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Papers

Physicians’ attitudes toward


direct-to-consumer prescription
drug marketing
Received (in revised form): 25th October, 2006

Michael Friedman
joined Purdue Pharma L.P. in 1985 as Vice President and Assistant to the President and Chairman. Prior to that, he spent 12
years in Sales and Marketing at Hilti Inc, where he held positions of increasing responsibility including Vice President of Marketing
and Chief Operating Officer of Hilti’s Pneumatic Fastening Systems Division. At Purdue, he was named Group Vice President
in 1988, Executive Vice President and Chief Operating Officer in 1999 and President and CEO of Purdue Pharma in 2003. In
this position, he directs and guides all company operations, including among others sales, marketing, licensing and business
development and research and development. He holds a BA degree from Brooklyn College, an MBA from the University of
Connecticut and a doctoral degree from Pace University.

James Gould
is Professor of Marketing at Pace University and has an MS and PhD from Cornell University. His academic interests include the
Assessment of Integrated Media Communications Programs, Interactive Communications, Consumer and Trade Promotions,
Performance of Direct Response Medium, Analysis of Price Behavior in Stock, Bond and Commodity Markets; Neural Network
Analysis. He is on the Board of Directors at MarketFax. Inc and the Executive Board of the Westchester Cornell University Alumni
Association.

Keywords advertising, doctors, DTC, patients, pharmaceuticals, pharmacists

Abstract This paper examines attitudes of physicians toward direct-to-consumer


advertising (DTCA) of prescription drugs. Physician awareness of DTCA continues at
a very high level, although, negative attitudes may impair its usefulness. This study
identified shortcomings of DTCA and physician concerns that could be addressed by
marketers. For example, three quarters of physicians agree strongly or somewhat that
DTCA does not provide adequate information on the risks and benefits of advertised
products. More than half of the physicians (53 per cent) believe DTCA results in many
patients requesting unnecessary prescriptions and an even greater percentage (66 per
cent) believe DTCA creates a preference for brands when lower-cost generics would be
sufficient. The negativism of physicians should cause marketers to ask if their return on
DTCA is worth the cost.
Journal of Medical Marketing (2007) 7, 33–44. doi:10.1057/palgrave.jmm.5050063

INTRODUCTION and (3) the impact of DTCA on


This paper is a study of physicians’ physicians’ behaviour, and also seeks
attitudes toward direct-to-consumer to identify areas for future research.
Michael Friedman
advertising (DTCA) of prescription drugs.
Purdue Pharma L.P.
One Stamford Forum
This is an exploratory study of physicians BACKGROUND
Stamford, CT 06901, USA to assess: (1) their current state of Domestic sales of the US pharmaceutical
Tel: + 1 (203) 588 7290
Fax: + 1 (203) 588 6211 knowledge regarding DTCA; (2) the industry were $242bn for the four quarters
e-mail: michael.friedman@
pharma.com effectiveness of DTCA tactics or methods ending Q1 20051 and physician

© 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 1 33–44 Journal of Medical Marketing 33
www.palgrave-journals.com/jmm
Friedman and Gould

