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DECEMBER 16, 2004

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NEWS ANALYSIS
By Amy Tsao

Drug Sites: Good Info Isn't Enough
In-depth data on prescription medications are now easily found on the Web. So why aren't consumers acting on what they learn?


In recent months, what people know (and don't know) about prescription drugs has spawned a flurry of Web resources -- databases of clinical trials, independent comparative analyses of drugs -- that aim to lessen the confusion. The latest: Consumers Union, the nonprofit publisher of Consumer Reports magazine, on Dec. 9 launched a site that will review and rank drugs for ailments such as high blood pressure, high cholesterol, and heartburn, based on safety, efficacy, and cost.


By factoring in cost, the site, Consumer Reports Best Buy Drugs, goes a step beyond what most others have done to date. For major disease categories, it'll come up with what it calls a "Best Buy" -- the most effective and affordable drug for the ailment. The site draws heavily on the Drug Effectiveness Review Project (DERP), a comparative drug-review service started by a dozen state Medicaid programs in late 2003. "We very systematically articulate a set of questions and qualifications for studies that will be considered in our reviews," says Mark Gibson, DERP's project director.

Most experts are applauding such attempts to help people decipher the conflicting messages about medicines. "They make the Web more valuable to people seeking information," say Laurence Baker, associate professor of health research and policy at Stanford University Medical Center. "People will use it."

SPARSE DATA SOMETIMES.  Not everyone is so sure. Certainly, making prescription-drug information more available is a positive. But sorting through it, making judgments on available data, and getting patients and doctors to follow through is a tall order, others say. "On the whole, more information is better," says Baker. "But there have been and will be some struggles along the way as doctors and patients learn to manage."

Some worry that these Web resources oversimplify the process of matching patients with the right treatments. "There are limits," says Susan Winckler, vice-president for policy and communications at the American Pharmacists Assn. For example, a Best Buy designation by Consumer Reports may prompt a patient to press a doctor for that treatment -- even if it isn't appropriate in that person's particular circumstances. "We hope that people will consider it as helpful information and that it will make them aware of options they didn't know about," Winckler says.

Data quality is also a concern. Groups like DERP evaluate the best available studies, though Gibson admits in some important areas like opioid pain medications, the data simply don't exist. And head-to-head studies designed specifically to examine competing drugs are also lacking.

MORE EVALUATION OF SUVs.  "Those studies just don't get performed enough because the drug companies prefer not to do them, and the Food & Drug Administration rarely makes them do so," says Jerry Avorn, associate professor of medicine at Harvard Medical School and author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs.

Then again, even though repositories of information exist, patients and doctors apparently don't use them much. "Patients do not engage in consumer behaviors," says Michael Montagne, professor of social medicine at the Massachusetts College of Pharmacy. Some people may go to great lengths to investigate the pros and cons of toasters and SUVs before buying one, but most "are not in that mode when it comes to choosing a prescription-drug product," says Montagne.

Before Consumer Reports and others created medication resources, plenty existed that doctors and consumers didn't use. Among the patient-focused sites is the American Society of Health-System Pharmacists' SafeMedication.com. Thomson, publisher of the Physicians Desk Reference (PDR), the widely used guide for general practitioners, also operates a consumer-oriented site, PDRHealth.

"THE OLD WAY."  The Internet has expanded health-care knowledge dramatically, but it isn't necessarily changing consumer behavior. In a survey conducted in 2001-02, researchers led by Baker at Stanford found that 40% of American adults with Internet access use the Web for health-care purposes. It improved their understanding of the issues, but only one-third of respondents said it affected a decision about health or their health care. Ninety-four percent said Internet use had no effect on the number of doctor visits they had made.

Doctors haven't exactly embraced the resources, either. The Cochrane Collaboration, a nonprofit organization begun in Britain to provide systematic comparisons of the safety and effectiveness of various treatments to doctors, is well-respected but underutilized, says Montagne.

Despite more emphasis on so-called "evidence-based" medicine, physicians still rely heavily on instinct and experience. "Doctors in practice are still doing things the old way," says Montagne. "For them, it's about evolving treatments based on their practice. They don't go to these databases."

The Information Age is changing the field of medicine. But it'll be a while before consumers and doctors make radical changes in their approaches to health care and prescription drugs -- even as the Internet boosts their ability to gather information, analyze, and compare.


Tsao is a reporter for BusinessWeek Online in New York
 Edited by Beth Belton
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