Quick: How many prescription drug ads did you see the last time you turned on the television? Now try this: How many pens do you have with the name of a drug on them? Since changes to Food and Drug Administration regulations in 1997 made it easier for drug companies to market directly to consumers, the amount of money companies have spent selling directly to consumers has skyrocketed. In 2003, companies spent $3.2 billion on direct-to-consumer marketing in the United States, up from less than $600 million before the policy change. Researchers from San Francisco, Sacramento, Calif., and Rochester, N.Y., looked to see how all those ads might be changing the way doctors prescribe drugs.

What the researchers wanted to know: Do patients' requests for certain drugs affect what doctors prescribe?

What they did: The researchers used 18 female actors, who made appointments with doctors and feigned symptoms of either depression or adjustment disorder (which is a more mild condition that usually does not require immediate medication). In all, the actors made nearly 300 visits to about 150 doctors; the same doctor saw both a case of depression and a case of adjustment disorder in all cases. On one third of the visits for both depression and adjustment disorder, the women mentioned seeing an ad for the antidepressant Paxil and asked the doctor if they thought it would help. On another third of the visits, the women in both groups said that, after seeing a television program about depression, they thought that medication might help, and in the final third, the women did not mention anything about medication for their condition.

What they found: In the group that described symptoms of depression, when the actors requested Paxil, they were given an antidepressant 53 percent of the time and Paxil specifically 27 percent of the time. When these actors mentioned antidepressants but not a specific drug, they were prescribed an antidepressant 76 percent of the time. Actors who did not request medication were prescribed an antidepressant in 31 percent of visits. In the group that described symptoms of adjustment disorder, the numbers of those getting Paxil versus a generic antidepressant were flipped. In this group, actors who requested Paxil specifically were prescribed an antidepressant 55 percent of the time, while those requesting medication in general were written a prescription only 39 percent of the time. Actors who described symptoms of adjustment disorder and made no request for medication were prescribed an antidepressant 10 percent of the time. While the researchers considered it a good thing that those with symptoms of major depression got an antidepressant more often when they requested a drug, those with adjustment disorder, whom the drug will most likely not help, fared worse by asking about the drug because they received an unnecessary prescription.

What it means to you: If you see a medication advertised on television or in a magazine that you think might help you, talk to you doctor about it—but be aware that your query might, in some cases, influence your doctor's thinking about whether to prescribe a drug. Having an honest conversation about whether or not you need medication is still your best bet. Also, remember that just because it's advertised as effective for a certain condition, that doesn't mean it's the best medication for you or your condition.

Caveats: The researchers based this study on the assumption that advertising campaigns prompted patients to ask their doctors directly about certain medications. However, that might not be true; it may be that consumers do not react to advertising by asking their doctor about specific pills or medications.

Find out more: The Food and Drug Administration did a survey about the impact of direct-to-consumer marketing of prescription drugs on patient and doctor relationships. You can see a slideshow of their findings at http://www.fda.gov.

A long report on direct-to-consumer spending from researchers at Harvard University and the Massachusetts Institute of Technology can be found on the Kaiser Foundation's website. (You'll need Adobe Acrobat to read this PDF.)

The organization No Free Lunch, with the motto "Just say no to drug reps," campaigns against marketing of prescription medications in doctors' offices.

Read the article: Kravitz, R.L. et al. "Influence of Patients' Requests for Direct-to-Consumer Advertised Antidepressants." Journal of the American Medical Association. April 27, 2005, Vol. 293, No. 16, pp. 1995–2002.

Abstract online: http://jama.ama-assn.org