prescribing of approximately 3.5bn MARKETERS’ TASKS


prescriptions drives this market.1 The Because of this complexity, marketers
prescription drug market grew at double- interact with different parties who specify,
digit rates from 1996 to 2003, then at 8.3 deliver, consume and pay for the product
per cent during 2004 and at a 7.1 per within a regulated framework that often
cent annual rate in the first quarter of specifies a specific product or brand and
2005.1 constrains those involved. Physicians,
The process of developing and patients, pharmacists and payees have
patenting a new pharmaceutical product somewhat different objectives, and each
is long and expensive. From discovery is a target for a different set of marketing
of a drug compound to launch of a tactics and strategies.
new pharmaceutical product takes Patented prescription products compete
approximately seven years and costs with other available pharmaceutical
more than $800m dollars.2 products and with generics. Some of these
The time to the second entry of a competitive products could be patent-
patented competitive product in a class protected branded or generic products that
has shortened, in recent years, from eight are not the same drug substances but treat
years in the 1970s to less than two years the same condition.
between 1995 and 1998.2 When a patent In this complex, competitive
expires, additional competitive products, environment, marketing is based on
in the form of ‘generic’ versions of the product features as perceived by the
product, are marketed at prices well below various parties involved in the process as
the price of the branded product. well as on cost. DTCA could influence
Marketing of pharmaceutical products patients to request, physicians to prescribe
is complex because the purchase process or pharmacists to suggest a specific
is fragmented among a variety of parties advertised product. DTCA has been
and subject to rigorous governmental criticised for encouraging the use of
regulations. In its simplest form, the advertised products, rather than branded
decision process involves a physician who or generic alternatives that might cost less.
recommends a product and writes a
prescription, a pharmacist who dispenses
the prescription to a patient and the
patient who consumes the product. This HISTORICAL PERSPECTIVE
process is complicated by the role of OF DTCA
various prescription-drug benefit providers The first reported advertisement for a
who are the principal payees for these patent medicine appeared in a Boston
products. newspaper in 1708. By the early 1800s,
The buying process is different for the press and the pharmaceutical industry
generic products than for patented had developed a strong symbiotic
brand-name pharmaceuticals. For example, relationship.3 To enable pharmaceutical
wholesalers and chains usually determine companies to comply with current laws,
which generic brand will be available the pharmaceutical industry asked the
at retail pharmacies. Physicians, who Food and Drug Administration (FDA) to
play a major role in the selection of provide guidelines for DTCA in 1981.
branded pharmaceutical products, The first modern-day DTCA for a
play almost no role in determining prescription drug appeared in Readers
the brand of generic dispensed by a Digest that same year. Early ads focused on
pharmacist. drugs that treated less serious conditions,

34 Journal of Medical Marketing Vol. 7, 1 33–44 © 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Physicians’ attitudes toward DTCA

such as a 1983 television campaign for pharmaceutical company sales


Boots’ Rufen arthritis pain medication.4 representatives, journal advertisements,
Concerned that the public health formulary programmes administered by
consequences of DTCA were unknown, prescription drug benefit managers,
the FDA initiated a voluntary moratorium internet marketing campaigns and
on such advertising in 1983.5 The FDA sampling.
lifted this moratorium in 1985, publishing
a notice in the Federal Register indicating Pharmaceutical companies
that existing regulations were sufficient to Pharmaceutical companies market their
protect consumers. The first print ads for products to physicians as the principal
drugs that treated more serious conditions, ‘prescribers’ of a course of treatment for
such as epilepsy and migraine, appeared in a patient. In recent years, however,
the 1990s.6 Such ads were required to physicians’ choices and control of
‘present a fair balance of benefit and risk prescribing have been diminished as a
information’ and contain a ‘brief summary’ result of formularies imposed by payees,
of comprehensive risk information.7 including managed care and state
DTCA spending grew rapidly from Medicaid programs.
$791m in 1996 to $3.2bn in 2003 (from
1.2 to 2.2 per cent of sales), and to $4.5bn Payors
in 2004.8 Because of a variety of factors, Payors promote patient and physician
including criticism of the industry and of preferences through established listings of
DTCA, some experts expect DTCA drugs allowed (formularies), lower or zero
spending to remain flat or even decline in ‘co-pays’ for generic drugs, and lower co-
2005.9 From 1996 to 2003, office-based pays for ‘preferred brands’.13. In addition,
promotion to physicians grew from $2.3bn brands achieve preferred status by offering
to more than $4.4bn, and all promotion to rebates to payors that lower their net
professionals grew from $8.4bn to $13.2bn acquisition costs.
(from 12.9 to 11.8 per cent of sales).10
The amount of DTCA used varies Consumers
considerably among and within classes Consumers are the end users to whom
of drugs.11 DTCA is directed. Expectations are that
consumers viewing DTCA will discuss
their condition and/or request a
MARKET PARTICIPANTS prescription for the advertised product
from their doctor.
Physicians
There are approximately 650,000 The industry
physicians in the US.12 All physicians are On 21st July, 2005, PhRMA, the industry
authorised to prescribe prescription trade association, announced that its Board
products, and in some states, Physician of Directors had given preliminary
Assistants and Nurse Practitioners are also approval to DTCA guidelines. These
authorised. A physician’s decision as to guidelines, which came into effect in
which product(s) to prescribe should January 2006, state that companies should
normatively be based upon medical need, promote health and disease awareness as
safety, efficacy, price, reimbursement and part of their DTCA and recommend that
other factors. manufacturers educate physicians about a
Physicians are the targets of direct-mail particular product before a DTCA
campaigns, personalised detailing by campaign begins. The guidelines also

