Doctors Prescribe Medicines that May Not Be Best for Patients

When it comes to choosing which medications to prescribe, patients may have as much influence as physicians, a study has found.

Researchers said that that patient requests for specific medications—often spurred by direct-to-consumer (DTC) advertising—have a substantial impact on doctors' prescribing decisions.

"A patient request for a specific medication dramatically increases the rate at which physician s prescribe that medication," said lead researcher John B. McKinlay, PhD, of New England Research Institutes, Watertown, Mass.

The researchers, whose findings were published in the journal Medical Care, added that the results show the potential negative influence of DTC advertising.

For the study, the researchers designed an experimental model to evaluate the effects of patient requests for specific medications. They made videos in which professional actors portrayed patients with two common, painful conditions: sciatica, causing back and leg pain. or osteoarthritis, causing knee pain.

Half of the sciatica patients with sciatica specifically requested oxycodone, a strong narcotic painkiller; while half of the patients with knee arthritis requested the prescription drug Celebrex. The other half of patients requested "just something to make it better."

The patients requesting oxycodone said they had tried their spouse's leftover medication; those requesting Celebrex said they saw it advertised, and that a co-worker took it and said it helped.

Then, the video scenarios were randomly shown to 192 primary care physicians who asked a series of questions about what treatment they would recommend.

The results suggested that the patient requests for drugs had a strong effect on recommended treatments. About 20 percent of sciatica patients requesting oxycodone would receive it, compared to one percent of those making no specific request. Strong narcotic pain relievers such as oxycodone are generally not recommended for sciatica, particularly for a new case.

About half of knee arthritis patients requesting Celebrex would receive that drug, compared to one-fourth of those requesting no specific medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Celebrex are recommended for treatment of knee arthritis.

But Celebrex is a "selective" NSAID that is much more expensive than other options, with no additional benefit.

Even if they didn't receive the specific drug they requested, treatment patterns differed for patients who made active requests. "Patients requesting oxycodone were more likely to receive a strong narcotic and less likely to receive a weak narcotic," according to Dr McKinlay and colleagues. "Patients requesting Celebrex were much less likely to receive a non-selective NSAID."

The findings add to concerns over the potential safety and economic impact of prescription drug requests driven by DTC advertising. The United States is one of only two countries that permit DTC advertising for prescription drugs.


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