July 18, 2001 -- When Americans visit their doctors they are likely to walk away with at least one prescription, and often that prescription is for a new, high-priced, well-advertised drug, according to a new report from the CDC.
In 1999, the most recent year for which data are available, doctors wrote 1.1 billion prescriptions, says Donald Cherry, MS, a CDC survey statistician and author of the new report. And going back to 1985, the survey shows the average number of prescriptions per doctor's visit has increased by a third.
When the CDC looked at just 104 new drugs that were approved by the FDA from 1997 to 1999, it found that 42.4 million prescriptions were written for new drugs, with drugs for arthritis, depression, asthma, and erectile dysfunction topping the list of most frequently prescribed new drugs.
Cherry tells WebMD that "our data don't really speak directly [to advertising]. ... I just know that these [drugs] that are heavily marketed do come out on top." He says that it seems "marketing does increase awareness of new drugs on the part of the patients and the doctors."
That "awareness" is so increased that patients often come to doctors with the specific purpose of requesting new drugs says Michael Wilkes, MD, a professor of medicine at UCLA. "About three times a day a patient comes with an ad in his pocket or her purse," says Wilkes who has authored several studies that are critical of new drug advertising.
Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, a drug industry trade group, tells WebMD that doctors are writing more prescriptions because "we have more medicines and better medicines." Disagreeing with critics of direct-to-consumer advertising, Trewhitt says the ads help empower patients to make more informed health decisions.
In the CDC report the most frequently prescribed drug was the allergy drug Claritin while the most frequently prescribed new drug was Celebrex. After Celebrex the top 11 new drugs were: Raxar, a powerful antibiotic, Celexa, an antidepressant, Viagra, for treating erectile dysfunction, Vioxx, an arthritis drug, Singulair, an asthma drug, Rezulin, a diabetes drug, which was withdrawn from the market, Avapro, a blood pressure drug, Detrol, for urinary control, Plavix, a blood thinner, and Flomax, a blood pressure drug used to symptoms of enlarged prostate.
Wilkes says the new report is especially timely in that Congress is making noises about considering adding a prescription drug benefit to Medicare. "When you talk about a drug benefit, you have to talk about effective vs. ineffective drugs," says Wilkes.
In general Wilkes is unconvinced about the value of most new drugs because he says that although the FDA approves dozens of new drugs each year, only "four to eight drugs truly offer a therapeutic advantage." The rest, he says, are 'me-too' drugs that ape the actions of already approved drugs but can be offered a much higher price because they are new. It is these drugs, Wilkes says, that are among the most heavily marketed.
The notion that the pharmaceutical industry is mainly devoted to producing so-called 'me-too' drugs is wrong, says Trewhitt. For example, he says that a third of drugs currently under development are "new biotechnology agents."
The other two-thirds of drugs in the pipeline "still involve conventional chemical compounds but calling them 'me-too' drugs is inaccurate," says Trewhitt. Over time, drug companies learn more about existing drugs, and each new drug in an existing class "involves some improvement." He points out that medicine involves "incremental knowledge and with the introduction of each new drug in a class more is learned about fighting disease."
Cherry says that the CDC survey, called the National Ambulatory Medical Care Survey, is based on a representative sample of patient records from more than 1,700 physician practices. He says that there were more than 750 million doctor visits in 1999, which works out to about 279 visits per 100 Americans.
As might be expected, older Americans visit doctors more often than younger people, and on average those 65 and older saw their doctors about six times during the year, which is an increase of 20% from the 1985 rate for visits by elderly patients.
Moreover, says Cherry, the elderly were more likely to leave the visit with multiple prescriptions, and they were six times more likely to have a prescription for a newly approved drug than were younger patients.
Wilkes explains this phenomenon this way: "Nothing is a more powerful incentive to a physician than a patient who comes in asking for a prescription." If a physician refuses the request, "the patient thinks the doctor is being cheap, and he or she goes to find another doctor."
He says, "This is a very difficult situation, trying to just say no to a silly drug. The doctor can spend the time, maybe 10 minutes or so, re-educating the patient about the drug or the doctor can spend 30 seconds writing a [prescription] for the drug and then moving on to the next patient."
Wilkes says that based on the CDC report, it appears that many doctors are opting for the 30-second solution.