© 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 1 33–44 Journal of Medical Marketing 35
Friedman and Gould

recommend that television commercials In the 2004 Presidential race, DTCA


should be targeted ‘for audience and age became a campaign issue when candidate
appropriateness’, and they encourage Howard Dean called for a ban on DTCA
DTCA to include information about of prescription drugs and a cut in the level
patient assistance programmes.14 of Medicare reimbursement given to
marketers for more heavily advertised
US congressional activity drugs.17
Members of Congress have been critical
of DTCA. In July 2001, the Senate’
Subcommittee on Consumer Affairs, LITERATURE REVIEW
Foreign Commerce and Tourism held a Physicians’ opinions of DTCA have
hearing on the subject but no legislative changed with the passage of time. A 1998
action was taken as a result of that position paper by the American College of
hearing. Physicians supported increased consumer
Some members of Congress have awareness but questioned whether
claimed that DTCA has increased drug information provided by DTCA is
costs for consumers and certain federal accurate or the best means to achieve this
programmes such as Medicaid. They asked goal. The American Medical Association
the US General Accounting Office (AMA), which has generally been opposed
(GAO), to study the effect of DTCA on to many aspects of DTCA, announced
medical costs. Major findings of the GAO that it plans to study the effect of DTCA
report were: Pharmaceutical companies on patient–physician relationships and
spend more on R&D than on all drug healthcare costs.4,18
promotional activities, including DTCA. Lipsky and Taylor19 surveyed 454
DTCA appears to increase prescription physicians representing a systematic
drug spending and utilisation. Most of the sampling of members of the American
spending increase for heavily advertised Academy of Family Physicians (AAFP).
drugs is the result of increased utilisation, They concluded that physicians had a high
not price increases. Five per cent of awareness of DTCA, since 95 per cent had
consumers have both requested and encountered this type of advertising
received from their physician a personally. Eighty per cent of the
prescription for a particular drug in respondents, however, felt that print
response to seeing a DTCA DTCA was not ‘a good idea’, and ‘84 per
advertisement’. cent expressed negative feelings about
Among legislative proposals that television and radio advertising’. These
have been floated but not enacted are physicians indicated that they felt DTCA
elimination of tax deductions to was misleading and biased.
advertisers for the costs of DTCA, The FDA conducted an extensive
mandating comparative research on the survey of office-based physicians in
effectiveness and safety of drugs, legislative 2002.20 Major findings were: Many
change to allow FDA to require review physicians (41 per cent) believed DTCA
and approval of DTCA prior to use, could play a positive role in their
banning of DTCA, establishing limits on interactions with patients. Fifty-three per
timing and placement of advertisements, cent felt it led to better discussions with
expanding FDA enforcement activity their patients, 42 per cent said it made
and cutting the level of Medicare their patients more aware of treatment
reimbursement given to marketers for options and 10 per cent said it had
more heavily advertised drugs.15,16 informed and educated patients. Eighteen

36 Journal of Medical Marketing Vol. 7, 1 33–44 © 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Physicians’ attitudes toward DTCA

