Direct to consumer advertising's effect on medical students: The case of fibromyalgia

Dear Sir

We performed a study to assess the role of direct to consumer advertising (DTCA) in medical students’ understanding of fibromyalgia (FM). A brief questionnaire was given to medical students attending the University of Miami Miller School of Medicine. Students were asked to choose the statement that “most closely correlates with” their understanding of FM from the following options:

1. “Fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals” (Mayo Clinic)

2. “Fibromyalgia is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation” (National Fibromyalgia Association)

3. “Fibromyalgia is due to overactive nerves that cause chronic widespread pain” (Lyrica advertisement)

4. “Psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of pain” (DSM IV criteria for pain-disorder)

5. “I don’t have enough of an understanding of fibromyalgia to determine the cause”

Though the exact mechanism of FM is uncertain, much evidence exists regarding the role of central and neurotransmitter dysregulation as described in choice 1 and 3 (Henningsen et al. 2007; Yunus 2007). Choice 3 does not specify whether the dysregulation of pain occurs at the central or peripheral level and additionally suggests overactive nerves as opposed to decreased pain regulation. Choice 4 describes pain-disorder, a separate condition, and choice 5 was provided to reduce guessing.

We divided our sample group into two cohorts, pre-clinical and clinical students. Pre-clinical students included first-year and second-year students who had not yet received lectures on musculoskeletal diseases. Clinical students had completed all coursework and at least six months of required clinical clerkships. We compared the proportion of students endorsing the pharmaceutical advertisement's explanation between the two groups using a χ² test.

We received 247 responses, which after excluding students who stated that they did not have enough of an understanding, yielded 120 responses, 86 pre-clinical and 37 clinical. Half of pre-clinical students chose the television advertisement's explanation with 27% of students endorsing the Mayo Clinic's explanation. In contrast, only 16% of clinical students endorsed the advertisement's explanation with 49% endorsing the Mayo Clinic's explanation. The decrease between pre-clinical to clinical students endorsing a pharmaceutical explanation (p < 0.01) and increase between students endorsing Mayo Clinic's explanation (p = 0.02) were both significant.

The study's main finding suggests that pre-clinical medical students’ understanding of FM may be influenced by DTCA and that after sufficient medical education, students’ understanding of FM becomes more influenced by evidence-based sources, successfully reversing any influence DTCA may have.