholesterol, and Statin Use. J GEN INTERN MED 28, 886–893 (2013). https://doi.org/10.1007/s11606-013-2379-3
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DOI: https://doi.org/10.1007/s11606-013-2379-3