Drug advertising, response shift in patients with hypertension, and medication error interception

Abstract

concluded that dif- ferences in the Food and Drug Administra- tion (FDA) and Federal Trade Commission (FTC) regulation of advertising affected the balance of risk and benefit informa- tion that appeared and the specificity of risk information available. Adequacy of information about a pharmaceutical prod- uct after switching from legend to over- the-counter (OTC) status is an important public health issue. Information abstract- ed from pre-and postswitch advertise- ments for loratadine (Claritin—Schering- Plough), cetirizine (Zyrtec—McNeil-PPC), and omeprazole (Prilosec—Procter & Gamble) was evaluated. Information was abstracted from 2,002 ads obtained from the Vanderbilt Television News Archive. Ads for the legend product were sig- nificantly longer than those for the OTC products. Compared with OTC advertise- ments, prescription ads had fewer asser- tions about the product's benefit and more about its risks, possibly because of their longer length. When equal length ads were examined, prescription ads had an equal number of assertions about the products' benefits and risks (1.5 vs. 1.8, P > 0.05) but OTC ads had significantly more as- sertions about benefits versus risk (6.6 vs. 1.2, P < 0.001). Moreover, toll-free numbers and Internet URLs were found more frequently in prescription (97% and 100%, respectively) than OTC (4% and 10%) ads. Implications. For instances in which the product must be prescribed by a health professional, the benefit-to-risk assertion ratio in ads was equal. In the case of OTC ads, where patients are left to their own devices to correctly interpret the mes- sage, the benefit-to-risk assertion ratio is heavily unbalanced toward the benefits. Pharmacists are among the most acces- sible and trusted of professionals. When it comes to self-care decisions based on pro- motional information for these products, pharmacists' counsel may be essential to offset an unbalanced presentation of ben- efit-to-risk information. Response shift in patients with hypertension Gandhi et al. 2 found that some hyperten- sive patients with CAD (coronary artery disease) experienced a response shift over a 1-year period in their physical functioning (n = 909). Recalibration re- sponse shift is based on changes in one's internal standards and not necessarily objective evidence. In the case of physi- cal functioning, the individual's standard of performance for important life tasks may be lowered for health reasons. Self- reported physical functioning was mea- sured using mailed surveys containing items from SF-36 at both baseline and 1 year later. Response shift was assessed using structural equation modeling sta- tistical techniques. Some patients recali- brated perceptions of their health, most likely because they changed their idea of how their health limited their physi- cal activity (e.g., walking, climbing stairs). Implications. After starting treat- ment, how many of you have asked a pa- tient, are you feeling? How do you explain it when the patient replies much better when they can't walk up a flight of stairs without gasping for breath? Are they lying? Identifying response shift is impor- tant to effectively monitoring health out- comes because patients may adjust their perceptions of the benefits of treatment or disease progression to maintain a sense of optimism or protect their self-image. Medication error interception