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Ethical and epistemic issues in direct-to-consumer drug advertising: where is patient agency?

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Abstract

Arguments for and against direct-to-consumer drug advertising (DTCA) center on two issues: (1) the epistemic effects on patients through access to information provided by the ads; and (2) the effects of such information on patients’ abilities to make good choices in the healthcare marketplace. Advocates argue that DTCA provides useful information for patients as consumers, including information connecting symptoms to particular medical conditions, information about new drug therapies for those conditions. Opponents of DTCA point out substantial omissions in information provided by the ads and argue that the framing of the ads may mislead patients about the indications, uses, and effectiveness of the drugs advertised. They also suggest that DTCA has a number of potentially negative effects on the doctor–patient relationship. The standard arguments appear to assume a simplistic correlation—more information means more agency for patients. However, empirical studies on medical decision making suggest that this relationship is much more complex and nuanced. I examine recent research on ways in which patients are vulnerable with respect to DTCA. In order to address the complex issues of information acquisition and consumer decision-making in the health care marketplace, the focus should not be simply on what information patients need in order to make medical decisions, but also on the conditions under which patients actually are able to make medical decisions requiring complex medication information. This requires examining both the cognitive limitations of patients with respect to drug information and investigating patients’ preferences and needs in a variety of medical contexts.

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References

  • Atherly, A., and P. Rubin. 2009. The cost-effectiveness of direct-to-consumer advertising for prescription drugs. Medical Care Research and Review 66: 639–657.

    Article  PubMed  Google Scholar 

  • Auton, F. 2009. Opinion: The case for advertising pharmaceuticals direct to consumers. Future Medicinal Chemistry 1(4): 587–592.

    Article  PubMed  CAS  Google Scholar 

  • Bekker H., J. Thornton, C. Airey, J. Connelly, J. Hewison, M. Robinson, J. Lilleyman, M. MacIntosh, A. Maule, S. Michie, and A. Pearman. 1999. Informed decision making: An annotated bibliography and systematic review. Health Technology Assessment 3(1): 1–156.

    Google Scholar 

  • Bell, R., M. Wilkes, and R. Kravitz. 2000. The educational value of consumer-targeted prescription drug print advertising. The Journal of Family Practice 49(12): 1092–1098.

    PubMed  CAS  Google Scholar 

  • Bradford, W., and A. Kleit. 2006. Evaluating the welfare effects of drug advertising. Regulation 29(1): 58–62.

    Google Scholar 

  • Brodie, M., and L. Levitt. 2002. Drug advertising: The right or wrong prescription for our ailments? National Review of Drug Discoveries 1: 916–920.

    Article  CAS  Google Scholar 

  • Calfee, J. 2003. What do we know about direct-to-consumer advertising of prescription drugs? Health Affairs, Jan–Jun, W3-116-9.

  • Carter, S., G. Samuel, I. Kerridge, R. Day, R. Ankeny, C. Jordens, and P. Komesaroff. 2010. Beyond rhetoric in debates about the ethics of marketing prescription medicines to consumers: The importance of vulnerability in people, situations, and relationships. AJOB Primary Research 1(1): 11–21.

    Article  Google Scholar 

  • Chesnes, M, and G. Jin. 2010. Direct to consumer advertising and online search. Unpublished working paper. Online at http://www.chesnes.com/research.html. Accessed 5 January 2012.

  • Davis, J. 2000. Riskier than we think? The relationship between risk statement completeness and perceptions of direct to consumer advertised prescription drugs. Journal of Health Communication 5: 349–369.

    Article  PubMed  CAS  Google Scholar 

  • Davis, J. 2007. Consumers’ preferences for the communication of risk information in drug advertising. Health Affairs 26(3): 863–870.

    Article  PubMed  Google Scholar 

  • Day, R. 2006. Comprehension of prescription drug information: Overview of a research program. Proceedings of the American Association for Artificial Intelligence, Argumentation for ConsumerHealthcare. Accessed online from http://www.aaai.org.

