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PubMed2004

Direct-to-consumer pharmaceutical advertising: physician and public opinion and potential effects on the physician-patient relationship.

BACKGROUND: Previous studies have shown that direct-to-consumer (DTC) pharmaceutical advertising can influence consumer behavior and that many physicians have negative views of these advertisements. Physician and public opinions about these advertisements and how they may affect the physician-patient relationship are not well established. METHODS: Mail survey of 523 Colorado physicians and 261 national physicians and telephone survey of 500 Colorado households asking respondents to rate their agreement with statements about DTC advertising. RESULTS: Most physicians tended to view DTC advertisements negatively, indicating that such advertisements rarely provide enough information on cost (98.7%), alternative treatment options (94.9%), or adverse effects (54.8%). Most also believed that DTC advertisements affected interactions with patients by lengthening clinical encounters (55.9%), leading to patient requests for specific medications (80.7%), and changing patient expectations of physicians' prescribing practices (67.0%). Only 29.0% of public respondents agreed that DTC advertising is a positive trend in health care and 28.6% indicated that advertisements make them better informed about medical problems; fewer indicated that advertisements motivated them to seek care (10.5%) or led them to request specific medications from their physicians (13.3%). CONCLUSIONS: Most physicians have negative views of DTC pharmaceutical advertising and see several potential effects of these advertisements on the physician-patient relationship. Many public respondents have similarly negative views, and only a few agree that they change their expectations of or interactions with physicians. While these advertisements may be influencing only a few consumers, it seems that the impact on physicians and their interactions with patients may be significant.

Adult↗
PubMed1982

Future requirements for and supply of ophthalmologists. What do the forecasts show?

Forecasts of the requirements for and supply of ophthalmologists in 1990 have produced conflicting results because of varying assumptions about the future utilization of eye care services, incidence and prevalence of ophthalmic disease, physician productivity, and availability of residency training positions. A typical "utilization-based" models, founded on present consumer behavior, predicts a substantial 1990 surplus of ophthalmologists at current rates of residency training. Two "need-based" models, founded on ideal rather than actual use, reach different conclusions because of varying use of a fragile data base and the need to rely heavily on the subjective judgment of experts with regard to norms of care. The 1980 Graduate Medical Educational National Advisory Committee forecasted a surplus, while the 1978 American Academy of Ophthalmology predicted a deficit. Utilization-based models may slightly underestimate future ophthalmologist requirements. However, analysis of the factors that will influence future use suggests that need-based models are likely to overestimate the requirements. It is risky to accept the need-based model projections because of the high cost of a surplus, which include not only the expenses of training unneeded ophthalmologists but also the cost of their decreased exposure to disease and of declining physician morale, acumen, and thresholds for surgical procedures. Because free market mechanisms are ineffective in governing the supply of health providers, it will be necessary for the profession itself to review the current and projected supply and to set limits on the number of persons in training.

Education, Medical, Graduate↗
PubMed1992

Factors influencing the choice of a residency training program. A student's perspective.

Current trends in pediatric residency training have shown that a growing number of programs have been unable to fill their available positions through the National Resident Matching Program, Evanston, Ill. This has caused a competitive climate among programs to attract medical students as potential residents. The purpose of this study was to learn what factors are important to all students in determining the rank order of the residency training programs to which they have applied. Analysis of data obtained from 600 survey respondents (40%) showed that program curriculum was most important. Factors, such as night call and benefits, took on much less importance. Differences did exist between students who applied for pediatric vs other residencies. The balance between primary and tertiary care and a university setting are examples of variables that had a greater influence on aspiring pediatricians. This information has important implications for training program directors.

Choice Behavior↗
PubMed2002

Limitations of direct-to-consumer advertising for clinical genetic testing.

Although direct-to-consumer (DTC) advertisements for pharmaceuticals have been appearing in the mass media for 20 years, DTC advertisements for genetic testing have only recently appeared. Advertisements for genetic testing can provide both consumers and physicians with information about test availability in an expanding market. However, 3 factors limit the value and appropriateness of advertisements: complex information, a complicated social context surrounding genetics, and a lack of consensus about the clinical utility of some tests. Consideration of several advertisements suggests that they overstate the value of genetic testing for consumers' clinical care. Furthermore, advertisements may provide misinformation about genetics, exaggerate consumers' risks, endorse a deterministic relationship between genes and disease, and reinforce associations between diseases and ethnic groups. Advertising motivated by factors other than evidence of the clinical value of genetic tests can manipulate consumers' behavior by exploiting their fears and worries. At this time, DTC advertisements are inappropriate, given the public's limited sophistication regarding genetics and the lack of comprehensive premarket review of tests or oversight of advertisement content. Existing Federal Trade Commission and Food and Drug Administration regulations for other types of health-related advertising should be applied to advertisements for genetic tests.

