When the pharmaceutical industry successfully lobbied for the right to advertise its products to consumers, it was understood that such advertising would be educational.
Shortly after the laws controlling direct-to-consumer advertising were eased in 1997, the number of television advertisements promoting prescription drugs increased dramatically. By 1999, the average citizen in the US was exposed to nine such ads every day. (Abramson J. Overdosed America: The Broken Promise of American Medicine. Harper Collins, 2004, p. 152)
The United States and New Zealand are the only two developed nations that currently allow direct-to-consumer advertising (DTCA) of prescription drugs. Representatives of the pharmaceutical industry continue to lobby for similar privileges in Canada, Europe, and other countries.
Does Direct-to-Consumer Advertising (DTCA) Work?
- In 2008, Harvard Medical School researchers concluded that DTCA is not creating the impact in sales that drug manufacturers claim it does. These scientists collected data from Canadian sales of medications that were advertised to consumers via “spillover”—that is, American ads that were viewed by Canadian citizens in spite of Canada’s ban on DTCA.
- They concluded that DTCA leads to only transient increases in sales for the drugs they reviewed, and that drug companies base their faith in such advertising on sparse data. (Law M, Majumdar S, Soumerai S. Effect of illicit direct to consumer advertising on use of etanercept, mometasone, and tegaserod in Canada: controlled longitudinal study. BMJ 2008;337:1055)
- However, Dr. Barbara Mintzes, a Canadian physician and researcher, contends that DTCA compels patients to request medications they have seen on television, and that such requests lead to altered prescribing patterns in physicians:
- “Our results suggest that more advertising leads to more requests for advertised medicines and more prescriptions (for advertised drugs)…often despite physician ambivalence about treatment choice.” (Mintzes B, et al. How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA. CMAJ. 2003;169(5):405-12)
- In essence, patients who have been exposed to DTCA become representatives for the companies who make the advertised medications.
How Does Direct-to-Consumer Advertising (DTCA) Influence Consumers?
- Pharmaceutical companies claim that their ads serve an educational purpose; they contend that patients who might not otherwise receive important information about their medical conditions and prescription drugs will benefit from DTCA.
- In December, 2008, Billy Tauzin, President and CEO of PhRMA, praised the industry's efforts to bring pertinent information to the American public: “Pharmaceutical research companies for years have voluntarily exceeded regulatory requirements for direct-to-consumer advertising of prescription medicines. Our Guiding Principles help ensure that DTCA appropriately and accurately conveys important information about medical conditions, medicines and other treatment options.”
- Alas, a 2007 study demonstrated that DTCA falls short of its intended educational goals. In fact, such advertisements “…provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.” (Frosch D, et al. Creating demand for prescription drugs: A content analysis of television direct-to-consumer advertising. Annals of Family Medicine 2007;5:6-13)
In coding a variety of pharmaceutical companies’ advertisements, these researchers found:
- Most ads (82%) did make some factual claims about the product’s use.
- Most ads (86%) made rational arguments for using the product.
- A minority of ads (26%) described condition causes.
- Only 26% outlined risk factors for the condition specified.
- Still fewer (25%) addressed the prevalence of a given condition.
- Emotional appeals to consumers were nearly universal (95%).
- No ads mentioned lifestyle change as an alternative to the advertised product, although a few (19%) portrayed it as an adjunct to the medication.
- A similar number of ads (18%) stated that lifestyle changes were insufficient for controlling the condition.
- A majority of ads portrayed the medication as something needed by individuals who had lost (58%) and could regain control (85%) over some aspect of their lives.
- The use of the advertised medications was often (78%) described as something that would engender social approval.
- Advertised products were frequently (58%) characterized as medical breakthroughs.
In summary, direct-to-consumer advertising of pharmaceutical products probably financially benefits the companies that make the products, it probably indirectly affects physicians’ prescribing habits, and manufacturers who employ DTCA use the same techniques to sell their wares that have been successfully used to market other products.
The copyright of the article Selling Drugs to Patients in American Affairs is owned by Stephen Allen Christensen. Permission to republish Selling Drugs to Patients in print or online must be granted by the author in writing.