  • Donohue, J. 2006. A history of drug advertising: The evolving roles of consumers and consumer protection. Millbank Quarterly 84(4): 659–699.

    Article  Google Scholar 

  • Donohue, J., M. Cevasco, and M. Rosenthal. 2007. A decade of direct-to-consumer advertising of prescription drugs. New England Journal of Medicine 357(7): 673–681.

    Article  PubMed  CAS  Google Scholar 

  • Food and Drug Administration. 2011. Report to congress: Implementation of section 3507 of the patient protection and affordable care act of 2010; first progress report. Accessed online 4 June 2011 at: http://fda.gov/downloads/AboutFDA/CentersOffices/…/UCM250581.pdf.

  • Frosch, D., P. Krueger, R. Hornik, P. Cronholm, and F. Barg. 2007. Creating demand for prescription drugs: A content analysis of television direct-to-consumer advertising. Annals of Family Medicine 5: 6–13.

    Article  PubMed  Google Scholar 

  • Frosch, D., D. Grande, D. Tarn, and R. Kravitz. 2010. A decade of controversy: Balancing policy with evidence in the regulation of prescription drug advertising. American Journal of Public Health 100(1): 24–32. doi:10.2105/AJPH.2008.153767.

    Article  PubMed  Google Scholar 

  • Gigerenzer, G., W. Gaissmaier, E. Kurz-Milke, L. Schwartz, and S. Woloshin. 2008. Helping doctors and patients make sense of health statistics. Psychological Science 8(2): 53–96.

    Google Scholar 

  • Kallen, A., S. Woloshin, J. Shu, E. Juhl, and L. Schwartz. 2007. Direct-to-consumer advertisements for HIV antiretroviral medications: A progress report. Health Affairs 26(5): 1392–1398.

    Article  PubMed  Google Scholar 

  • Kaphingst, K., R. Rudd, W. Dejon, and L. Daltroy. 2005. Comprehension of information in three direct-to-consumer television prescription drug advertisements among adults with limited literacy. Journal of Health Communication 10(7): 609–619.

    Article  PubMed  Google Scholar 

  • Kees, J., P. Bone, J. Kozup, and P. Ellen. 2008. Barely or fairly balancing drug risks? Content and format effects in direct-to-consumer online prescription drug promotions. Psychology & Marketing 25(7): 675–691.

    Article  Google Scholar 

  • Kelly, P. 2004. DTC advertising’s benefits far outweigh its imperfections. Health Affairs (Millwood) Suppl Web Exclusives W4:246–248.

    Google Scholar 

  • Lipsky, M., and C. Taylor. 1997. The opinions and experiences of family physicians regarding direct-to-consumer advertising. Journal of Family Practice 45: 495–499.

    PubMed  CAS  Google Scholar 

  • Murray, E., B. Lo, L. Pollack, K. Donelan, and K. Lee. 2003. Direct-to-consumer advertising: Physicians’ views of its effects on quality of care and the doctor-patient relationship. The Journal of the American Board of Family Practice 16: 513–524.

    Article  PubMed  Google Scholar 

  • Murray, E., B. Lo, L. Pollack, K. Donelan, and K. Lee. 2004. Direct-to-consumer advertising: Public perceptions of its effects on health behaviors, health care, and the doctor-patient relationship. Journal of the American Board of Family Medicine 17(1): 6–18.

    Article  Google Scholar 

  • Paterniti, D., T. Fancher, C. Cipri, S. Timmermans, J. Heritage, and R. Kravitz. 2010. Getting to “no”: Strategies primary care physicians use to deny patient requests. Archives of Internal Medicine 170(4): 381–388.

    Article  PubMed  Google Scholar 

  • Riggs, D., S. Holdsworth, and D. McAvoy. 2004. Direct-to-consumer advertising: Developing evidence-based policy to improve retention and comprehension. Health Affairs 23: w249–w252.

