Consumer advertising and doctors' prescribing

Editor—The most interesting result from the study reported by Gottlieb is not that patients' requests influence the choice of treatment, which is good to hear, but that minimal acceptable care was given in only 56% of cases where the patient made no request for drugs (general or specific).¹ Given type 1 and type 2 errors,² advertising directly to consumers seems to help to generate correct treatment more than it leads to incorrect treatment (inappropriate choice of drug).

My immediate reaction is not to recommend advertising directly to consumers (there are far too many caveats to be applied) but to query why clinicians needed to be prompted to provide a minimal level of care. This is not to pillory doctors, who have much to contend with (including “standard patients”), but to consider whether we need improvements in the use of care protocols and decision-support systems to improve the quality and consistency of care.

McAll's comment (previous letter) about the harmlessness of the condition may imply that doctors take a very “medical” view of the problem without considering the impact on the social life and sense of wellbeing of the patient. The drug treatment is probably not the best choice as a first option, but neither is ignoring the condition as “harmless,” especially when patients have clearly gone to some trouble to find out about their condition before bothering their doctor.

Being “empowered” by information may enable patients to push for the treatment they need. Doctors too need to be empowered by information about best practice and effective alternative treatments, as well as having ready information to give to patients to support their recommendations.