News flash: Drug ads work
“To conduct the study, Richard Kravitz, director of primary-care research at the University of California, Davis, in Sacramento, Calif., hired a group of women actors to mimic different forms of depression and to make various requests of physicians during unscheduled visits.

The actors made a total of 298 visits to 152 doctors’ offices in Rochester, N.Y., San Francisco and Sacramento.

When they made a general request for drugs, saying they had seen a TV segment on depression, the pretend patients left the office with a prescription for their feigned condition 76 per cent of the time. When they asked for the heavily advertised antidepressant Paxil by name, they were prescribed that specific drug 53 per cent of the time. And when the mock patients made no request for drugs, they were nonetheless prescribed an antidepressant 31 per cent of the time.”

No surprise here. Consider a common scenario: you are a primary-care physician that has appointments every 15 minutes. You running behind schedule and patients in the waiting room are starting to complain. There are 20 messages on your desk that have yet to be seen. Phones are ringing off the hook – the hospital is calling for you for another admission. Your next patient comes in and says “I have depression and want Paxil”. Now you have two options:

1) Discuss with the patient how psychotherapy and counseling can be as effective as medication. If medication is needed, you can further discuss that generic fluoxetine or citalopram is just as good. After 20 minutes of discussion, the patient leaves angry at not getting what they saw on TV and leaves. Most likely, they will find another physician who will prescribe what they want. The doctor has now lost a patient, feels that all that time was wasted, and falls further behind schedule. Patients in the waiting room start to leave because of the wait.

2) Screen the patient for depression. Give Paxil. Move on to the next patient on time. Patient is happy. Doctor is happy.

This may seem extreme, but believe me these are the two choices that physicians face every day. Option two looks pretty good most of the time.

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