Does Direct-to-Consumer Drug Advertising Enhance Patient Choice?

In the modern developed world, there is no shortage of information presented to the

average adult. Many of us spend the majority of our time in front of a screen, whether a TV,
computer, or smartphone. With all this information comes the inevitable - advertising. Since
1997, pharmaceutical advertisements have begun to work their way into those media, and are
now more prolific than ever (McGraw Hill 2015, pg. 2-3).

This method of selling

pharmaceuticals has come under fire, to such a degree that various committees of Congress have
begun to hold hearings in relation to Direct-to-Consumer (DTC) marketing by pharmaceutical
companies.
During one such hearing of the Senate Special Committee on Aging, Pharmaceutical
Research and Manufacturers of America (PhRMA) Chief Medical Officer Paul Antony gave
written testimony asserting the importance of DTC Marketing. To Mr. Antonys mind, DTC
marketing is an invaluable tool for patient education, providing information on both available
pharmaceuticals as well as potentially helping consumers diagnose conditions they were not
previously aware of. He acknowledges that DTC must be used responsibly, going so far as to
cite various Guiding Principles to be adopted by PhRMA members. While (according to its
critics) there are many potential risks to DTC advertising of pharmaceuticals, these risks are
insignificant when compared to the amount of information being provided to consumers through
these advertisements. One of the primary concerns expressed during Mr. Antonys testimony
concerned over- or mis-prescribed medications, which he refuted with evidence. According to a
General Accounting Office report on DTC drug marketing, while 61.1 million people began
conversations with their doctors due to DTC marketing, only 8.5 million actually received the
prescriptions they were seeking. This, he explained, was explained by an FDA study in which
72% of physicians surveyed stated that they felt little to no pressure to write a prescription
when requested due to DTC marketing.

He also attempted to quiet concerns of the

pharmaceutical industrys motivations in marketing to consumers directly by citing data from

2004 when ...pharmaceutical companies spent an estimated 4.15 billion on DTC advertising,
as opposed to ...49.3 billion in total R&D spending... during the same time span. With all of
this, he explains, patients will be informed, and will begin conversations about undiagnosed
conditions they were unaware of, possibly indicated by symptoms they had previously not

connected or acknowledged as serious. Some of these conditions may even be stigmatizing,

causing patients such embarrassment that they may feel uncomfortable seeking their doctors
advice before DTC marketing made it approachable. Mr. Antony goes so far as to state that
doctor-patient relationships will benefit from this increase of communication. Throughout Mr.
Antonys statement, he stresses how informing consumers will directly affect the way patients
handle their own medical care, thereby removing the major obstacle in receiving prescriptions
which they would not have previously accessed. He also attempts to present the marketing
budgets of major pharmaceutical companies as significantly lower than their R&D budgets.
(U.S. Senate, 2005) Unfortunately, both of these assertions are incorrect.
In a counterpoint, an article in Annals of Family Medicine, a major medical journal,
presents DTC marketing as irresponsible and potentially dangerous for consumers. According to
the authors, DTC marketing tactics fail to provide a reliable source of information to patients and
is often designed with the pharmaceutical companys sales numbers and profit margin in mind as
opposed to the best interests of patients. In a study of the content of television pharmaceutical
commercials, it was found that the vast majority of these materials were designed to sell their
products through emotional appeals while neglecting to inform potential consumers of potential
alternatives, negative side effects or other risks associated with the drug in question. In fact,
pharmaceutical advertising was so misleading that a FDA study had shown that 41% of patients
had unrealistic views of the efficacy of a drug due to DTC advertisements. Countering Mr.
Antonys statement as to doctors tendencies to feel pressured by patients, the article also gives
light to the fact that 22% of primary care physicians felt exactly the opposite. The article does
state that pharmaceutical companies should be allowed to communicate with consumers, but that
they needed to follow the standards of medicine, as opposed to ethical guidelines used when
promoting products with less risk. The assertion is made that this could be achieved by changing
the tone and content balance of current DTC advertising methods. The authors of the article still
give credence to the effectiveness of DTC advertising on prescription consumption in the United
States, viewing it as overriding physician choice, which is an incorrect assumption.
With the market for pharmaceutical products continuously on the rise, it is important for
consumers to be informed on all aspects of their medical care, including their prescriptions.
DTC marketing has an important role to play in that education, but not necessarily in the way
presented in either of the above articles. The article from the Annals of Family Medicine

