NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.
Sunday, April 20, 2014
You have probably noticed those ads on TV encouraging you to try some medication for a health condition. These medications promise relief from various problems, such as gastric reflux, high cholesterol, erectile dysfunction, and insomnia. Perhaps you've even thought about asking your doctor whether one of these drugs would help your medical condition.
Or maybe you have felt confused. More and more medications are on the market, but is a "pill" always the best way to fix what ails you?
To sort this out, it might help to know a little more about the background of these TV advertising practices, known as direct-to-consumer advertising (DTCA) of prescription medications. Only the United States and New Zealand allow direct-to-consumer advertising of prescription medications.
The debate on the appropriateness of DTCA began immediately upon the Food and Drug Administration's (FDA) 1997 decision to allow such practice. Proponents argue that DTCA provides an educational service that patients would not otherwise have. Opponents respond that DTCA is misleading and entices patients to self-diagnose and to ask for medications they may not need or that have less expensive alternatives.
There are doctors on both sides of this issue.
To be educational, an ad should be balanced, accurate, objective, and should not promote unsafe practices. Although this may seem intuitive, it is often not the case. In a recent study, Dominick Frosch and colleagues completed a comprehensive analysis of DTCA. They found that the pharmaceutical companies used two major persuasive styles: Appeals, and Lifestyle Approaches.
Many ads use appeal by showing attractive, happy people enjoying life. An illustrative example is a current ad for injectable insulin to treat diabetes in which an attractive middle-aged woman rides her motorcycle on the open road to meet her friends for coffee and camaraderie. However, the use of injectable insulin to treat diabetes instead of oral medications leads to lower blood sugar episodes - and that can cause many side effects, especially seizures. Certainly not what one would want to happen while riding a motorcycle! In addition, this ad implies that insulin is the only way to control your diabetes and be happy when, in actuality, diet and exercise are the most important components of blood sugar control in a patient with adult onset, Type 2 diabetes.
Lifestyle ads tend to show a patient with a particular problem engaged in physical activity. In a recent statin ad for low cholesterol medication, a world-renowned physician was shown jogging with his son. The implication was that without the medicine he was advertising, he would not be able to do this, which of course is not true. In addition, he stated that the drug he was promoting was the most-studied of its class in the world. Might sound nice, but this has absolutely nothing to do with the use, quality or safety of the drug from the patient perspective. This ad has since been cancelled pending congressional probes into concerns that it failed to encourage patients to talk with their physicians about cardiovascular disease, the number one cause of death in the United States.
There is a lot of misdirection in DTCA. For example, a current ad for a nasal steroid proudly proclaims that its product is the only one FDA-approved for all the symptoms of allergy. This statement is irrelevant. All nasal steroid sprays treat all the symptoms of allergy. The only difference is that this particular pharmaceutical company is the only one that paid to do a study so that they could say so.
Most of the drugs you see in DTCA are for brand name drugs that are losing market share to generic drugs within their class. An example of this would be the ad for a combination drug which treats both blood pressure and cholesterol. This is only a brand name drug because it is a combination pill. The two components of the drug (one for blood pressure and one for cholesterol) are comprised of drug classes with available generics. With very rare exceptions, generic drugs are every bit as beneficial as brand name and a lot less expensive.
In 2005, pharmaceutical companies in the United States spent $1.19 billion on TV advertising in an attempt to influence the public's thought process as to which prescription medication to take, and for what problem. A Harvard University study found that every $1 the pharmaceutical industry spent on DTCA in 2000 resulted in an additional $4.20 in drug sales. A 2005 report to Congress affirmed that of the 12 leading brand-name drugs with DTCA campaigns, 10 recorded sales in excess of $1 billion annually.
Some studies have suggested that DTCA may motivate consumers to ask better questions of their healthcare providers. This improved communication has in some cases uncovered previously unrecognized and untreated medical conditions. Fostering open and well-informed dialogue between patients and their doctors has the potential for improving health outcomes if it leads to significant health behavior changes, regardless of whether or not the individual is treated with the advertised medication.
It is important to keep in mind, however, that TV ads have a lower standard for disclosure of information than print advertising. Due to the time limitations imposed in broadcasting, TV drug ads can not fully disclose all the risks and benefits that must be described in detail in a printed advertisement. Although the FDA requires that TV drug ads provide fair balance with regards to risks and benefits, only "major risks information" must be revealed. Concern has been raised that DTCA downplays harmful side effects of drugs while promoting their alleged benefits.
