Direct-to-consumer advertising

Direct-to-consumer advertising (DTCA) is the promotion of prescription drugs through newspaper, magazine, television and internet marketing. Drug companies also produce a range of other materials, including brochures and videos, that are available in doctors offices or designed to be given to patients by medical professionals or via patient groups.

The only two developed countries where DTCA is currently legal are the U.S. and New Zealand. (See Direct-to-consumer advertising in the United States and Direct-to-consumer advertising in New Zealand for more country-specific details). While banned elsewhere, the drug industry is mounting major lobbying campaigns to have DTCA allowed in Europe and Canada. (See Direct-to-consumer advertising: The Campaign To Overturn Europe's Ban and Direct-to-consumer advertising: CanWest's Bid to Overturn Canada's Ban for further details).

DTCA advertising is just one strand in the marketing and PR efforts of drug companies to promote brand-name prescription drugs. Some aimed at potential consumers are video news releases for use in television news bulletins and programs, the hiring of celebrities.

Other elements in the marketing and PR mix aimed at doctors include advertising in medical journals, the placement and promotion of favourable studies in medical journals, the visits of sales representatives to doctors, the provision of free samples of drugs for doctors to give to their patients, gifts for doctors and subsidised 'educational' events and conferences.

The Pros and Cons of DTCA
The drug industry argues that DTCA advertising helps 'educate' consumers of potential conditions and encourages them to see their doctor for diagnosis and treatment. While acknowledging that DTCA increases the amount spent on prescription drugs, they argue that in the long run early treatment and diagnosis reduces spending on other medical services, such as hospitalisation.

Critics of DTCA argue that the industry's advertising is primarily emotional in style and understates the adverse side-effects and as such is misleading. The imagery of the ads is appealing while the potentially serious side effects are buried in the fine-print. They also argue that the claimed health benefits are overstated. Surveys reveal that people who have seen DTCA ads will often request and be prescribed the drug. DTCA campaigns will usually aim to have pre-primed doctors via a parallel promotional campaign. Critics argue that this results in over-diagnosis of a condition and the inappropriate use of prescription drugs, even where non-drug treatments are as or more effective. As a result, DTCA unnecessarily drives up the overall cost of healthcare without necessarily improving the health of those treated.

A November 2006 report by the U.S. Government Accountability Office report noted that "studies we reviewed found that increases in DTC advertising have contributed to overall increases in spending on both the advertised drug itself and on other drugs that treat the same conditions. For example, one study of 64 drugs found a median increase in sales of $2.20 for every $1 spent on DTC advertising. Consumer surveys suggest that DTC advertising increases utilization of drugs by prompting some consumers to request the advertised drugs from their physicians, who studies find are generally responsive to these requests. The surveys we reviewed found that between 2 and 7 percent of consumers who saw DTC advertising requested and ultimately received a prescription for the advertised drug." 

The Narrow Focus of DTCA
In a review of DTCA spending between 1997 and 2005, the U.S. Government Accountability Office noted that "drug companies concentrate their spending on DTC advertising in specific forms of media and on relatively few drugs. Television and magazine advertising represented about 94 percent of all spending on DTC advertising in 2005. DTC advertising also tends to be concentrated on relatively few brand name prescription drugs--in 2005, the top 20 DTC advertised drugs accounted for more than 50 percent of all spending on DTC advertising." 

"Many of the drugs most heavily advertised to consumers in 2005 were for the treatment of chronic conditions, such as high cholesterol, asthma, and allergies," it noted. 

The Digital Age and DTCA
From Wikipedia:

The pharmaceutical industry as a whole has not been as quick as other sectors to jump on the digital marketing bandwagon, in part due to unclear guidelines from the FDA. Nonetheless, many DTCA marketers are beginning to recognize the opportunities that new media offers for reaching consumers. Though the vast majority of DTCA budgets are still allocated to traditional offline media, marketers are beginning to shift some of their spending to digital activities such as product websites, online display advertising, search engine marketing, social media campaigns, and mobile advertising.

SourceWatch Resources

 * Drug industry
 * Pharmaceutical Research and Manufacturers of America
 * Direct-to-consumer advertising in New Zealand
 * Direct-to-consumer advertising in the United States
 * Direct-to-consumer advertising: The Campaign To Overturn Europe's Ban
 * Direct-to-consumer advertising: CanWest's Bid to Overturn Canada's Ban
 * Disease awareness campaigns

