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Abstract

Explicit patient involvement in the selection of medications has become more frequent. Pharmaceutical companies have targeted lay persons for direct-toconsumer advertising (DTCA), and the rise of the patient empowerment movement has helped lead to more egalitarian models of shared decision making between patient and physician. This Article explores the challenge of involving patients more actively in medication choice through DTCA and patient decision aids. I will outline the optimal conditions for shared decision making between patients and physicians in drug selection and then discuss some of the key evolving issues surrounding increased patient involvement in the drug selection process. In particular, I will explore the flow of information to patients, with a specific emphasis on issues involved with DTCA, and also cover some of the challenges and promise of patient decision aids for the choice of medication. The former will cover some of the difficult macro health policy issues related to free speech and consumer protectionism while the latter will address some of the practical challenges of trying to improve patient decision making at the level of the individual clinical encounter. Current regulatory and enforcement practices have been insufficient to prevent the dissemination of some inaccurate or misleading advertisement. Informed, empowered patients can make decisions with their physicians that are more likely to be consistent with their values and preferences.

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