Advertising↗
PubMedDate not supplied

Using conjoint analysis to assess women's preferences for miscarriage management.

To date, standard gamble, time trade-off, visual analogue and, more recently, willingness to pay, have been most commonly employed in health economics to assess utilities from various health care interventions. This article considers the use of conjoint analysis as an alternative technique to assess utilities. The technique is applied to assess women's preferences for the management of miscarriage. The paper addresses methodological issues in the application of the technique to health care and demonstrates its use in estimating willingness to pay and utilities. It is concluded that conjoint analysis is potentially a very useful tool and that future research should investigate more thoroughly the potential application of the technique in health economics.

Abortion, Spontaneous↗
PubMedDate not supplied

Values and preferences are not necessarily the same.

Economic theory typically draws no distinction between preferences and values, assumes that preferences are stable and complete and that all that need be done to elicit them is to ask the right question in the right way. It is argued here that values for some fundamental aspects of life, such as health, are not the same as preferences. The former are less differentiated and require construction and clarification before they can be elicited. The implications of this for health state valuation are discussed.

Choice Behavior↗
PubMed1998

Discounting life-years: whither time preference?

If elicited time preferences are to be incorporated into economic evaluations, not only social but also individual preferences may be included. The view of this paper is that social intertemporal preferences should govern social intertemporal choices when prioritising between the saving of lives now or in the future. However, the present value of an individual's stream of future health benefits is a matter of private consumption and hence either individual time preferences or social interpersonal preferences could be applied when evaluating the value of extended life or improved quality of life. This paper shows that it is possible to incorporate both types of time preferences in an economic evaluation; using the individual time preference or the social interpersonal preference when discounting the remaining life expectancy and the social intertemporal time preference for discounting the health benefits from the time of the risk reduction to present time. Such a scenario could solve potential problems such as double discounting of QALYs, the paradox of intertemporal equity versus interpersonal equity, as well as include elements of quantity, risk and uncertainty which are otherwise ignored in evaluations of life-saving therapies.

Attitude to Health↗
PubMed1976

The concept of suggestion in the early history of advertising psychology.

As early as 1896, experimental psychologists began studying the mental processes involved in advertising. The first psychological theory of advertising maintained, in effect, that the consumer was a nonrational, suggestible creature under the hypnotic influence of the advertising copywriter. Walter Dill Scott was the major proponent of this theory, and it was largely through his writings that advertising men learned about the psychology of suggestion. Scott's theory was consistent with a growing trend in the advertising profession toward viewing consumer behavior as irrational. Scott's efforts might also be viewed as part of the trend in the advertising profession toward seeking a scientific basis for copywriting theory and practice.

Advertising↗
PubMed2004

Autoproteolysis rate of rainbow trout muscle proteins.

Effect of some physicochemical agents (pH, temperature and incubation time) and iced storage of farmed rainbow trout (Oncorhynchus mykiss) on autoproteolysis of muscle proteins and quality (sensory assessment, instrumental texture, total bacterial counts) were determined. The results showed that the autoproteolysis rate proceeded with its highest intensity at pH 4.2 and temperature about 55 degrees C. The rate of protein hydrolysis and protease activity, as well as microbial contamination, gradually increased with prolonged periods of iced storage of fish. Properly iced trout immediately after its evisceration was acceptable in quality for up to 10 days.

Animals↗
PubMed2007

The relationship between reliability and size of willingness-to-pay values: a qualitative insight.

In a previous paper, the reliability of willingness-to-pay (WTP) values was found to be an increasing function of the size of WTP expressed. Here, the results of a qualitative exercise conducted alongside this quantitative study are presented. The results of this exercise suggest that higher WTP values may require more thought from the respondent which, in turn, gives them greater stability. At low levels of WTP, values appear to be taken from a 'discretionary account', where expenditure is more volatile. Caveats to this result, and suggestions for future research, are considered in the discussion.

Adult↗
PubMed2002

Measuring willingness-to-pay for risk reduction: an application of conjoint analysis.

This study applies conjoint analysis (CA) to estimate the marginal willingness-to-pay (MWTP) of elderly individuals for a reduction of the risk of fracture of the femur. The good in question is a hypothetical hip protector which lowers the risk of a fracture by different amounts. Other attributes are ease of handling, wearing comfort, and out-of-pocket cost, which are traded off against risk reduction. In 500 face-to-face interviews, pensioners stated whether or not they would buy the product. Results suggest that MWTP for wearing comfort exceeds that for risk reduction. Indeed, willingness-to-pay for the product as a whole is negative, indicating that it should not be included as a mandatory benefit in health insurance.

