An innovative approach to educating medical students about pharmaceutical promotion.

Prescription drugs comprise approximately 9% of the total cost of health care in the United States. The manner in which doctors obtain information about new and changing pharmaceuticals obviously has the potential to have a profound impact on health care costs, pharmaceutical companies' profits, and the quality of health care. Patterns learned in medical school undoubtedly influence physicians' future behaviors. The authors describe an educational program, in which university pharmacists portrayed pharmaceutical company representatives to model a promotional presentation, that they designed to generate critical thinking among third-year medical students regarding the influence of pharmaceutical representatives on the prescribing practices of physicians. The authors also provide information suggesting that the program increased the uncertainty many students felt about the accuracy and ethics of standard drug "detailing."

The educational value of consumer-targeted prescription drug print advertising.

BACKGROUND: The case for direct-to-consumer (DTC) prescription drug advertising has often been based on the argument that such promotions can educate the public about medical conditions and associated treatments. Our content analysis of DTC advertising assessed the extent to which such educational efforts have been attempted. METHODS: We collected advertisements appearing in 18 popular magazines from 1989 through 1998. Two coders independently evaluated 320 advertisements encompassing 101 drug brands to determine if information appeared about specific aspects of the medical conditions for which the drug was promoted and about the treatment (mean kappa reliability=0.91). We employed basic descriptive statistics using the advertisement as the unit of analysis and cross-tabulations using the brand as the unit of analysis. RESULTS: Virtually all the advertisements gave the name of the condition treated by the promoted drug, and a majority provided information about the symptoms of that condition. However, few reported details about the condition's precursors or its prevalence; attempts to clarify misconceptions about the condition were also rare. The advertisements seldom provided information about the drug's mechanism of action, its success rate, treatment duration, alternative treatments, and behavioral changes that could enhance the health of affected patients. CONCLUSIONS: Informative advertisements were identified, but most of the promotions provided only a minimal amount of information. Strategies for improving the educational value of DTC advertisements are considered.

A comparative study of measures to evaluate medical students' performance.

PURPOSE: To assess how new National Board of Medical Examiners (NBME) performance examinations--computerbased case simulations (CBX) and standardized patient exams (SPX)-compare with each other and with traditional internal and external measures of medical students' performances. Secondary objectives examined attitudes of students toward new and traditional evaluation modalities. METHOD: Fourth-year students (n = 155) at the University of California, Los Angeles, School of Medicine (including joint programs at Charles R. Drew University of Medicine and Science and University of California, Riverside) were assigned two days of performance examinations (eight SPXs, ten CBXs, and a self-administered attitudinal survey). The CBX was scored by the NBME and the SPX by a NBME/Macy consortium. Scores were linked to the survey and correlated with archival student data, including traditional performance indicators (licensing board scores, grade-point averages, etc.). RESULTS: Of the 155 students, 95% completed the testing. The CBX and the SPX had low to moderate statistically significant correlations with each other and with traditional measures of performance. Traditional measures were intercorrelated at higher levels than with the CBX or SPX. Students' perceptions of the various evaluation methods varied based on the assessment. These findings are consistent with the theoretical construct for development of performance examinations. For example, to assess clinical decision making, students rated the CBX best, while they rated multiple-choice examinations best to assess knowledge. CONCLUSION: Examination results and student perception studies provide converging evidence that performance examinations measure different physician competency domains and support using multipronged assessment approaches.

Direct-to-consumer prescription drug advertising, 1989-1998. A content analysis of conditions, targets, inducements, and appeals.

BACKGROUND: We conducted a content analysis of consumer-targeted prescription drug advertisements to explore trends in prevalence, shifts in the medical conditions for which drugs are promoted, reliance on financial and nonmonetary inducements, and appeals used to attract public interest. METHODS: We collected the drug advertisements appearing in 18 consumer magazines from 1989 through 1998. Two judges independently coded each advertisement and placed it in a category pertaining to the target audience, use of inducements, and product benefits (mean kappa=0.93). We employed descriptive statistics, cross-tabulations, and curve estimation procedures. RESULTS: A total of 320 distinct advertisements were identified, representing 101 brands and 14 medical conditions. New advertisement and brand introductions increased dramatically during this decade. Advertisements for drugs used for dermatologic, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and obstetric/gynecologic conditions were most common. Almost all of the advertisements were aimed at the potential user of the drug, not third-party intermediaries such as parents and spouses. Although most advertisements were gender-neutral, women were more likely to be exclusively targeted. One eighth of the advertisements offered a monetary incentive (eg, a rebate or money-back guarantee), and one third made an offer of additional information in printed or audio/video form. The most common appeals used were effectiveness, symptom control, innovativeness, and convenience. CONCLUSIONS: Consumer-directed prescription drug advertising has increased dramatically during the past decade. The pharmaceutical industry is turning to this type of advertising to generate interest in its products. Our data may be useful to physicians who want to stay abreast of the treatments that are being directly marketed to their patients.

Direct-to-consumer prescription drug advertising: trends, impact, and implications.

We provide an overview of what is known about the impact of direct-to-consumer (DTC) advertising of prescription drugs. Specifically, we explore the historical trends that led to the industry's increasing use of this form of promotion. Then, using the published literature to date, we review the impact of DTC advertising on the consumer, the medical profession, and the health care system. We conclude by offering policy suggestions for how the pharmaceutical industry can promote its products more responsibly, how the Food and Drug Administration (FDA) can regulate DTC advertising more effectively, and how the medical and public health communities can educate the public about drug therapies more constructively.