Direct-to-consumer ads change MD/patient dynamic

Docs say they sometimes feel pressured

You think the patient before you suffering from minor acid reflux will respond just fine to over-the-counter antacids, and you tell her so. But before you ever saw her, she had already decided that that purple pill advertised on television is what she needs, and there’s no changing her mind.

It’s direct-to-consumer (DTC) advertising at work.

"A lot of times, it’s going to fall on the physicians to educate or re-educate their patients, who have seen coverage of medications in the media, whether it’s accurate or misleading," points out Sarah Oetgen, MPH, senior vice president of SENSEI Health, a media relations and marketing communications firm specializing in health care issues. "It often says a lot about the background of the person who is reading the ads."

Informed drug consumers

Information about prescription drugs was once considered the exclusive domain of physicians, but that changed in 1997 when the U.S. Food and Drug Administration (FDA) lifted its ban against DTC pharmaceutical advertising.

The FDA oversees the advertising of prescription drug products under the federal Food, Drug, and Cosmetic Act and related regulations that aim to ensure that information provided by advertisers is balanced and accurate. Most other advertising, including for over-the-counter drugs, is overseen by the Federal Trade Commission.

According to the Kaiser Family Foundation of Menlo Park, CA, a philanthropy that analyzes and provides information on health care issues, more than 90% of the public reports seeing prescription drug advertisements. Not a surprising finding, considering that pharmaceutical companies spent almost $4 billion in advertising to consumers in 2004, compared to about $250 million a decade ago.

Even critics of heavy DTC advertising, however, concede that well-designed advertising can inform and educate consumers, making them better equipped to make health care decisions. The FDA, in a 2003 report in FDA Consumer magazine, said DTC ads "can prompt thoughtful discussions between patients and physicians that result in needed treatments being prescribed."

"DTC ads help educate patients about their health problems, and provide greater awareness of treatments," the FDA reported, citing surveys of physicians and patients and the effects advertising has on them. FDA research demonstrated then that when patients asked about a drug, 88% of the time they had the condition that the drug treated, and 80% of physicians believed patients who ask about a drug understood what condition the drug treats.

Critics counter that DTC ads lead to pressure on physicians to overprescribe unnecessary, expensive, and potentially harmful medications.

Oetgen says DTC advertising "has definitely changed the physician–patient dynamic."

"The whole concept of advertising is to increase awareness, but with direct-to-consumer advertising of drugs, is it making the consumer more aware of the brand name than they are of the side effects?" she says.

Though it has been pressured to endorse limits or bans on DTC ads, the American Medical Association (AMA) has instead called for more study. At its 2005 annual meeting, some AMA delegates had urged an outright moratorium on drug ads, while others suggested any AMA position should come only after more research. Some consumer groups called on the AMA to disclose how much money its Journal of the American Medical Association makes on pharmaceutical ads printed in its issues.

The FDA permits three types of advertising of pharmaceuticals to the public:

  • product claim advertisements, which include both the product name and specific therapeutic claims;
  • reminder advertisements, which provide the name of a product without stating its use;
  • help-seeking advertisements, which inform consumers of new but unspecified treatment options for diseases or conditions.

Some critics have said that major pharma companies are spending more on marketing and advertising than on research and development, but according to a 2002 report from the General Accounting Office (GAO), "Prescription Drugs: FDA Oversight of Direct-to-Consumer Advertising Has Limitations," industry analyses show spending on research and development in 2001 was more than 10 times the spending on DTC advertising.

"Pharmaceutical companies spent an estimated $30.3 billion on research and development and $19.1 billion on all promotional activities, including $2.7 billion on DTC advertising in 2001," according to the GAO report.

But spending on advertising has grown at a far greater pace than has spending on research and development of new drugs, the GAO said. From 1997 through 2001, spending on DTC increased from $1.1 billion to an estimated $2.7 billion, a growth rate of nearly 250%, while spending on research and development increased from $19.0 billion to an estimated $30.3 billion, a growth rate of 160%.

Sources

  • Sarah Oetgen, MPH, Senior Vice President, SENSEI Health, 440 Ninth Ave., 16th Floor, New York, NY 10001. Phone: (212) 631-7779.
  • Kaiser Family Foundation, Menlo Park, CA. "Impact of Direct-to-Consumer Advertising on Prescription Drug Spending," study available at www.kff.org/rxdrugs/6084-index.cfm.
  • U.S. Food and Drug Administration, FDA Consumer, "The impact of direct-to-consumer advertising," March 2003. Available on-line at www.fda.gov/fdac/features/2003/203_dtc.html.