DTCA can lead patients to both overestimate a drug’s potential benefits and underestimate its risks. “It’s not hard to understand why,” said Vinay Rathi, MD, MBA, chief resident of otolaryngology–head and neck surgery, at Massachusetts Eye and Ear. “Televised prescription drug ads often feature smiling patients stepping out into a brightly lit world surrounded by loved ones. This type of marketing often discusses potential harms as an afterthought in rushed voiceovers.”
Explore This Issue
December 2022DTCA in Otolaryngology
DTCA can have both positive and negative aspects. Favorable outcomes include empowerment and promotion of autonomy among patients, avoidance of low-value clinical encounters, self-directed education, and decreased healthcare expenditures, said Edward McCoul, MD, MPH, professor and vice chair in the department of otorhinolaryngology at the Ochsner Clinic in New Orleans. This is balanced by potential concerns including the lack of rigorous regulation of OTC drugs, the burden of self-diagnosis, the risk of unsupervised use resulting in adverse effects or drug interactions, and redistributing pharmacy costs to consumers (Laryngoscope. 2020;130:2114–2119).
Douglas D. Reh, MD, director of clinical research at Centers for Advanced ENT Care, LLC, in Baltimore, said that DTCA can give the drugs that he prescribes credibility with patients. Considering the record amount of money spent on advertising Dupixent, he says it’s not surprising that Dupixent is the top drug that his patients ask about.
On the downside, Amber Luong, MD, PhD, professor and vice chair for academic affairs in the department of otorhinolaryngology–head and neck surgery and Center of Immunology and Autoimmune Diseases at the Institute of Molecular Medicine, McGovern Medical School at UTHealth in Houston, said that DTCA may heighten patients’ expectations for a drug. “A lot of DTCA for respiratory drugs includes phrases such as ‘improves nasal congestion’ and ‘helps you breathe.’ Patients may not know how much improvement to expect,” she said.
Providers should educate patients on why they did or didn’t prescribe a drug initially or why it may or may not be the right treatment for them. —Marc G. Dubin, MD
DTCA is used for prescription drugs and much more. Regarding otolaryngology procedures, according to Medicare Part B national summary data files, there was a 468% increase from 2011 to 2017 in the number of balloon dilations performed annually in the United States. “It wouldn’t surprise me if this was at least partly a result of DTCA, given the increase in patient questions regarding balloon dilation at my practice,” said George A. Scangas, MD, an assistant professor of otolaryngology–head and neck surgery and a physician and surgeon at Massachusetts Eye and Ear.