Direct to Consumer: Perpetuating Prescribing Myths

Misleading language in DTC ads leads to patient confusion and NP/PA frusration.
Sep 01, 2005

David Mittman
DTC advertising has the potential to positively affect its target audience. It can enable people to become educated about diseases and the products that can help them cope or alleviate their conditions. It may even drive them to request a product from their doctor. But DTC can also serve to confuse some consumers. For nurse practitioners (NPs) and physician assistants (PAs), the problem usually lies within the use of these two phrases: "You must see a doctor, because only a doctor can prescribe xxx." Or, "Only a doctor can diagnose xxx."

While 35 years ago these statements were true, today they are not. PAs and NPs, who are collectively known as advanced practice clinicians (APCs), can and do prescribe, often writing 16 to 22 prescriptions each day. Over the last three decades or so, APCs have grown from a few thousand clinicians to more than 170,000. While the majority of them provide primary care services, they practice in nearly every field of medicine.

Demystifying APCs

R. Mimi Clarke Secor
The number of APCs has grown as more and more states have passed prescriptive practice legislation. Both PAs and NPs also can prescribe in the Veteran's Administration Medicine system and in all branches of the US military. As it is, more than 95 percent of APCs can legally prescribe. Only three states currently do not allow APCs to prescribe (Georgia prohibits NPs and Ohio and Indiana prohibit PAs). But all three states expect to introduce legislation this year to allow prescribing.

One of the benefits of allowing APCs to prescribe is to provide increased care for people in rural and underserved areas. In fact, military PAs and NPs are providing a significant amount of emergency and trauma care in Iraq and Afghanistan. While other segments of the medical system have embraced them, NPs and PAs are concerned that pharma marketing companies have not recognized that they too are prescribers.

Average Prescriptions Written Per Week
Even though most states allow APCs to prescribe, many consumers still believe that only doctors can diagnose conditions and prescribe medications. At a minimum, the current DTC ads, through their persistent use of only the term "doctor," are misleading to the public and keep all other prescribers invisible to patients. People are getting mixed messages as to who can prescribe and who can't. These messages fragment the system and may cause patients to seek out a doctor for medicines that other clinicians can prescribe.

"These ads really confuse patients," says Elayne DeSimone, PhD, ANP, professor at the Stony Brook Nurse Practitioner Program. "They may have just received a prescription from us during a visit where we educated them that we were not physicians and we do prescribe. Then they get 20 messages per day saying only a physician can do these things."

These ads can also be hurtful to PAs and NPs who may feel they are not being recognized for what is a very important part of their professional role. According to a survey published in Clinician News in 2003, 87 percent of NPs and 80 percent of PAs said they found the phrase "Only your doctor can prescribe" offensive when used in DTC advertising.

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