Accidental Falls↗
PubMed2002

Obtaining disability weights in rural Burkina Faso using a culturally adapted visual analogue scale.

Burden of disease (BOD) estimates used to foster local health policy require disability weights which represent local preferences for different health states. The global burden of disease (GBD) study presumes that disability weights are universal and equal across countries and cultures, but this is questionable. This indicates the need to measure local disability weights across nations and/or cultures. We developed a culturally adapted version of the visual analogue scale (VAS) for a setting in rural Burkina Faso. Using an anthropologic approach, BOD-relevant health states were translated into culturally meaningful disability scenarios. The scaling procedure was adapted using a locally relevant scale. Nine hypothetical health states were evaluated by seven panels of in total 39 lay individuals and 17 health professionals. Results show that health professionals' rankings and valuations of health states matched those of lay people to a certain extent. In comparison to that of the lay people, health professionals rated seven out of nine health states as slightly to moderately less severe. The instrument scored well on inter-panel and test-retest reliability and construct validity. Our research shows the feasibility of eliciting disability weights in a rural African setting using a culturally adapted VAS. Moreover, the results of the present study suggest that it might be possible to use health professionals' preferences on disability weights as a proxy for lay people's preferences.

Activities of Daily Living↗
PubMed2003

Preferences and person trade-offs: forcing consistency or inconsistency in health-related quality of life measures?

We consider assumptions about preferences implicit in the person trade-off exercises used to derive health-related quality of life measures for the Global and US Burden of Disease Projects. Because these methods and their results have the potential of being adopted by other researchers, a critical review of this methodology and its assumptions is warranted. Exercise participants are told that quality of life valuation is approached using two different questions to reveal logical inconsistencies in each person's responses. An inconsistency is claimed to exist if a participant's two responses violate a particular mathematical relationship, and participants are forced to modify their responses to satisfy that relationship. We demonstrate that this supposed 'logical' relationship need not hold for logically consistent, rational individuals, and we prove that the relationship will in fact hold only for a particular class of social value functions exhibiting two characteristics that may not be consistent with the preferences of some participants. These results imply that the forced modification may invalidate some responses, as it may require some participants to provide final answers that are inconsistent with their true preferences. We then discuss preference characterizations in the existing person trade-off literature, from which this relationship may have been derived.

Attitude to Health↗
PubMed2003

An experiment on simplifying conjoint analysis designs for measuring preferences.

In conjoint analysis (CA) studies, choosing between scenarios with multiple health attributes may be demanding for respondents. This study examined whether simplifying the choice task in CA designs, by using a design with more overlap of attribute levels, provides advantages over standard minimal-overlap methods. Two experimental conditions, minimal and increased-overlap discrete choice CA designs, were administered to 353 respondents as part of a larger HIV testing preference survey. In the minimal-overlap survey, all six attribute levels were allowed to vary. In the increased-overlap survey, an average of two attribute levels were the same between each set of scenarios. We hypothesized that the increased-overlap design would reduce cognitive burden, while minimally impacting statistical efficiency. We did not find any significant improvement in consistency, willingness to trade, perceived difficulty, fatigue, or efficiency, although several results were in the expected direction. However, evidence suggested that there were differences in stated preferences. The results increase our understanding of how respondents answer CA questions and how to improve future surveys.

AIDS Serodiagnosis↗
PubMed2005

Empirical investigation of experimental design properties of discrete choice experiments in health care.

Experimental design is critical to valid inference from the results of discrete choice experiments (DCEs). In health economics, DCEs have placed limited emphasis on experimental design, typically employing relatively small fractional factorial designs, which allow only strictly linear additive utility functions to be estimated. The extensive literature on optimal experimental design outside health economics has proposed potentially desirable design properties, such as orthogonality, utility balance and level balance. However, there are trade-offs between these properties and emphasis on some properties may increase the random variability in responses, potentially biasing parameter estimates.This study investigates empirically the design properties of DCEs, in particular, the optimal method of combining alternatives in the choice set. The study involves a forced choice between two alternatives (treatment and non-treatment for a hypothetical health care condition), each with three, four-level, alternative-specific attributes. Three experimental design approaches are investigated: a standard six-attribute, orthogonal main effects design; a design that combines alternatives to achieve utility balance, ensuring no alternatives are dominated; and a design that combines alternatives randomly. The different experimental designs did not impact on the underlying parameter estimates, but imposing utility balance increases the random variability of responses.

Adolescent↗