Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [10]
The study concluded that the large majority of TV ads fail to fulfill an educational purpose. There was not sufficient information about the causes of the health problem, how common it is among different patient groups, who might actually benefit from the treatment, and how meaningful that benefit may be. Nonetheless, such drug advertisements clearly work, at least from the point of view of sales: Every $1,000 spent on advertising translated into twenty-four new prescriptions, according to an analysis by the House Energy and Commerce Committee.
Another illuminating study conducted by researchers at the Dartmouth Institute for Health Policy and Clinical Practice examined the impact of printed drug ads on patient preferences. The research trial involved more than five hundred adults. One group was given actual ads. A second group received the same ads, except that the brief summary at the end of the text was replaced by a “drug facts box.” The box presented information in a clear, accessible fashion, similar to the way we recalculated the benefits and risks of a statin for Susan. Participants in the study came from across the United States and, except for a slightly higher number of women, largely reflected the country’s demographic diversity. The ad for a statin showed a smiling woman who seemed to be about Susan’s age walking briskly in the rain, holding an umbrella that protected her from the downpour. The image clearly communicated the message that statin therapy was a shield prudent people used to protect them—in this case, from a heart attack.
The results of the Dartmouth research are impressive. Nearly two-thirds of the group that saw the original ads and therefore relied on information framed by the drug company dramatically overestimated the benefits of the treatment. They believed it was ten times more effective than it actually was. But nearly three-quarters of the participants who saw the information in the drug facts box correctly assessed the actual benefits of the treatment.
Even more striking was another finding. When people were given readily understandable information about the statin’s actual benefit in preventing future heart disease, nearly twice as many said they wouldn’t take the drug in light of its side effects. This was an unexpected finding and contrary to conventional wisdom, the assumption that people do not act the way experts contend is “rational” because of a lack of clearly understandable information. Experts assumed that once a patient was “informed” accurately and completely about a medication, he or she would choose the treatment option that the experts saw as “best,” in this case taking the medication. But in the Dartmouth study, this was not what happened. When given clearer information, the patients weighed the risks and benefits differently from the experts and were less likely to take the medication.
Loss aversion, the reluctance to risk side effects for what is perceived to be a small future benefit, becomes more powerful for many people in the setting of more understandable information. The Dartmouth research shows that Susan is not an outlier in declining statin therapy after learning all the numbers.
Not long after Susan saw the primary care physician, her employer changed the company’s health insurance plan, and she had the option to find another doctor who accepted her new coverage. She chose Dr. Jacques Carter, who practices at our hospital. For the past four years, he has been her internist. He’s a tall, broad-shouldered man in his early sixties, with a ready smile. He told us that he likes to begin with banter before raising the contentious issue of statin treatment with a patient like Susan.
“Gee, I think I see something that looks familiar,” Carter said at her most recent visit.
Susan laughed.
“Your blood tests show that your cholesterol is still high.” Carter looked squarely at Susan.