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October 23, 2001

Prescription Drug Ads Target the Consumer

People are becoming more involved in their own health care and in some cases are more aware of new drugs and therapies than their own doctors. This is partially due to the explosion of medical information - facts once reserved only for health care professionals - now readily available to the public.

Many people rely on a wide range of medical web sites for health care information and tips. But glossy advertisements in popular magazines and commercials on nightly television touting the latest drugs are also changing attitudes about health care, including how people use and perceive prescription drugs.

Data show that in 1999 the pharmaceutical industry spent almost $14 billion on drug promotions, and 13 percent was spent on direct-to-consumer (DTC) advertising.

The drug industry's hefty investment in patient marketing efforts have made drug advertisements ubiquitous; in fact, a 1997 national survey of consumers found that 95 percent of them had been exposed to at least one DTC advertising for a prescription drug. These and other data were discussed this month at a program sponsored by the Center on Consumer Self Care of the School of Pharmacy.

It wasn't until the early 1980s that the public was considered a viable target audience for drug advertisements, when Eli Lilly launched a successful advertising campaign aimed not only at doctors, as was common practice, but also at patients. But when the drug marketed by Lilly was taken off the shelves due to adverse health effects, the Food and Drug Administration (FDA) reacted by restricting such DTC advertisements.

However, in 1995, the FDA lifted he restriction and mandated that a drug advertisement must include a "brief summary" of the product's indications, contraindications, warnings, adverse reactions and other risk information. But in 1997, the FDA removed their requirement for a "brief summary" of risk information.

As a result of the FDA's changes in restrictions, there was a huge surge in the number of drug advertisements appearing in national media, and in some cases, more room for inaccuracies and misinformation.

For example, a survey of advertisements in Canadian magazines found that 24 percent of the ads contained minor errors such as failure to mention side effects or exaggerating efficacy, while 39 percent had major errors such as unapproved claims or misrepresentation. Similar inaccuracies have been found in advertisements to physicians.

Clinical pharmacists evaluated the content of print advertisements appearing in three consumer magazines and found that only about 50 percent of the advertisements presented accurate information or enough information for patients to make an informed choice.

Content analysis of DTC advertisements appearing in 18 magazines from 1989 through 1998 found that most advertisements lacked information on the drug's mechanism of action, success rate, treatment duration, and alternative treatments, including non-drug treatments.

Information on prevalence or etiology of the health condition discussed was also rare. Content analyses have also concluded that educational content of the advertisements is low compared to their promotional content. Although there is plenty of room for criticism about DTC advertising, many health care professionals are staunch supporters of DTC advertising. Some believe that drug ads initiate greater dialogue between physicians and patients, while raising awareness of conditions that are often under-diagnosed, such as incontinence and impotence.

For instance, studies have found that 20-40 percent of consumers who saw an ad for a drug talked to their doctor or pharmacist about it.

Yet critics claim that DTC advertising contributes to the "medicalization" of everyday problems, such as shyness, aging and premenstrual syndrome.

Other vital issues, such as DTC advertising's influence on health care costs and most importantly, patients' outcomes, are hot topics of debate among the medical and pharmaceutical industries.

Lisa A. Bero, PhD, a member of the Center for Consumer Self Care and professor of clinical pharmacy and health policy, has researched extensively on the effects of DTC advertising on health outcomes and health services. She shared her thoughts on the following questions:

How does DTC advertising affect patients' health care outcomes?

The bottom line is that unfortunately we don't know the answer to this yet. This is the burning question for researchers and it is a difficult question to answer because it is hard to isolate the effects of DTC advertising on health.

What are the potential dangers and dangers of DTC advertising?

The main danger is that DTCA provides misinformation about drugs because such ads tend to emphasize the benefits and minimize the harms of drugs, while ignoring the possibilities of alternative therapies, including generic treatments that are often less expensive, but just as effective, as brand name drugs.

One potential benefit of DTCA is that it can increase communication between physicians or pharmacists and the public.

How does DTC advertising affect patient demand for drugs and patient-physician relationships?

There is evidence that DTCA exposure increases patient requests for the advertised drugs and surveys suggest that patients have mixed attitudes toward the ads, while most physicians are critical of them. There are really no data on the effects on the patient-physician relationship.

What is the FDA's role in reviewing pharmaceutical companies' advertisements?

The FDA does not proactively review DTC advertisements. If someone (usually a competing drug company) brings a complaint against an ad, the FDA will review it for accuracy and balance.

How does "public patient education" differ from DTC advertising?

It depends on the source. The source of DTC advertising is always the marketing company whereas education could come from other sources such as patient groups, health care providers, etc. DTC advertising is inherently promotional and not educational.

Based on your research regarding DTC advertising, what recommendations would you make to the public when viewing drug ads?

Review the ads very critically -- much in the same way you would review an ad for an automobile. Do you believe everything the ad says? Are harms mentioned or only benefits? Are any comparisons to other marketed drugs mentioned?

How can patients ensure that their doctors will prescribe them the most beneficial and cost-effective drug?

That's a tough question, but discussing treatment alternatives with your physician as well as the pros and cons of each drug is always recommended. Also, make sure to always ask your doctor for the source of their evidence for making a decision.

For additional information regarding the Center for Consumer Self Care, email director Lorie Rice .

UCSF News Release
Source: Maureen McInaney


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