The bottom line with DTCA is to keep in mind that the purpose of the ad is to get you to purchase a specific medication. When watching such ads, it is educational to pay attention to the symptoms discussed and to the disease that causes them. If the ad provides a source of additional product information, you may want to review drug information from other credible resources as well.
Remember, the best way to treat your health-related condition is to start with an open-minded discussion with your physician. It could be that lifestyle change is all you need to achieve the health effect you want.
American Advertising Federation. DTC Prescription Drug Advertising. www.aaf.org/default.asp?id=248.
Bell, RA.; Kravitz, RL.; Wilkes, MS. "Direct-to-consumer prescription drug advertising and the public." Journal of General Internal Medicine, v. 14 issue 11, 1999, p. 651-7.Boden, WE.; Diamond, GA. "DTCA for PTCA -- Crossing the Line in Consumer Health Education?." New England journal of medicine, May 22, 2008.
Brodie, M.; Levitt, L. "Drug advertising: the right or wrong prescription for our ailments?." Nature Reviews Drug Discovery, v. 1 issue 11, 2002, p. 916-20.
Donohue, J. "A history of drug advertising: the evolving roles of consumers and consumer protection." The Milbank Quarterly, v. 84 issue 4, 2006, p. 659-99.
Friedman, M.; Gould, J. "Physicians' attitudes toward direct-to-consumer prescription drug marketing." Journal of Medical Marketing, v. 7 issue 1, 2007, p. 33-44.
Frosch, DL., et al. "Creating demand for prescription drugs: a content analysis of television direct-to-consumer advertising." Annals of Family Medicine, v. 5 issue 1, 2007, p. 6-13.
Gardner, DM.; Mintzes, B.; Ostry, A. "Direct-to-consumer prescription drug advertising in Canada: permission by default?." CMAJ : Canadian Medical Association Journal, v. 169 issue 5, 2003, p. 425-7.
Harvard School of Public Health, Massachusetts Institute of Technology, Harvard Medical School. "Impact of Direct to Consumer Advertising on Prescription Drug Spending." Kaiser Family Foundation, June 2003.
Holmer, AF. "Direct-to-consumer prescription drug advertising builds bridges between patients and physicians." JAMA : Journal of the American Medical Association, v. 281 issue 4, 1999, p. 380-2.IMS Management Consulting [David Gascoigne], "DTC at the Crossroads: A 'Direct' Hit...or Miss?" IMS Issues and Insights, Sept. 23, 2004, at [www.imshealth.com/ims/portal/front/articleC/0,2777,6599_5266_58193110,00.html].
Lewis, Carol. "The impact of direct-to-consumer advertising." FDA consumer, v. 37 issue 2, 2003, p. 8. www.fda.gov/fdac/features/2003/203_dtc.html.
Macias, W.; Pashupati, K.; Lewis, LS. "A wonderful life or diarrhea and dry mouth? Policy issues of direct-to-consumer drug advertising on television." Health Communication, v. 22 issue 3, 2007, p. 241-52.
National Consumers League. "Research Overview." Conference on Direct to Consumer Advertising: Shaping the Research, June 2006.
Prescription drugs. Media Week. May 1, 2006;SR30.
Rosenthal, MB.; Berndt, ER.; Donohue, JM.; Epstein, AM.; Frank, RG. Demand Effects of Recent Changes in Prescription Drug Promotion. Harvard School of Public Health, Massachusetts Institute of Technology, Harvard Medical School, June 2003. Prepared for the Kaiser Family Foundation: www.kff.org/rxdrugs/upload/Demand-Effects-of-Recent-Changes-in-Prescription-Drug-Promotion-Report.pdf
Stange, KC. "Time to ban direct-to-consumer prescription drug marketing." Annals of Family Medicine, v. 5 issue 2, 2007, p. 101-4.
Vogt, DU. "Direct-to-Consumer Advertising of Prescription Drugs." Congressional Research Service Report for Congress, Order Code RL32853. March 25, 2005. www.law.umaryland.edu/marshall/crsreports/crsdocuments/RL3285303252005.pdf
Wilkes, MS.; Bell, RA.; Kravitz, RL. "Direct-to-consumer prescription drug advertising: trends, impact, and implications." Health affairs (Project Hope), v. 19 issue 2, 2000, p. 110-28.
This article is a NetWellness exclusive.
Last Reviewed: May 22, 2008
Randy Wexler, MD, MPH, FAAFP
Associate Professor of Family Medicine
College of Medicine
The Ohio State University