Since the American Medical Association (AMA) called for a direct-to-consumer (DTC) ad ban last November, the issue of pharmaceutical and medical device advertising has been hotly debated. While the opinion that pricey DTC ads are at least partially responsible for the rising cost of prescription drugs is widely accepted, other views on the issue are often underrepresented.
The main arguments against DTC advertising of prescription drugs are that it:
- Provides misinformation to patients
- Places a disproportionate emphasis on drug benefits
- Encourages patients to overuse prescription pharmaceuticals
- Complicates the fragile patient-doctor relationship
- Increases the market cost of pharmaceuticals
Are there positive effects of DTC advertising on patient understanding and awareness? Does advertising treatments on the internet, TV, print and radio, reduce the social stigma surrounding certain conditions? DTC advertising is an issue in which many stakeholders – namely pharmaceutical companies, physicians and patients – have diverse opinions.
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From the perspective of the pharmaceutical company, DTC advertising is an important tool for marketing drugs and devices to a wide audience. Advertising also requires a significant investment on the part of the company; in 2014, pharmaceutical developers and medical device makers spent around $4.5 billion on marketing their products to US consumers.
In defense of this practice, pharmaceutical companies claim that their ads present the pros and cons of any given drug in a balanced manner. Advertisers are bound by US Food and Drug Administration (FDA) regulations to ensure that pharmaceutical ads are truthful, accurate and do not minimize the risks associated with taking the drug.
“Research shows that accurate information about disease and treatment options makes patients and health care providers better partners,” said Andrew Powaleny, a spokesperson for the pharmaceutical industry group, Pharmaceutical Research and Manufacturers of America (PhRMA). “Providing FDA-regulated, scientifically accurate information to patients so that they are better informed about their health care and treatment options is the goal of DTC advertising about prescription medicines.”
While it’s certainly in the pharmaceutical industry’s best interest to stop the US government from imposing a ban on DTC advertising, this form of marketing was almost nonexistent in the industry before the year 1990. Before this time, prescription drugs were promoted almost exclusively to physicians who would be solely making key decisions about patient care. As patients began to take a greater interest in decisions surrounding their health, pharmaceutical companies began to generate targeted marketing campaigns toward the public.
“Beyond increasing patient awareness of disease (including undiagnosed conditions) and available treatments, DTC advertising has been found to increase awareness of the benefits and risks of new medicines and encourage appropriate use of medicines,” said Powaleny. “In addition, DTC advertising encourages patients to visit their health care providers’ offices for important conversations about health that might otherwise not take place.”
In response to the AMA’s proposed ad ban, two of the largest pharmaceutical trade associations – PhRMA and the Biotechnology Innovation Organization (BIO) – have launched emotional ad campaigns aimed at improving the industry’s reputation. The ads – called “From Hope to Cures” and “Time is Precious”, respectively – highlight pharma’s role as a developer of cures for diseases, thereby prolonging human life.
“With this effort, BIO is advancing the national public policy debate over the cost and value of medicine, shining a spotlight on the fact that innovative, life-saving medicines provide benefits far beyond their costs,” said Jim Greenwood, CEO of BIO. As much of the controversy surrounding DTC ads centers on the issue of how high marketing budgets lead to expensive drugs, these industry associations are appealing to the public’s sentimental side to attempt to win back some favour.
While the AMA – the largest physician’s group in the US – is the driving force behind the proposed DTC ad ban, many physicians seemed to have mixed feelings about the form of marketing. In 2004, the FDA released the results of a 500-physician survey on DTC advertising and its effects on patient care.
When considering specific patient encounters, the survey found that 41 percent of physicians thought that patient exposure to DTC advertising led to benefits – including greater awareness of treatment options and more productive discussions between patient and physician – while 18 percent reported that it led to problems. Interestingly, while 73 percent of physicians surveyed reported that patients asked more thoughtful questions after seeing DTC pharmaceutical ads, 41 percent indicated that the patients were confused about the drug’s effectiveness.
In general, 65 percent of physicians expressed their belief that DTC drug ads confuse consumers about the benefits and risks of particular medication, while 75 percent said DTC ads cause patients to believe a drug will work better than it actually does.
Interestingly, eighty percent of physicians reported feeling very pressured to prescribe the brand-name version of a drug when asked by a patient. While this particular statistic suggests that DTC advertising may be doing exactly what its designed to do – namely, increasing brand awareness to increase drug sales – it is concerning to think that the majority of doctors feel pressured to prescribe a drug when patients ask for it by name.
In order to reassess the public’s opinion when it comes to DTC advertising, the FDA plans to conduct another DTC ad survey for the first time in over a decade. “Numerous changes have affected the DTC landscape since 2002 including declines in print readership, the rise in online prescription drug promotion, and self-imposed industry guidelines for DTC advertising,” said the FDA. “These changes may have affected consumers’ exposure to different kinds of DTC advertising and its influence on their attitudes and behaviors.
“The purpose of the National Direct-to-Consumer Advertising Survey is to collect updated insights on consumer experiences with and attitudes towards DTC promotion of prescription drugs,” the FDA continued. “This study will build on previous research by recruiting a wider range of respondents, weighting the data to make it nationally representative, and ask a wider range of questions about DTC promotion, including in online formats.”
No discussion on the effects of DTC advertising is complete without considering its impact on patients. The same 2004 FDA survey that asked physicians to share their views on DTC ads, also included patients’ perspectives on the pharmaceutical advertisements.
According to the results of the survey, 58 percent of patient respondents agreed that the ads provide sufficient information to help consumers decide whether to talk to their doctor about the drug. Sixty percent of patients believe that DTC drug ads do not contain enough information about potential risks associated with taking the drug.
When asked about the influence of DTC ads on the patient’s own health, 32 percent said the ads help them to make better health choices. Interestingly, the same percentage of patients reported that they enjoy seeing DTC ads.
Based on the results of the survey, one could conclude that the public’s opinion of DTC advertising – much like that of physicians – is mixed. It’s important then, to consider whether the practice has an overall positive or negative affect on all three groups – including pharmaceutical companies, physicians and patients – when deciding whether or not to enforce a ban.
What do you think about DTC advertising of pharmaceuticals and medical devices? Do you think the US government should ban the practice? Share your thoughts in the comments section below!