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Article Excerpt
As one of the most controversial modern business practices in history, direct-to-consumer advertising of prescription medications is a critical topic for consumer advocates, but the current body of literature falls short of providing practical guidance for the eminent policy change. The current article reviews the existing perspectives on direct-to-consumer advertising and offers directions for answering important questions that focus on the consumer's interests.
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Direct-to-consumer (DTC) advertising continues to be one of the most controversial modern business practices, and when one of the most heavily advertised drags of 2000 was forcibly recalled from the marketplace, the debate escalated toward acrimony. The result is an extensive body of literature from the medical, consumer, and corporate perspectives, but this eclectic body of research provides limited direction on how to ensure consumers' interests and leaves numerous questions unanswered. Over thirty years ago, Wilkie and Gardner (1974) noted that "policy changes are going to be made, with or without research evidence" and that researchers need to "conduct studies that are more relevant to public policy decision making" (p. 46). DTC advertising regulation is in the midst of change, and consumer advocates need to better understand the relevant issues and existing data rather than reacting to a negative image of advertising's power over consumers.
TWO COMPETING PERSPECTIVES
There is considerable evidence that the direct marketing of prescription medications can be both beneficial and potentially detrimental to consumers. While each side of the debate has received considerable attention, the majority of published studies focus on either the benefits or the harms to the exclusion of the other. If we apply the consumer rights advanced by President Kennedy (the fight to be informed, to choose, to safety, and to be heard) as a starting point in evaluating current policy (Brobeck 2006), we recognize that both the positive and the negative positions focus on consumer interests from different perspectives, but a true resolution must balance information and safety.
Proponents of DTC advertising cite the increased availability of information as the greatest benefit (Auton 2004; Meek 2001) because it allows consumers to make educated decisions. According to supporters, DTC advertising is necessary to inform consumers about health problems, treatment options, and medical advances (Peyrot et al. 1998). Supporters also claim that DTC advertising encourages consumers to seek medical attention for conditions that would otherwise go unidentified and untreated (Rubin 1991). In short, the positive view of DTC advertising suggests that the educational value of the information provided is in the consumers' best interests and outweighs any potential negative consequences.
Additional support for DTC advertising comes from a series of surveys that the Food and Drug Administration (FDA) commissioned (Aikin, Swasy, and Braman 2004). For example, nearly half of the respondents in both the 1999 and the 2002 surveys who recalled seeing DTC ads indicated that the ad motivated them to seek additional information from their doctor, pharmacist, the Internet, friends, or other sources providing evidence that DTC advertising informs consumers. Calfee (2002) argues that by motivating consumers to seek additional information, DTC advertising increases the salience of the risk of prescription medications, brings consumers' attention to nondrug health alternatives and improves compliance in individuals already taking the medication.
In contrast, DTC advertising opponents feel that prescription drugs differ from other products, and, therefore, should not be advertised in a similar manner. Critics maintain that DTC advertising intrudes into the physician-patient relationship and confuses patients by representing promotional messages as educational (Wolfe 2002). Further, opponents believe that DTC advertising increases demand for more expensive medications and medicalizes normal human experience (Mintzes 2002), rather than providing consumers with information needed to make better health-care decisions. Critics also contend that the increase in patient requests for advertised medications (Peyrot et al. 1998) leads to preference toward branded, advertised prescriptions over more affordable and effective treatments (Dyer 2002; Findlay 2002). This view of DTC advertising suggests that the practice has serious consequences that are not in the consumer's best interests.
Lexchin and Mintzes (2002) argue that DTC advertising supporters overlook key issues such as the balance of risks and benefits. Their article highlights a 1996 Consumer Reports study where a panel of medical specialists concluded that the majority of the ads they studied failed to prominently include important information on side effects. They also note Roth's (1996) study, which found that one-third of the ads sampled did not contain the regulatory required balance of risk and benefit information as evidence that DTC ads are more concerned with promotion than education.
DTC advertising critics also believe that while more patients with high cholesterol or depression seek treatment because of ads for Lipitor or Prozac, they could be treated with equally effective generic drugs in the same classes. Experts also note that medications in DTC ads often give the appearance of being "new and improved" over alternative treatments, but in several categories, older drugs may actually be both the better and the cheaper alternative (Appel 2002). Other advertised drugs (e.g., Nexium) are virtually identical to existing medications, leading DTC opponents to argue that the true value of DTC advertising is to the pharmaceutical companies' bottom lines (Avorn 2003).
THE STAKEHOLDERS
One reason for the contrasting nature of DTC advertising is that several parties have key interests in the DTC environment. Pharmaceutical companies, consumers, physicians, insurers, and government agencies all hold a stake in the practice--and the stakes are very high with DTC ad spending at $4.2 billion in 2005 (GAO 2006). The largest and perhaps most widely researched constituency in the DTC arena are the consumers. More specifically, research related to consumers has examined the influence of DTC advertising in effectiveness, value, and understanding.
For instance, Roth (2003) investigated the effects of advertising strategies on awareness. His study found greater awareness for ads without symptom information as well as for those that used transformational messages rather than informational ones. Another study found that a higher risk to benefit information ratio reduced involvement, impaired recall, and resulted in a negative affective response (Kavadas, Katsanis, and LeBel 2007), suggesting that a balanced presentation of risks and benefits is less effective for advertisers.
Some research has examined overall consumer response to DTC ads. Bell, Kravitz, and Wilkes (1999) studied DTC ad awareness, misconceptions, and attitudes as well as behavioral responses to such ads. The authors found that awareness was associated with a number of variables including prescription drug use, media exposure, existing positive attitudes toward DTC advertising, and health and insurance status. Their study also revealed substantial misconceptions about DTC advertising as well as an influence on consumer behavior with one-third of their respondents talking to their doctors about an advertised drug and one-fifth requesting a prescription.
An effort has also been made to understand how DTC ads are received by consumers. For example, Abernathy and Adams-Price (2006) examined older versus younger adults' ability to remember and comprehend drug information. They found that younger adults (as compared to older adults) experienced a greater increase in their knowledge of drugs after exposure to drug advertising. Mehta and Purvis (2003) found that respondents generally valued DTC advertising and felt that such ads provided more important information than ads for other products. A majority of the respondents found DTC ads believable, but about one-third felt that DTC advertising underplays the serious nature of the products advertised.
Examples of DTC influence on consumers are readily available. Take for instance, the patient having cataract surgery who provided her nurse with an array of drug ads. The patient described various symptoms and concluded that she needed prescriptions for high cholesterol, osteoporosis, and acid reflux. She instructed the nurse to tell her physician (in this case an opthalmologist) to have the prescriptions ready upon her discharge (Salladay...
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