Articles From Academic Journals

 * Jerome R Hoffman and Michael Wilkes, "Direct to consumer advertising of prescription drugs, Editorial, British Medical Journal, May 1999.
 * Barbara Mintzes, Arminée Kazanjian, Ken Bassett and Joel Lexchin, "Pills, persuasion and public health policies: Report of an expert survey on direct to consumer advertising of prescription drugs in Canada, the United States and New Zealand", Centre for Health Services and Public Policy, University of British Columbia, 2001.
 * Barbara Mintzes, Morris L Barer, Richard L Kravitz, Arminée Kazanjian, Ken Bassett, Joel Lexchin, Robert G Evans, Richard Pan, and Stephen A Marion, "Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey", British Medical Journal, February 2002.
 * Barbara Mintzes, "For and against: Direct to consumer advertising is medicalising normal human experience: For", British Medical Journal, April 2002.
 * Joel Lexchin and Barbara Mintzes, "Direct-to-consumer advertising of prescription drugs: The evidence says no", Journal of Public Policy and Marketing, Volume 21, Number 2, 2002, pages 194-202.
 * Silvia N Bonaccorso and Jeffrey L Sturchio, "Direct to consumer advertising is medicalising normal human experience: Against", British Medical Journal, April 13, 2002. (Bonaccorso is vice president, marketing and medical services and Sturchio is executive director, public affairs (Europe, Middle East, Africa) for Merck.)
 * Julie M. Donohue, Ph.D., Marisa Cevasco, B.A., and Meredith B. Rosenthal, Ph.D., "A Decade of Direct-to-Consumer Advertising of Prescription Drugs," New England Journal of Medicine, Volume 357:673-681, Number 7, August 16, 2007.

General Articles

 * "$2.8B spent for DTC ads", O'Dwyers PR Daily, April 15, 2002. (Sub req'd).
 * Peter R Mansfield, Barbara Mintzes, Dee Richards, and Les Toop, "Direct to consumer advertising", Editorial, British Medical Journal, January 2005.
 * Alan Zarembo, "TV Ads for Drugs Help Boost Prescriptions, Researchers Say", Los Angeles Times, April 27, 2005.
 * Beth Herskovits, "Attendees debate DTC advertising at PRSA health academy meeting", PR Week, May 11, 2005. (Sub req'd).
 * "TV ad spend squeeze", PMLive.com, May 24, 2005. (PMLive is the online version of Pharmaceutical Marketing). This artice indicates that several large drug companies are reviewing the amount they spend on DTC television ads in the U.S.
 * Stephanie Saul, "A Self-Imposed Ban on Drug Ads", New York Times, June 15, 2005.
 * Jeanne Lenzer, "American Medical Association rejects proposal to ban consumer adverts for prescription medicines", British Medical Journal, Volume 331 Number 7, July 2, 2005.
 * Pharmaceutical Research and Manufacturers of America (PhRMA), "America’s Pharmaceutical Industry Announces Guidelines on Direct-to-Consumer Advertising", Media Release, August 2, 2005.
 * Pharmaceutical Research and Manufacturers of America (PhRMA), "PhRMA Guiding Principles Direct to Consumer Advertisements About Prescription Medicines", August 2, 2005.
 * Jim Edwards, "PhRMA Unveils New Guidelines", MediaWeek, August 02, 2005.
 * Beth Herskovits, "Hefty Merck verdict spurs firms to rethink DTC efforts", PR Week, August 29 2005. (Sub req'd)
 * Rich Thomaselli, "PR Seems To Be the Rx to Get Around DTC Rules: Firms Confirm Pharma Is Seeking Ways To Live with (But Not Skirt) Guidelines," Advertising Age, September 26, 2005, p. 6 (not available online).
 * Rich Thomaselli, "FDA Hearings Could Bring DTC Regulations: Big Pharma Marketers Expect Change After Year of Political Scrutiny," Advertising Age, October 3, 2005, p. 8 (not available online).
 * "200+ Medical School Professors Call for End to DTC Prescription Drug Ads", Commercial Alert, October 27th, 2005.
 * Diedtra Henderson, "Rise of Celebrity Testimonials Spurs FDA Scrutiny", Boston Globe, October 30, 2005.
 * "Celebrity endorsement on the rack", Pharmaceutical Marketing, November 1, 2005.
 * Beth Herskovits, "Both sides of DTC debate rally while FDA holds panels", PR Week, November 3, 2005. (Sub req'd).
 * Beth Herskovits, "FDA seeking contractor to focus on effectiveness of promotions", January 5, 2006. (Sub req'd).
 * Alan Cassels, "Canada may be forced to allow direct to consumer advertising", British Medical Journal, June 24, 2006. (Sub req'd.)
 * "CSR and Big Pharma", Chief Executive, June 2006. (This is an interview with Hank McKinnell, chief executive of Pfizer, with the New York Times).
 * "Drug Trade Group Spent $10.7M Lobbying", Associated Press, August 17, 2007.
 * Matthew Perrone, "FDA to Study Images' Impact in Drug Ads," Associated Press, August 21, 2007.