The Impact of Pharma Info vs. Neutral Info on Patients’ Drug Decisions

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Patients who reviewed an industry-sponsored booklet about a commonly used rheumatoid arthritis drug were twice as likely to choose the proposed therapy as were patients who reviewed similar decision-aid material presented in a neutral manner, according to a recent study.

Richard Martin, MD, MA, professor of medicine, rheumatology, at Michigan State University College of Human Medicine in Grand Rapids, and colleagues evaluated responses to a simulated decision posed in a mail survey sent to patients with rheuma­toid arthritis who had never taken the drug etanercept (Enbrel). Results of the Michigan-based study, which compared effects on patient choice of the industry decision guide with other decision aids, were published in Medical Decision Making.

“They were twice as likely to agree to use the proposed medication, but they knew less,” says Dr. Martin about the patients who reviewed the industry-sponsored material. “So if you’re much more motivated but you know less about the drug, you’ve got to really ask, ‘Well, why are you so motivated?’”

Industry decision aids are booklets or flyers from the drugmaker required by the U.S. Food and Drug Administration to help patients decide whether to take a drug or therapy based on a variety of aspects, including safety, efficacy, risks and benefits. However, the authors argue the pharm booklet studied aims to promote the drug and elicit positive feelings about it.

“The pharm booklet’s effects are partially mediated through persuasive communication techniques that influence patients’ beliefs that symptoms will improve, and increase social normative beliefs, rather than by increasing the relevant knowledge, clarifying patient values about positive or negative treatment outcomes, or increasing their self-efficacy,” states the article.

Dr. Martin sponsored the study and his research team recruited participants from West Michigan Rheumatology, his Grand Rapids-based practice of 2,200 rheumatoid arthritis patients. He chose Enbrel as the test drug because of its frequent use in practice as a first biologic therapy and its complex attributes, which patients are asked to comprehend.

Methods

The single-blind, randomized, controlled study compared three educational interventions given to rheumatoid arthritis patients to help them decide whether to intensify medical therapy by adding etanercept to their current drug regimen. Study participants, who had never taken a disease-modifying anti-rheumatic drug (DMARD) biologic, received and reviewed one decision aid type before answering questions about the drug.

Researchers mailed a survey to 797 patients and just over half (52%) responded. The survey included a cover letter from each patient’s rheumatologist and an anonymous questionnaire.