Journal of Business Ethics

, Volume 105, Issue 4, pp 447–460 | Cite as

Role of Socioeconomic Status on Consumers’ Attitudes Towards DTCA of Prescription Medicines in Australia

  • Betty B. ChaarEmail author
  • Johnson Lee


The Pharmaceutical Benefits Scheme, operating in Australia under the National Health Act 1953, provides citizens equal access to subsidised pharmaceuticals. With ever-increasing costs of medicines and global financial pressure on all commodities, the sustainability of the PBS is of crucial importance on many social and political fronts. Direct-to-consumer advertising (DTCA) of prescription medicines is fast expanding, as pharmaceutical companies recognise and reinforce marketing potentials not only in healthcare professionals but also in consumers. DTCA is currently prohibited in Australia, but pharmaceutical companies continuously lobby for the ban to be lifted. There is evidence that such marketing strategies influence consumer behaviour and concerns have been raised about whether DTCA could affect government expenditure on the PBS in Australia. This pharmacy-based study explored Australian consumer attitudes towards DTCA and whether consumer attitudes regarding DTCA differ based on socioeconomic status, measured in terms of income and education. Consumers from different socioeconomic areas in Sydney were asked to respond to a survey about an advertisement created specifically for the promotion of a mock prescription medicine. Their views about the intent, value and reliability of the advertisement were explored. The study found that consumers of lower socioeconomic status were more likely to perceive DTCA as a source of valuable and reliable medical information, and that they were more likely to request an advertised medication from their physician. If DTCA of prescription medicines was to be introduced in Australia, an increase in government expenditure on the PBS would be anticipated. Findings of this study also expose a deficit in respect for patients’ right to autonomy and informed consent which should be based on evidence-based, unbiased, information rather than advertisements.


Australian government expenditure Autonomy Consumer attitudes Direct-to-consumer advertising of prescription medicines (DTCA) 



Direct-to-consumer advertising


Food & Drug Administration (USA)