per cent indicated that DTCA had led to cent of the Sacramento patients requested
problems with patients, including physician advertised drugs compared with 3 per cent
time spent correcting misperceptions (41 in Vancouver; physicians responded to
per cent), patients requesting drugs they most of the requests for advertised drugs
did not need (26 per cent) and patients (72 per cent in Vancouver and 78 per cent
wanting a drug rather than a treatment in Sacramento). The authors concluded
(9 per cent). that more advertising leads to more
Physicians were divided about whether requests for advertised medicines and more
DTCA had a positive or negative effect prescriptions.
on their practices. One-third were positive, Donohue and Berndt24 studied 25,716
another third neutral and another third cases on the effect of DTCA on the use
negative. This is, however, ‘less negative’ of antidepressants (Donohue Ernst, 2004).
than was found in the Lipsky–Taylor study. They concluded that DTCA had little
Interestingly, general practitioners were effect on the choice of antidepressant,
more negative than specialists. Seventy per although it did influence the choice of
cent of primary care physicians and 60 per treatments for patients with anxiety
cent of specialists felt that DTCA disorders — a different diagnosis.
confused patients about the relative risks Dubois25 studied the use of statins, a
and benefits of drugs. class of drugs that lower cholesterol.26,27
IMS Health conducted a nationwide Patients receiving statins were assigned
study of 2,300 physicians across 16 to 1 of 7 categories representing
specialties regarding their attitudes toward cardiovascular risk. Dubois concluded that,
DTCA.21 Fifteen per cent had positive even though there was significant
views of DTCA, while 33 per cent were promotion of statins during the time
neutral and 52 per cent disapproved. This period covered by the study, there was no
same survey reported that 70 per cent change in the cardiovascular risk profile
of the physicians were ‘more likely to of the patients who received statins. In
prescribe a brand name product medication addition, 95 per cent of the statin users
based on a patient request when they had a had existing heart disease or risk factors
sample to give the patient’. for development. He found: ‘Despite DTC
Weissman et al.22 surveyed 643 office promotion, [there was] no apparent
physicians. This study found that 77 per increase in the unnecessary use of this
cent of physicians ‘agree somewhat or medication class’.
strongly’ that DTCA encourages patients Kravitz et al.28 conducted a study in
to seek treatments they do not need; 80 which actors made 298 visits to 152
per cent feel that DTCA does not provide family physicians and general internists,
information on risks and benefits in a either making a specific request for the
balanced manner and 32 per cent ‘agree antidepression medication ‘Paxil’ or stating
somewhat or strongly’ that DTCA makes that they saw an ad for a medication
patients less confident in the physician’s without mentioning the brand. Actors
judgment. exhibiting signs of general depression
Mintzes et al.23 surveyed 1,431 patients who mentioned the brand received a
and 78 physicians in Vancouver, British prescription (not necessarily for the
Columbia and Sacramento California. product requested) 53 per cent of the
Major findings were: although DTCA for time, those who made a general request
prescription drugs is not allowed in for medication received medication 76 per
Canada, 87 per cent of the Vancouver cent of the time and those who made no
patients had seen such advertising; 7 per request, received medication 31 per cent

© 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 1 33–44 Journal of Medical Marketing 37
Friedman and Gould

of the time. Similar results were found in representatives who were selected
patients who exhibited adjustment randomly, and selection process was used
disorders. to select physicians for inclusion in the
study. The questionnaire was pilot-tested
to identify ambiguities or issues in
PHYSICIAN’S DTCA STUDY administration. A copy of the questionnaire
Objectives of this study were to determine: is located in the appendix.

(1) Adequacy of DTCA content: Does DTCA The sample


provide sufficient information on risks Physicians were located throughout the
and side effects? Does DTCA provide country, were representative of a variety
sufficient information to enable patients of medical specialties, and varied by the
to decide whether to discuss a drug number of years they practiced medicine
with their physicians? Does DTCA help (Table 2).
patients make better decisions about
their health? Does DTCA confuse
patients? KEY FINDINGS
(2) DTCA influence on patient/physician There is a high level of awareness of DTCA
roles and behaviour: Does DTCA help among physicians: Only 12 respondents (3
make patients aware of new drugs? Has per cent) had not seen an ad on television
DTCA disrupted the patient/physician during the last three months while only
relationship in the US? Does DTCA 11 respondents (3 per cent) had not seen
cause tension between the physician and ads for prescription drugs in magazines
the patient? Does DTCA lead patients during the last three months.
to inappropriately pressure physicians Physicians, especially younger ones, are
to prescribe unnecessary drugs? Does exposed to DTCA on the internet: Two-
DTCA encourage consumers to seek thirds of physicians (68 per cent) reported
medical advice for conditions that might seeing ads on the internet during the last
otherwise go untreated? three months.
(3) DTCA influence on prescribing: Does Most physicians are negative about DTCA:
patient awareness created by DTCA This negative view could reinforce
accelerate the adoption of new drugs? existing societal pressures against the
Does DTCA create a preference for pharmaceutical industry: Only 20 per cent
brands in cases where generics would be of physician respondents (82) agreed
sufficient? Does DTCA cause patients strongly or somewhat that that they ‘liked
to ask for unnecessary prescriptions? seeing ads directed at consumers for
Does DTCA promote compliance prescription drugs’. Despite the fact that
with treatment regimens? Does DTCA 65 per cent of doctors agreed that DTCA
lead to patients getting unnecessary encourages patients to seek medical
medications? attention for conditions that might
otherwise go untreated, only 22 per cent
agreed with the statement: ‘DTCA of
Methodology prescription products is a good thing’.
A nationwide survey of physicians was Younger doctors were, however, less
conducted to obtain their attitudes toward negative (2 test, p < 0.01). Interestingly,
DTCA (Table 1). A total of 416 specialists were more positive about
completed questionnaires were collected DTCA than family/general doctors and
by Purdue pharmaceutical sales pain specialists (2 test, p = 0.05).

