Patients may assume their doctors are intimately familiar with the drugs they prescribe. But doctors are busy people, and scanning the ads in medical journals is a quicker way to keep abreast of new treatments than poring over data from clinical trials. Various studies have found that ad campaigns help determine how doctors treat their patients. The new findings are enough to make you wish it weren’t true. Starting from the debatable assumption that prescription-drug ads should be more trustworthy than, say, toothpaste promotions, the UCLA researchers asked experts from appropriate fields to rate 109 ads in terms of educational value, scientific rigor and compliance with FDA standards. Rather than critiquing particular ads, the study simply tallied the experts’ verdicts. Of the 109 ads reviewed, 100 contained “deficiencies in areas for which the FDA has established explicit standards for quality.”
The FDA requires that advertisers present a “fair balance” when describing a drug’s risks and benefits. The rules bar erroneous statistics, misleading headlines or graphics and claims that aren’t supported by the scientific literature. Forty percent of the ads reviewed in the study failed the “fair balance” test, by exaggerating a drug’s benefits or downplaying its known hazards. In addition, 30 percent cited statistics from “inconclusive, dissimilar, or poorly designed studies” and 30 percent included misleading graphs or tables.
If doctors scrutinized the fine-print addendums that accompany prescription drug ads, such excesses would matter less. The addendums, drawn from FDA-approved package inserts, describe dangers and limitations. But the ads themselves seem to carry more weight. When they carry unfounded claims, says Dr. Michael Wilkes, the internist who led the new study, “drugs get used inappropriately, and expensive drugs displace cheap ones that are just as effective.” Jeff Trewhitt, spokesman for the Pharmaceutical Manufacturers’ Association, declines to comment on Wilkes’s findings. But he denies there is any cause for concern. " The FDA has stringent regulations," he says, “and it vigorously monitors drug advertising to ensure compliance.”
FDA Commissioner David Kessler writes in an editorial published with the UCLA study that the agency has recently tightened its scrutiny of journal ads and other prescription drug promotions, and “taken action where warranted.” Yet Kessler concedes that “enormous potential exists for misleading advertisements to reach the physician and influence prescribing decisions.” Agency staffers actively screen only 10 to 20 percent of all drug promotions, says Dr. Cheryl Graham, acting director of the FDA’s Division of Drug Marketing. Graham estimates that half of the journal ads screened violate FDA standards-and she says journal ads are among drug companies’ more reliable promotions. The industry may be satisfied with that record, but doctors shouldn’t be.
