Abstract
Spending on direct-to-consumer advertising (DTCA) in the US rapidly increased from $US150 million in 1992 to $US1.2 billion in 1998 (to the end of November). Despite this level of expenditure, there is no literature on how DTCA affects patientss’ level of knowledge about medications, physician prescribing behaviour or health outcomes. It seems certain that DTCA will affect patientss’ expectations of care in disease management, but without answers to the questions outlined above, the direction of that effect is unclear.
This article approaches the topic by analysing existing quantitative literature. Two reviews have documented that many DTC advertisements do not give an accurate picture of the products they are promoting. Although there are arguments in favour of leaving out risk information, they are far from proven. Surveys have looked at how DTCA affects consumer attitudes towards medication and care-seeking behaviour. Consumers feel that DTCA will enhance the doctor-patient relationship but physicians believe the opposite.
Many consumers respond to DTCA by calling or visiting a health professional to discuss either medications or health problems. A sizeable minority ask for drugs by brand name. These products tend to be newer, more expensive ones where safety information may be incomplete because they are early in their life-cycles. Not only are consumers asking for such medications but in a substantial number of cases they are receiving them. If they do not receive them, then up to one-third of patients say they would switch doctors. Responding to these requests does not necessarily lead to greater patient satisfaction and may result in inappropriate prescribing.
On the whole, it is likely that DTCA will have negative consequences for patient expectations of disease management. Patients may ask for and receive more expensive and newer products that have less well defined safety characteristics than older drugs. They may change doctors if they do not receive the medications that they request and transfer negative feelings about denial of therapy to the disease management setting. Good communication that is necessary for disease management may suffer. Finally, the clash between the expectations of both patients and doctors about how DTCA will affect the doctor-patient relationship may erode the patientss’ confidence in their physicians and the system they are working in.
Similar content being viewed by others
References
Lexchin J. Direct to consumer advertising of prescription drugs: the next step. Can J Clin Pharmacol 1996; 3: 65
Brown P. Talking to patients — a dangerous road for industry? Scrip 1997 Jul/Aug; 59: 3–4
Conlan MR In-your-face pharmacy. Drug Topics 1996 Jul 8; 140: 92-8
US DTC ad spending ‘to grow 50% this year’. Marketletter 1998; Jul 20: 15
Parker BJ, Delene PM. Direct-to-consumer prescription drug advertising: content analysis and public policy implications. J Pharm Market Manage 1998; 12(4): 27–42
Food and Drug Administration. FDA public hearing. Direct-to-consumer promotion. Panel 7. Silver Spring (MD): Food and Drug Administration, 1995 Oct 18
Schulman KA, Rubenstein E, Abernethy DR, et al. The effect of pharmaceutical benefit managers: is it being evaluated? Ann Intern Med 1996; 124: 906–13
Hunt M. Direct-to-consumer advertising of prescription drugs. National Health Policy Forum. Washington, DC: The George Washington University, April 1998
Gelles J. Drug-ad boom: a prescription for problems? Critics say the marketing is distorted. Proponents say consumers will be better informed. Philidelphia Inquirer 1997 Aug 17; Sect. A: 1
General Accounting Office. Prescription drugs: little is known about the effects of direct-to-consumer advertising. Washington, DC: General Accounting Office, 1991. Report no.: GAO/PEMD-91-19
Hall M. Disease management — what role for the industry in Europe? Scrip Magazine 1995 Jun; 36: 29–32
Drug advertising: is this good medicine? Consumer Rep 1996 Jun: 62-3
Roth MS. Patterns in direct-to-consumer prescription drug print advertising and their public policy implications. J Pub Policy Market 1996; 15: 63–75
Morris LA, Millstein LG. Drug advertising to consumers: effects of formats for magazine and television advertisements. Food Drug Cosmetic Law J 1984; 39: 497–503
Food and Drug Administration. FDA public hearing. Direct-to-consumer promotion. Panel 10. Silver Spring (MD): Food and Drug Administration, 1995 Oct 19
US DTC TV ads work, Web ‘useless’. Scrip 1998 Sep 16; 2370: 16-7
Reeves KN. Direct-to-consumer broadcast advertising: empowering the consumer or manipulating a vulnerable population? Food Drug Law J 1998; 53: 661–79
Everett SE. Lay audience response to prescription drug advertising. J Advert Res 1991 Apr/May; 31: 43–9
