A Drug's Brand Name Skews Patient Treatment Choices

The unexpected finding regarding the strong influence that drug names have on treatment choices emerged from a study undertaken by Dr. Anne Holbrook and McMaster colleagues who wanted to see if certain features of a decision aid -- i.e., format and graphic presentation of data on benefits and harms of treatment options -- make a difference.

They designed a decision aid for anticoagulant drug therapy for atrial fibrillation in 3 formats (decision board, decision booklet with audiotape, or interactive computer program) with 2 types of data presentation (pie graph or pictogram). The treatment options were identified initially as "treatment A" (warfarin), "treatment B" (acetylsalicylic acid) and "treatment C" (no treatment). The authors found that the participants' comprehension of the condition and treatment options improved significantly with the decision aid, regardless of the format or graphic presentation of data. Virtually all (96%) of the participants felt that the decision aid helped them make their treatment choice.

But unexpectedly, they also discovered that after participants were shown the true treatment names, 36% changed their initial choice (including 46% of those who initially chose warfarin and 78% of those who initially chose no treatment), even though the risks and benefits of each treatment were clearly laid out in the decision aid.

In a related commentary, Dr. Annette O'Connor notes that many common medical decisions exist in a "grey zone," where the best choice differs depending on how patients weigh the benefits and risks of each treatment option. She discusses how patient decision aids differ from educational aids and how they help patients and express their personal values.