Saint-John’s-wort is an herb that has been used since ancient times for treating depression. It is available over the counter without a prescription, but its clinical effectiveness for treating depression has been controversial. Studies in Europe have indicated that it is about as good as tricyclic antidepressants in treating mild depression. However, studies in the United States have indicated that this herbal supplement is not effective and should not be used for treating severe depression. Because Saint-John’s-wort is an herb, it is not governed by the FDA, but studies have shown that it interferes with liver enzymes that are critical for the metabolism and actions of other drugs (like HIV medications, cyclosporine and oral contraceptives). Therefore, the FDA has warned consumers not to take Saint-John’s-wort when taking other medications.
Traditionally, pharmaceutical companies have not had direct contact with consumers. Physicians and health care providers would get information about treatments and medications from pharmaceutical representatives, in a process called physician detailing. In 1996, the FDA relaxed the rules on direct-to-consumer advertising of prescription drugs (only the United States and New Zealand allow this practice). Pharmaceutical companies claimed that such advertising would benefit patients by educating them about conditions and available medications, enhancing communication between the primary care provider and the patient. So, you can now see full ads about various prescription medications, including antidepressants, in print media and on television [source: Frosch] estimate that consumers see up to 16 hours of ads for prescription drugs each year). Pharmaceutical companies increased expenditures on DTCA from about $11 billion in 1996 to about $30 billion in 2005.
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DTCA has been a controversial idea. Pharmaceutical companies claim that it helps patient education, but opponents claim that:
- Patients do not receive adequate education (especially in 45-second TV spots)
- In response to inquiries/pressure from patients, physicians are more likely to prescribe expensive name brands when generics or alternate treatments are available.
- The FDA has not enforced regulations regarding the accuracy of DTCA for prescription drugs, especially in TV spots.
The result is higher health care costs for medications without necessarily improving the quality of patient care.
In one study, investigators had groups of actors portray patients with MDD [source: Kravitz et al]. The actors visited more than 150 health care providers in Sacramento, Calif., San Francisco and Rochester, N.Y. In some visits, the actors would describe symptoms and request an advertised antidepressant, and others didn't mention brands or make requests. The investigators found that physicians were more likely to prescribe brand names when the patient requested a brand or when the patient requested a general antidepressant than when the patient made no requests at all. The investigators concluded that patients have a large influence on the prescribing patterns of health care providers when it comes to antidepressants. In contrast, another study concluded that physician detailing had more influence in prescribing name brands than did DTCA [source: Donohue et al]. So, the influence of DTCA remains controversial.
For more information about antidepressants, check out the links on the next page.