Law J. Assessing the impact of direct-to-consumer advertising. Scrip 1998 Nov: 21-2
Hodnett J. Targeting consumers. Med Market Media 1995 Nov; 30: 91–5
Food and Drug Administration. FDA public hearing. Direct-to-consumer promotion. Panel 4. Silver Spring (MD): Food and Drug Administration, 1995 Oct 18
Schommer JC, Doucette WR, Mehta BH. Rote learning after exposure to a direct-to-consumer television advertisement for a prescription drug. Clin Ther 1998; 20: 617–32
Alperstein NM, Peyrot M. Consumer awareness of prescription drug advertising. J Advert Res 1993 Jul/Aug; 33: 50–6
Lipsky MS, Taylor CA. The opinions and experiences of family physicians regarding direct-to-consumer advertising. J Fam Pract 1997; 45: 495–9
Cutrer CM, Pleil AM. Potential outcomes associated with direct-to-consumer advertising of prescription drugs: physicianss’ perspectives. J Pharm Market Manage 1991; 5(3): 3–18
Contrary surveys on value of DTC ads. Scrip 1998 Dec; 16 (2396): 16
Petroshius SM, Titus PA, Hatch KJ. Physician attitudes toward pharmaceutical drug advertising. J Advert Res 1995 Nov/Dec; 35: 41–51
Pines W. Some major issues in direct-to-consumer advertising. Food Drug Law J 1994; 49: 589–92
Turbayne E. Direct-to-consumer advertising of prescription drugs: review of the literature. Consultation Workshop, Drugs Programme, Health Protection Branch. Aylmer, Quebec: Health Canada, 1996 Jun 18–19
Basara LR. The impact of a direct-to-consumer prescription medication advertising campaign on new prescription volume. Drug Info J 1996; 30: 715–29
Maddox LM, Katsanis LR Direct-to-consumer advertising of prescription drugs in Canada: its potential effect on patient-physician interaction. J Pharm Market Manage 1997; 12(1): 1–21
Avorn J, Chen M, Hartley R. Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med 1982; 73: 4–8
s’t Hoen E. Direct-to-consumer advertising: for better profits or for better health? Am J Health Syst Pharm 1998; 55: 594–7
Pood and Drug Administration. PDA public hearing. Direct-to-consumer promotion. Panel 9. Silver Spring (MD): Pood and Drug Administration, 1995 Oct 19
Gilbert D. Direct-to-consumer advertising of prescription medicines. Scrip reports, industry alert. London: PJB Publications Ltd, 1998
Asking for it. Americas’s Pharmacist 1997 May; 119: 12
National Center for Health Statistics, Cypress BK. Drug utilization in general and family practice by characteristics of physicians and office visits. National Ambulatory Medical Care Survey, 1980. Advance Data from Vital and Health Statistics [no. 87, DHHS publ. no. (PHS) 83–1250]. Hyattsville (MD): Public Health Service, 1983 Mar 18
Williams AP, Cockerill R. Report on the 1989 survey of the prescribing experiences and attitudes toward prescription drugs of Ontario physicians. Prepared for: Pharmaceutical Inquiry of Ontario (Lowy Commission); Toronto, 1989 Dec
Vinson DC, Lutz LJ. The effect of parental expectations on treatment of children with a cough: a report from ASPN. J FamPract 1993; 37: 23–7
Britten N, Ukoumunne O. The influence of patientss’ hopes of receiving a prescription on doctorss’ perceptions and the decision to prescribe: a questionnaire survey. BMJ 1997; 315: 1506–10
Stimson GV. Doctor-patient interaction and some problems for prescribing. J R Coll Gen Pract 1976; 26 Suppl. 1: 88–96
Virji A, Britten N. A study of the relationship between patientss’ attitudes and doctorss’ prescribing. Fam Pract 1991; 8: 314–9
Wartman SA, Morlock LL, Malitz FE, et al. Do prescriptions adversely affect doctor-patient interactions? Am J Public Health 1981; 71: 1358–61
Cowan PF. Patient satisfaction with an office visit for the common cold. J Fam Pract 1987; 24: 412–3
Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract 1996; 43: 56–62
Schwartz RK, Soumerai SB, Avorn J. Physician motivations for nonscientific drug prescribing. Soc Sci Med 1989; 28: 577–82
Macfarlane J, Holmes W, Macfarlane R, et al. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ 1997; 315: 1211–4
Little P, Williamson I, Warner G, et al. Open randomised trial of prescribing strategies in managing sore throat. BMJ 1997; 314: 722–7
Little P, Gould C, Williamson I, et al. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ 1997; 315: 350–2
Anders G. Drug makers help manage patient care. Wall Street J 1995 May 17: Sect. A: 1
Sasich LD. Public Citizens’s Health Research Groups’s comments on: Food and Drug Administration: attitudinal and behavioral effects of direct-to-consumer advertising of prescription drugs. 1998 Sep 28
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lexchin, J. Direct-To-Consumer Advertising. Dis-Manage-Health-Outcomes 5, 273–283 (1999). https://doi.org/10.2165/00115677-199905050-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00115677-199905050-00004