Has social anxiety put your life on hold?"

That question appeared recently in a advertisement for Paxil (paroxetine) in the pages of Redbook magazine, the women’s monthly periodical about "balancing family, work, love, and time for you."

Wedged between articles about dieting, menstrual cycles, and tips for improving married couples’ sex lives, the advertisement notes that Paxil is the only medication proven effective and approved by the FDA for the treatment of social anxiety. A brief questionnaire about symptoms—Does an unreasonable fear of embarrassment cause you to avoid most social interaction? Is the anxiety you feel around people so intense it sometimes feels like a panic attack? Has this overwhelming anxiety significantly impaired your work or social life?—concludes with the advice: "Ask your doctor about Paxil today. . . . Your life is waiting!"

The same issue of the same magazine contained an advertisement for Buspar (buspirone) for treatment of anxiety, and the Paxil ad also appeared in a recent issue of Life magazine. The pages of Time and Newsweek carry similar advertisements for prescription medications.

Pharmaceutical advertising aimed at the public primarily in the print and broadcast media and on the Internet, known as "direct-to-consumer advertising" (DTCA), is a dramatic new twist in the competitive field of drug promotion that appears to be affecting the prescribing habits of doctors.

In a study presented at the annual meeting of the American Association of Pharmaceutical Scientists, researchers at the University of Mississippi reported that physicians appear to have more positive attitudes toward DTCA than in the past and are fairly responsive to patients’ requests. For some product categories, DTCA may be an important factor in prescription-product selection, said B.F. Banahan, Ph.D., and colleagues.

In telephone interviews with 199 primary care physicians in Pennsylvania and Ohio, respondents indicated that on average six patients a week ask them questions about specific drugs, and 36 percent of the time they prescribe the product in question. An average of five patients a week specifically ask for a prescription, and physicians comply 30 percent of the time, the researchers said.

Only 9 percent of respondents reported they felt no pressure to prescribe products; 38 percent said they felt very little pressure, 47 percent felt little pressure, and 6 percent felt a lot of pressure.

Physicians most frequently identified TV ads (77 percent), print ads (51 percent), TV news stories (49 percent), and print news stories (48 percent) as the sources that stimulated patients to ask about medications.

Psychiatrists who spoke with Psychiatric News said they believe DTCA to be a largely benign phenomenon—with even some positive effects—but has the potential for misuse.

"Prior to discussing medication with physicians, people can be influenced by many sources," said Michael Blumenfield, M.D., a professor of psychiatry at New York Medical College and chair of APA’s Joint Commission on Public Affairs. "This includes friends, relatives, newspapers, books, movies, and television. They cannot help but to have seen direct advertising. Also, their friends and relatives who may influence them can also be influenced by some level of advertising."

Blumenfield said DTCA has the potential to educate the public that mental illnesses are treatable and may prompt patients to seek care. "Usually, such advertising tends to destigmatize mental illness and treatment, which can only be beneficial," said Blumenfield.

"In today’s society, it is no longer a question of whether the public should be given limited information about medication or options for their treatment. We are in an open-information society where information and opinions are widely available to everyone through the Internet, as well as through mass media. The public has to learn to distinguish good information from bad information, and it is appropriate that they turn to their physician to help them."

Blumenfield added that pharmaceutical advertising must adhere to guidelines of the federal Food and Drug Administration. Most other information on the Internet is not subject to any form of quality control.

Dennis Milke, M.D., Assembly liaison to the APA Council on Psychiatric Services, said that he has had patients ask for prescriptions for specific drugs, but he does not necessarily regard such requests as an unwelcome phenomenon.

"Clearly, patients would not ask for a drug if they had not heard about it before through some mechanism or other," he commented. "I have never prescribed a medication for a patient through DTCA pressure. Instead, I use the occasion to discuss the pharmacology of drugs and steer them to an appropriate choice. I have no problem prescribing if the choice for which they are asking is appropriate."

Milke said the poor publicity that Prozac has received in the past and the overly positive support that drugs like St. John’s Wort has received have impacted psychiatry.

"Like any advertising, DTCA can be misleading," he said. "Education of the patient is always a plus, but unfortunately some patients are quite gullible and impressionable. As professionals, our consultation time should be used to present the best clinical evidence possible."

Milke said that all physicians—and psychiatrists especially—are obliged to discuss thoroughly the merits, disadvantages, and potential side effects of all drugs prior to prescribing.

"Advertising should be instructional, particularly pharmaceutical advertising," he said. "Responsible pharmaceutical advertising should give a balanced presentation about the product. When presented in this manner, it can allow patients to be better informed. As with deceiving advertising in any arena, it can be misleading and possibly destructive. It is the job of the psychiatrically trained physician to be the clearinghouse for patients regarding matters pertaining to drugs treating mental illness."

Nada Stotland, M.D., immediate past chair of the Joint Commission on Public Affairs and chair of the department of psychiatry at Illinois Masonic Medical Center., said that DTCA was a topic of discussion at a meeting last year between APA leaders and prominent media representatives. A consensus emerging from that conference was that DTCA was largely beneficial because of its potential for educating patients.

"DTCA is good inasmuch as it demystifies medications and destigmatizes psychiatric medications in general," she said. "It may prompt some people who have been ignoring their symptoms to seek medical attention by imparting the sense that there is real relief available."

But there are downsides for the practice of medicine in general, and for individual patient care in particular. "The negative aspects are the commercialization of medicine, and the impetus to give patients whatever they want without a thorough diagnostic evaluation and discussion, especially with the time constraints currently operative in medicine," Stotland said.

Nonetheless, she pointed out, DTCA is here to stay. "So we need to concentrate our efforts on turning it to the best possible account and minimizing the negatives by stressing the need for proper workup, diagnosis, and patient education."