presents various facts supporting their opinions along with references for those opinions,
including multiple findings from FDA studies on DTC marketing. However, the article fails to
explore just how often DTC marketing directly affects prescribed drugs, which is the primary
concern expressed. Mr. Antony presents a great many facts, however, many of them have no
reference. Of those facts which do come from neutral sources, few of them actually support his
claims as to the effectiveness of DTC marketing techniques. When fewer than one seventh of
patients who begin a conversation with their doctor about a new drug actually wind up receiving
the medication they were seeking, DTC marketing may not be making as large a difference as
presented. While, yes, nearly one in five patients are beginning conversations with their doctors
due to information presented in DTC materials (U.S. Senate 2015), there was no data given by
either party on how often these patients were correct in their self diagnosis. However, given the
41% rate at which doctors questioned patients understanding of a drugs efficacy due to DTC
marketing, one can only assume that the number of patients confused by potential lists of
diagnostically significant symptoms is not insignificant.

With all that being said, the true

effectiveness of DTC marketing has to be called into question, when over 70% of doctors do not
feel pressured to write prescriptions at a patients request, and when a small fraction of patients
end up receiving the requested drug they saw in an advertisement. Both authors stress the
importance of DTC marketing in deciding which drugs patients wind up taking, but this is far
from the largest factor in determining what drugs doctors write prescriptions for. While, yes, it is
true that DTC marketing costs only a fraction of what companies spend on research and
development, this is not the whole picture. In 2013, according to The Washington Post, the top
10 pharmaceutical companies spent $98.3 billion on Sales and Marketing, as opposed to $65.8
billion on Research and Development (Swanson 2015). According to the a Bloomberg article,
during the same year, DTC spending by the pharmaceutical industry totaled approximately $3.8
billion (Koons 2015), leaving $94.5 billion spent on Sales and Marketing, still over $28 billion
more than is spent on Research and Development. Most of this money is spent marketing to
doctors, using various means, some of which are less ethical than simply leaving out a side effect
during a disclaimer at the end of a commercial. With such a significant marketing budget being
used to attempt to sway doctors decisions as to which companys drugs to prescribe, any and all
information which consumers can obtain is to their advantage. Currently, DTC marketing is not
regulated to the point where consumers can believe they are getting all the necessary

information, it does provide a starting point. While it may fall to the consumer to seek the actual
research on any medications they are considering, it provides some other option to medical
companies potentially buying doctors loyalty.
References
U.S. Senate Special Committee on Aging (September 29, 2005). The Impact of Direct-toConsumer Drug Advertising on Seniors Health and Health Care Costs Senate Hearing 109317. U.S. Government Printing Office, Washington, D.C. (Accessed through
https://www.gpo.gov/fdsys/pkg/CHRG-109shrg25879/html/CHRG-109shrg25879.htm
3/30/2016)
David A. Kessler and Douglas E. Levy (January/February 2007). Direct to Consumer
Advertising: Is It Too Late To Manage The Risks? Annals of Family Medicine. Annals of
Family Medicine, Inc., Leawood, KS (Reprinted in Biology 1090, Human Biology Salt Lake
Community College Taking Sides Readings. McGraw Hill Education, Columbus, OH.)
McGraw Hill Education (2015). Biology 1090, Human Biology Salt Lake Community College
Taking Sides Readings. McGraw Hill Education, Columbus, OH.
Cynthia Koons (March 30, 2015). Its Like Viagra for Pharma Ads: Pfizers $1.4 Billion
Marketing Blitz Bloomberg. New York, NY. (Accessed through
http://www.bloomberg.com/news/articles/2015-03-30/pain-and-erectile-dysfunction-makepfizer-biggest-in-drug-ads, 3/30/16)
Ana Swanson (February 11, 2015). Big pharmaceutical companies are spending far more on
marketing than research. The Washington Post. Washington, D.C. (Accessed through
https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-arespending-far-more-on-marketing-than-research/, 3/30/16)