Director, Medicaid Research Center and Co-Director, Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh Graduate School of Public Health
Dissertation Title: "Pharmaceutical Promotion in an Age of Consumerism"
This thesis examines the effects of direct-to-consumer advertising (DTCA) and traces the evolution of pharmaceutical promotion and its regulation by the Food and Drug Administration (FDA) throughout the 20th century. The thesis sheds light on the role of consumers in medical decision-making, and consumerism in affecting public policy in health care.
The first chapter examines the impact of pharmaceutical promotion to consumers and physicians on public health. Specifically, it assesses the effect of promotion of antidepressants on (1) the likelihood that someone diagnosed with a new episode of depression received medication, and (2) whether antidepressant medication was provided for the appropriate duration. We assessed the association between variation in spending on pharmaceutical promotion for antidepressants and patterns in the treatment of depression. DTCA was associated with an increase in the number of people with depression who initiated medication therapy and a small increase in the number of individuals treated with antidepressants who received the appropriate duration of therapy. Promotion to physicians was not associated with either the initiation of treatment with an antidepressant or with the duration of therapy.
The second chapter examines the impact of pharmaceutical promotion on medication choice in the antidepressant market. We assessed the association between variation in spending on pharmaceutical promotion for antidepressants and choice of antidepressant observed at the individual level. We found no effect of DTCA on drug choice, except for individuals diagnosed with anxiety disorders who were slightly more likely to fill prescriptions for advertised drugs. Pharmaceutical company spending on detailing to physicians was positively and significantly associated with an increase in a drug's choice probability even after controlling for other factors likely to affect medication selection.
The third chapter traces DTCA through three periods of consumer involvement in health care. Consumer-directed pharmaceutical promotion dominated the first period of self-medication when most medicines were available without prescription. During the second period of patient dependence and physician autonomy, pharmaceutical promotion was exclusively focused on physicians. The trend toward greater consumer involvement in the third period of consumer empowerment is related to recent changes in pharmaceutical marketing strategies and FDA regulation of drug advertising.