    Google Scholar 

  • Robinson, A., and R. Thomson. 2001. Variability in patient preferences for participating in medical decision making: Implication for the use of decision support tools. Quality in Health Care 10 (suppl I): i34–i38.

    Google Scholar 

  • Robinson, A., K. Hohmann, J. Rifkin, D. Topp, C. Gilroy, J. Pickard, and R. Anderson. 2004. Direct-to-consumer pharmaceutical advertising: Physician and public opinion and potential effects on the physician-patient relationship. Archives of Internal Medicine 164: 427–432.

    Article  PubMed  Google Scholar 

  • Ruger, J. 2009. Health capability: Conceptualization and operationalization. American Journal of Public Health 100(1): 41–49.

    Article  Google Scholar 

  • Ruger, J. 2010. Health and social justice. Oxford: Oxford University Press.

    Google Scholar 

  • Schwartz, L., S. Woloshin, and H. Welch. 2007. The drug facts box: Providing consumers with simple tabular data on drug benefit and harm. Medical Decision Making 27: 655–662.

    Article  PubMed  Google Scholar 

  • Stange, K. 2007. Time to ban direct-to-consumer prescription drug marketing. Annals of Family Medicine 5: 101–104.

    Article  PubMed  Google Scholar 

  • Tentler, A., J. Silberman, D. Paterniti, R. Kravitz, and R. Epstein. 2007. Factors affecting physicians’ responses to patients’ requests for antidepressants: Focus group study. Journal of General Internal Medicine 23(1): 51–57.

    Article  PubMed  Google Scholar 

  • Viale, P., C. Sanchez, and D. Yamamoto. 2004. The attitudes and beliefs of oncology nurse practitioners regarding direct-to-consumer advertising of prescription medications. Oncology Nursing Forum 31: 777–783.

    Article  PubMed  Google Scholar 

  • Weissman, J., D. Blumenthal, A. Silk, M. Newman, K. Zapert, R. Leitman, and S. Feibelmann. 2011. Physicians report on patient encounters involving direct-to-consumer advertising. Health Affairs, April 2011. doi:10.1377/hlthaff.W4.219.

  • Woloshin, S., L. Schwartz, and M. Welch. 2004. The value of benefit data in direct-to-consumer drug ads. Health Affairs W4:234–245. Jan–Jun; Supplement Web Exclusives.

    Google Scholar 

  • Woloshin, S., L. Schwartz, J. Tremmel, and H. Welch. 2001. Direct-to-consumer advertisements for prescription drugs: What are Americans being sold? The Lancet 358: 1141–1146.

    Article  CAS  Google Scholar 

  • Zhang, F. 2009. FDA considers ‘drug fact boxes’. The Darmouth, published Wednesday, May 6, 2009. Article accessed online June 4, 2011 at: http://thedartmouth.com/2009/05/06/news/fda.

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Acknowledgments

I would like to thank David Badcott for developing, organizing and shepherding this project, which began with a panel presentation at the 2009 meetings of the European Society for Philosophy of Health and Medicine. My thanks also go to the other panelists at this meeting, where we started to work on the ideas for a set of papers on ethical challenges created by Big Pharma. I thank Norah Mulvaney-Day for her very helpful comments and support on earlier drafts of this paper. Thanks also go to the anonymous reviewers who provided valuable feedback on an earlier draft of this paper.

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  1. Department of Philosophy, Bridgewater State University, Bridgewater, MA, 02325, USA

    Catherine A. Womack

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  1. Catherine A. Womack
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Correspondence to Catherine A. Womack.

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Womack, C.A. Ethical and epistemic issues in direct-to-consumer drug advertising: where is patient agency?. Med Health Care and Philos 16, 275–280 (2013). https://doi.org/10.1007/s11019-012-9386-8

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