New Zealand


Pharmaceutical Management Agency


Pharmaceutical Benefits Scheme


United States of America


World Health Organisation


  1. Australian Bureau of Statistics. (2006). Socioeconomic indexes for areas (SEIFA) Postal Areas. Australian Bureau of Statistics. Accessed June 13, 2009, from
  2. Auton, F. (2004). The advertising of pharmaceuticals direct to patients: A critical review of the literature and debate. International Journal of Advertising, 23(1), 5–52.Google Scholar
  3. Beauchamp, T., & Childress, J. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.Google Scholar
  4. Boden, W. E., & Diamond, G. A. (2008). DTCA for PTCA—Crossing the line in consumer health education? Perspective. New England Journal of Medicine, 358, 21.CrossRefGoogle Scholar
  5. Bonaccorso, S. N., & Sturchio, J. L. (2002). For and against: Direct to consumer advertising is medicalising normal human experience. British Medical Journal, 324, 910–911.CrossRefGoogle Scholar
  6. Brekke, K. R., & Kuhn, M. (2006). Direct to consumer advertising in pharmaceutical markets. Journal of Health Economics, 25(1), 102–130.CrossRefGoogle Scholar
  7. Centrelink. (2009). Low income health care card. Commonwealth of Australia. Accessed October 24, 2009, from
  8. Chaar, B., & Kwong, K. (2010). Direct-to-consumer advertising: Australian pharmacists’ experiences with non-prescription medicines. International Journal of Pharmacy Practice, 18, 43–50.CrossRefGoogle Scholar
  9. Cleanthous, P. (2002). Patient welfare implications of innovation and diffusion in the US antidepressant market. Working Paper, New York University.Google Scholar
  10. Cleanthous, P. (2004). Analyzing the effects of marketing efforts by pharmaceuticals on patient welfare. Working Paper, New York University.Google Scholar
  11. Davis, J. J. (2007). Consumers’ preferences for the communication of risk information in drug advertising. Health Affairs, 26, 863–870.CrossRefGoogle Scholar
  12. Davis, K., Schoen, C., Schoenbaum, S. C., Doty, M. M., Holmgren, A. L., Kriss, J. L., et al. (2007). Mirror, mirror on the wall: An international update on the comparative performance of American health care. The Commonwealth Fund. Accessed October 24, 2009, from
  13. Department of Health and Ageing. (2005). Overview of the Australian healthcare system. Department of Health and Ageing. Accessed 12 October 12, 2009, from
  14. Department of Health and Ageing. (2008). Quality use of medicines. Commonwealth of Australia. Accessed October 15, 2009, from
  15. Department of Health and Ageing. (2009). About the PBS. Commonwealth of Australia. Accessed October 24, 2009, from
  16. Desselle, S., & Aparasu, R. (2000). Attitudinal dimensions that determine pharmacists’ decisions to support direct-to-consumer advertising of prescription medicines. Drug Information Journal, 34, 103–114.CrossRefGoogle Scholar
  17. Donohue, M., Cevasco, M., & Rosenthal, M. B. (2007). A decade of direct-to-consumer advertising of prescription drugs. New England Journal of Medicine, 357, 673–681.CrossRefGoogle Scholar
  18. Fetto, J. (2002). Drugged out. American Demographics, 24, 11.Google Scholar
  19. Galbally, R. (2001). Review of drugs poisons and controlled substances legislation. Final Report. Canberra: Commonwealth of Australia. Accessed September 03, 2010, from
  20. GAO. (2006). Prescription drugs: Improvements needed in FDA’s oversight of direct-to-consumer advertising. Report No. 07-54. United States General Accounting Office. Accessed September, 2010, from
  21. Gardner, D. M., Mintzes, B., & Ostry, A. (2003). Direct-to-consumer prescription drug advertising in Canada: Permission by default? Canadian Medical Association Journal, 169, 425–427.Google Scholar
  22. Gascione, D. (2004). DTC at the crossroads: A “direct” hit… or miss? IMS issues and insights, September 23, 2004, pp. 111–123. Plymouth Meeting, PA: IMS Health.Google Scholar
  23. Gilbody, S., Wilson, P., & Watt, I. (2005). Benefits and harms of direct to consumer advertising: A systematic review. Quality and Safety in Health Care, 14(4), 246–250.CrossRefGoogle Scholar
  24. Gillon, R. (2003). Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”. Journal of Medical Ethics, 29(5), 307–312.Google Scholar
  25. Hall, D. V., & Jones, S. C. (2008). Australian consumer responses to DTCA and other pharmaceutical company sponsored advertisements. Australian and New Zealand Journal of Public Health, 32(5), 471–478.CrossRefGoogle Scholar
  26. Hansen, R., Schommer, J., Cline, R., Hadsall, R., Schondelmeyer, S., & Nyman, J. (2005). The association of consumer cost-sharing and direct-to-consumer advertising with prescription drug use. Research in Social and Administrative Pharmacy, 1, 139–157.CrossRefGoogle Scholar
  27. Hoek, J., & Gendall, P. (2002). To have or not to have? Ethics and regulation of direct to consumer advertising of prescription medication. Journal of Marketing Communications, 8, 71–85.CrossRefGoogle Scholar
  28. Joseph, M., Spake, D. F., & Finney, Z. (2008). Consumer attitudes toward pharmaceutical direct-to-consumer advertising: An empirical study and the role of income. International Journal of Pharmaceutical and Healthcare Marketing, 2(2), 33–177.CrossRefGoogle Scholar
  29. Kerridge, I., Lowe, M., & Stewart, C. (2009). Ethics and law for the health professions (3rd ed., pp. 79–90). Annandale: The Federation Press.Google Scholar
  30. Medicines Australia. (2008). Pharmaceutical benefits scheme quarterly fact sheet. Commonwealth of Australia. Accessed October 24, 2009, from
  31. Miller, K. E., & Waller, D. S. (2004). Attitudes towards DTC advertising in Australia: An exploratory study. International Journal of Advertising, 23(3), 389–405.Google Scholar
  32. Mintzes, B., & HAI Europe. (1998). Blurring the boundaries—New trends in drug promotion. Accessed January 24, 2011, from
  33. Mintzes, B. (2006). What are the public health implications? Direct-to-consumer advertising of prescription drugs in Canada. Health Council of Canada. Accessed June 15, 2009, from
  34. Morgan, S. G., Mintzes, B., & Barer, M. L. (2003). The economics of direct-to-consumer advertising of prescription-only drugs: Prescribed to improve consumer welfare? International Journal of Health Services Research and Policy, 8(4), 237–244.CrossRefGoogle Scholar
  35. National Prescribing Service (NPS). (2009). Proton pump inhibitors-prescribing practice review for primary care. RADAR, 1–4.Google Scholar
  36. Poser, M. (2010). DTCA of prescription medicines in the European Union: Is there still a need for a ban? European Journal of Health Law, 17, 471–484. doi: 10.1163/157180910X527897.CrossRefGoogle Scholar
  37. Prat, P. (2000). The results of a regulatory compliance survey of direct-to-consumer advertisements for medicines. Wellington: Ministry of Health (Medsafe).Google Scholar
  38. Semin, S., Aras, S., & Guldal, D. (2007). Direct to consumer advertising of pharmaceuticals: Developed countries’ experiences and Turkey. Health Expectations, 10(1), 4–15.CrossRefGoogle Scholar
  39. Silver, L. S., Stevens, R. E., & Loudon, D. (2009). Direct-to-consumer advertising of pharmaceuticals: Concepts, issues, and research. Health Marketing Quarterly, 26(4), 251–258.CrossRefGoogle Scholar
  40. Sub-Committee DU. (2008). Top 10 drugs. Commonwealth of Australia. Accessed October 21, 2009, from
  41. Weissman, J. S., Blumenthal, D., Silk, A. J., Newman, M., Zapert, K., Leitman, R., et al. (2004). Physicians report on patient encounters involving direct-to-consumer advertising. Accessed October 21, 2009, from
  42. WHO. (1988). Ethical criteria for medicinal drug promotion. The World Health Organisation. Accessed June 14, 2009, from
  43. Williams, J. R., & Hensel, P. J. (1995). Direct-to-consumer advertising of prescription drugs. Journal of Health Care Marketing, 15(1), 35–41.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Faculty of PharmacyUniversity of SydneySydneyAustralia

Personalised recommendations