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Direct to Consumer…or The other information providers

While we reach patients and the public by providing health information resources from print and online; tips on being better searchers, the pharmaceutical industry reaches the public with direct appeals at purchasing their prescription drugs. I thought I would devote some time to reading up on Direct to Consumer (DTC) advertising. I found some interesting things. What follows are some brief facts and figures, some resources that highlight some of the arguments surrounding DTC, and some annotations on the sources I consulted.

Factors that caused the growth in consumer health information also spurred the growth of direct to consumer marketing of pharmaceuticals--heightened patient involvement, managed care's restrictions in overall spending. Studies indicate that 91% of people surveyed have seen or heard an ad for prescription medications. (Kaiser Trends)

Studies on the effects of DTC drug advertising are pretty telling: One third of people surveyed indicated that an advertisement prompted a discussion with their physician about a prescription drug. Another study cited the same percentage, only the conversation with their physician was about a condition they had not discussed before.(MM&M Magazine Power) Yes, some of you are saying 'would that our influence be as widespread or as noticeable as DTC advertising!'

Direct to consumer (DTC) advertising of prescription drugs was legalized in 1983 (BMJ). Within the last 8 years, DTC advertising has been more widespread. From 1994 to 2000 spending on DTC advertising has grown from $266 million to $2.5 billion.

While the influence of DTC advertising seems staggering, there are a few facts to keep in mind. DTC advertising is faulted for the spike in prescription drug prices. Marketing budgets for drug companies are not up in proportion to their actual sales. Budgets for all promotional advertising (physician promotion and consumer promotion) hover around 14%. The proportion has remained the same over the last 5 years, but that's a high percentage when compared to other industries: Beer 7.5%, Tobacco 4%, Cosmetics 11.9%. Also, pharmaceuticals spending on actual research and development is slightly smaller (12% of sales) than their spending on promotions. (Kaiser Trends)

Despite the pervasiveness of DTC advertising, it is a smaller percentage of total drug advertising and promotion. Physician promotion accounts for a large portion of all advertising, around 85%. Included in that figure is the 50%-60% that is spent on drug samples distributed to physicians (MM&M Perfect Storm).

The Pharmaceutical Research and Manufacturers of American (PhRMA) is the organization that represents larger pharmaceutical and biotechnology companies. Their website is full of position papers.

"PhRMA believes that advertising directly to consumers serves to improve public health. As patients are participating more and more in decisions concerning their health care, pharmaceutical advertising helps meet consumer demand for information about health conditions and possible treatments. Often, this information prompts people to seek medical attention, promotes informed discussions with medical professionals and further enhances the dialogue between physicians and their patients"

The Center for Medical Consumer's aim is to improve the quality of health care and protect consumer rights. The center works to improve oversight throughout the health care industry and works on New York state health issues. Excerpts from their HealthFacts newsletter are available on their website. Of interest is an article on Drug Advertising
The article outlines some of the approaches drug advertising takes: selling fear by outlining the dangers of a given disease; selling a test which would which would create a demand for the drug being advertised, advertising a drug without mentioned what the drug is indicated for, this way side effect need not be mentioned in the advertising.

The American Medical Association: Questions swirl around drug ads for patients...for an article on physicians perceptions of DTC.
The AMA policy statement on DTC advertising directed towards physicians:

physicians should resist commercially induced pressure to prescribe drugs that may not be indicated. Physicians should deny requests for inappropriate prescriptions and educate patients as to why certain advertised drugs may not be suitable treatment options providing, when available, information on the cost effectiveness of different options

Other articles and links:

See the BMJ article Direct to consumer drug advertising is billion dollar business in the US. for the briefest of overviews and abbreviated guidelines developed by the AMA, FDA, and the Pharmaceutical Manufacturers Association.

Families USA the national nonprofit organization dedicated to the high-quality, affordable health and long-term care for Americans. They have numerous reports and overviews on drug companies and drug legislation.
In addition to providing a useful primer on the drug approval process their Overview on the Hatch-Waxman Amendments provides background on the drug patenting process and how they help extend a pharmaceutical's market charge of a specific type of drug.

The Kaiser Family Foundation is an independent philanthropy that publishes numerous reports on health care issues. See their section on prescription drugs Of interest are
Trends in Direct to Consumer Advertising of Prescription Drugs And Trends and Indicators on the Changing Health Care Marketplace

Medical Marketing & Media Magazine offers tips and trends to the industry. See their reprints page. Suggested articles to review in relation to DTC advertising:
Power to the People: reaching the Smart Market of empowered consumers describes the IMS Health survey that gave feedback on consumer perceptions of DTC advertising. Representative quote:

"In this world where services - including the delivery of information - win customers, marketers will increasingly supplement their broad DTC messages with highly specific direct-to-patient (DTP) messages, having used the Internet as a pre-qualifying tool."

"company websites can provide both a highly informative and a remarkably "safe" medium for discussing off-label or preapproval information - "safe" meaning legally defensible and therefore at low risk for regulatory challenge