One of the key manners in which direct-to-physician advertising of pharmaceuticals can lead to health promotion is in the reduction of malpractice on the part of physicians when it comes to the administering of pharmaceuticals. It is of course the primarily (and ultimately, solely) the physicians' responsibility to ensure the proper and effective use of pharmaceutical products, just as it is their responsibility to ensure that all care practices and interventions are in the best interests of the patient. Pharmaceutical companies have this goal and this responsibility as well, however, and they can be instrumental in making sure that true best interests are served with current knowledge of best practices and new potentials. As advertising is ultimately the provision of information, it can be seen that the direct advertising of pharmaceuticals to physicians can provide more comprehensive, detailed, and current information regarding new products, new uses, and the risks and benefits of specific pharmaceutical agents. The direct advertising constitutes an information-sharing relationship, and arming physicians with better information can only serve to assist them in their quest to achieve the best results for their patients (Schwartz et al., 2009).
While concerns have been raised about direct and even indirect financial relationships between pharmaceutical companies/drug representatives and physicians, it has also been noted that physicians can depend on the information provided by drug representatives to make decisions based on the most current available information (Matthews, 2007; Schwartz et al., 2009). At the same time, not all or even most physicians recognize the level of influence that the information provided by pharmaceutical companies in regards to their products can have on the prescription habits of physicians, though these influences have been measured and reported in numerous studies (Matthews, 2007). Promoting physician awareness of pharmaceutical advertising as a means of gathering relevant information and then consciously applying this information could help them make more effective decisions and provide greater clarity and transparency in the pharmaceutical representative/physician relationship, both of which could lead to greater levels of health promotion in patients and therefore reduced incidence and accusations of malpractice.
Direct-to-physician advertising need not only be utilized in the promotion of more effective pharmaceutical use in terms of encouraging prescription use, but also when it comes to preventing misuse of prescriptions. Off-label prescribing has been a major concern in the medical community and advertising off-label uses has been strictly prohibited by law, and thus any direct-to-physician advertising would necessarily be directed towards encouraging the proper and approved use of pharmacological agents, which would necessarily discourage off-label uses and prescriptions (Klasmeier & Redish, 2011). In this manner, direct-to-physician advertising works to limit potential malpractice claims and accusations as well as truly negative events from both ends, promoting the effective and proper use of medications and defining the limits of use to ensure that medications are not prescribed for situations that they are not suited to. This relates directly to one of the most pressing ways in which direct-to-physician advertising can reduce malpractice: the presentation of research.
Pharmaceutical advertising that appears in medical journals affects malpractice potentials in two primary ways. First, the advertising itself typically contains detailed information about the specific pharmacological agents being advertised, including the results of evaluational research conducted in clinical trials and practice, providing in a concise and widely-read and -- disseminated form all of the information that a physician needs to make a responsible and effective decision based on the information that is currently available (Rotfield & Taylor, 2009). This direct-to-physician advertising is actually far more preferable to direct-to-consumer advertising in terms of ensuring that proper decisions are being made, and that malpractice potentials are being reduced or avoided through the increased knowledge and competence of the decision makers (Nguyen, 2010). Second, the pharmaceutical advertising published in medical journals is a major source of the revenue that these journals need in order to remain operational, and so in a slightly indirect manner the pharmaceutical industry and the direct-to-physician advertising it engages in are responsible for maintaining adequate levels of information flowing within the medical community, which has a profound impact on health promotion and the ability of physicians to reduce malpractice potential through the adoption of best practices (Gagnon & Lexchin, 2008). The research contained in these journals covers all imaginable medical issues and areas, and thus it is clear that direct-to-physician advertising promotes the use of evaluational research in clinical practice.
Cost Analysis in Direct-to-Physician Advertising
There are other ways that direct-to-physician advertising can alter malpractice potentials and otherwise alter physician and overall medical community performance when it comes to prescribing medications. Cost controls are an important feature of medical practice for patients and medical institutions alike, and ineffective prescription, over-prescription, or other unintentional misuses of pharmacological and inefficiencies in prescription practices can lead to overspending and reductions in the cost-effectiveness of medications. Some studies have found that direct-to-physician advertising by pharmacological companies actually lowers prescription costs for physicians, a finding which has several implications (Spurling et al., 2010). First, it can be seen that pharmacological advertising includes information that is at least tangentially related to prescription costs, to a high enough degree to affect physician thinking and decision-making in regards to the writing of prescriptions. Second, the specific findings in regards to this observed cost reductions are not especially wide-spread and could likely be made more significant and more prevalent if a more direct and conscious effort to provide cost analyses in pharmaceutical advertising was made by the pharmaceutical companies (Spurling et al., 2010).
Interestingly, a study of general practice physician outcomes and trends in England found no statistically significant correlation between prescription costs and the quality of patient outcomes; that is, lower prescriptions costs were not consistently associated with a higher overall quality of care and health promotion, nor were they associated with lower qualities of care (Fleetcroft et al., 2011). This suggests that there are a multitude of factors involved in the relationship between prescription cost and health promotion when it comes to pharmaceuticals, with direct implications on direct-to-physician advertising. If advertising has been associated with lower prescription costs but these lower costs are not associated with higher levels of care quality, health promotion, and ultimate outcomes, though, this advertising is not as effective as it potentially could be. To make matters even more pressing, other research has demonstrated that there might actually be a negative correlation between exposure to direct-to-physician advertising and the overall quality of prescribing behaviors in some physicians (Spurling et al., 2010). Though this finding has only emerged in a very small number of studies from a rather large body of research that has examined the issue, it is enough to suggest that more direct attention needs to be paid to associating cost effectiveness with quality outcomes in direct-to-physician advertising, maximizing the potential for increasing health promotion through this method of information provision.
Well-informed physicians are capable of making better and more consistent decisions; this fact is essentially self-evident and is of paramount importance in developing and effectively utilizing direct-to-physician advertising by pharmaceutical companies. Less self-evident but equally important is the observation made in current research that well-informed physicians are more capable of controlling prescription costs in a much more consistent manner than other patient and clinical settings (Aguado et al., 2008). In a comparison of physicians to adjusted clinical groups and other group settings in medical centers, it was found that physicians achieved lower prescription costs than other settings with the same basic level of health promotion and quality of care, meaning that cost benefits can be achieved for patients and fro medical institutions by both making sure that physicians remain well-informed in regards to pharmacological practices and opportunities and that they are given the necessary latitude in decision-making to take full advantage of the knowledge they obtain from various sources. Direct-to-physician advertising can be a significant and meaningful source of this information if it is properly designed and developed, providing clear and concise assessments of costs and needs that might warrant certain prescriptions at higher costs, or even suggesting alternatives that might be cheaper and still appropriate in certain situations.
The increasing prominence of direct-to-consumer advertising by pharmacological companies has implications that encourage the presenting of cost analyses in direct-to -- physician, as well. Though there are both benefits and risks to direct-to-consumer advertising, one of the most consistent features of this advertising that has been noted is the lack of true need and benefit appraisal by consumers when considering pharmacological treatments (Frosch et al., 2010). Physicians are in a much better position to make such appraisals, but are often less directly aware of and concerned with costs than patients. Including cost analysis information in direct-to-physician advertising would help to rectify this difference in awareness and focus and lead to even more effective considerations and decisions by physicians in regards to the cost benefits of utilizing certain prescriptions.
Aguado, A., Guino, E., Mukherjee, B., Sicras, A…. & Moreno, V. (2008). BMC Health Services Research 8(1):…