38 Journal of Medical Marketing Vol. 7, 1 33–44 © 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Physicians’ attitudes toward DTCA

Table 1: Survey questions

1 Have you seen or heard any ads for prescription drugs on television during the last three months? Y/N
2 Have you seen any ads for prescription drugs in magazines during the last three months? Y/N
3 Have you seen or heard any ads for prescription drugs on the internet during the last three months? Y/N
4 I like seeing ads directed to consumers for prescription drugs. Agree/disagree etc
5 Direct-to-consumer advertisements for prescription drugs help make my patients aware of new drugs.
Agree/disagree etc
6 Direct-to-consumer advertisements for prescription drugs give enough information for a patient to decide
whether to discuss the drug with a doctor. Agree/disagree etc
7 Direct-to-consumers advertisements for prescription drugs help my patients make better decisions
about their health. Agree/disagree etc
8 Direct-to-consumer advertisements for prescription drugs do not give enough information about the
possible risks and negative effects of using the drug. Agree/disagree etc
9 Direct-to-consumer advertising of prescription products causes patients to ask for unnecessary
prescriptions.
10 Direct-to-consumer advertising leads to patients getting unnecessary prescriptions from their doctors.
Agree/disagree etc
11 Direct-to-consumer advertising creates tension between me and my patients. Agree/disagree etc
12 Overall, direct-to-consumer advertising of prescription products is a good thing. Agree/disagree etc
13 Direct-to-consumer advertising encourages patients to seek medical attention for conditions that might
otherwise go untreated. Agree/disagree etc
14 Direct-to-consumer advertising creates an incorrect preference for brands in cases where a generic
product would be sufficient. Agree/disagree etc
15 When my patients make a request for specific brand I respond to my patients’ requests for brands they
see advertised X? per cent of the time.
16 Direct-to-consumer advertising confuses patients. Agree/disagree etc
17 Has patient awareness caused by direct-to-consumer advertising led to more rapid adoption of new
drugs? Y/N
18 Does direct-to-consumer advertising improve patient compliance? Y/N
19 Direct-to-consumer advertising leads to patients inappropriately pressuring physicians to prescribe
unnecessary drugs? Y/N
20 Medical specialty?
21 Years in practice?

Table 2: Demographics and medical specialty of respondents


Location Number %

Northwest 76 18
Midwest 102 24
South 153 37
West 85 20

Years practicing medicine


1–5 42 10
6–10 99 24
11–15 100 25
16–20 77 18
21+ 89 21

Medical specialty Total USA29 Study sample


Frequency % Frequency %
FP/GP/IM30 185,982 27 248 60
Specialists (excl. pain) 440,169 64 111 27
Pain doctors 58,126 9 48 12
Missing 0 0 9 2
Total 684,277 100 416 100

This negative view may in part be their patients. In addition, one of the
due to the perception by 78 per cent of purported benefits of DTCA is that it
octors surveyed (315) that DTCA confuses leads to improved compliance. Since only

© 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 1 33–44 Journal of Medical Marketing 39
Friedman and Gould

13 per cent of physician respondents (52) physicians believe that DTCA results in
agreed that DTCA improved compliance, the patients inappropriately pressuring
physician respondent generally did not perceive physicians: One-hundred seventy-eight
this benefit of DTCA, or perhaps others. doctors (43 per cent) agreed strongly or
One criticism of DTCA is that it somewhat that DTCA created tension
increases the rate of adoption of new between themselves and their patients, and
drugs. Fifty-four per cent of doctors 299 (73 per cent) felt that DTCA led
surveyed agreed that DTCA has led to patients to inappropriately pressure their
more rapid adoption of new drugs.31 This physicians to prescribe drugs and this view
is consistent with the finding that 78 per was more prevalent among primary care
cent of physician respondents agreed physicians than specialists (2 test, p = 0.05).
somewhat or strongly that DTCA helps The findings from this study indicate
make their patients aware of new drugs. that the majority of physicians are negative
Physicians do not feel DTCA provides about DTCA. Their negativism may
adequate and accurate information: Only 27 impair the economic value and utility of
per cent of physicians (112) agreed with this type of advertising in the future. It
the statement: ‘DTCA gives patients may also stimulate political attacks that
enough information to decide whether to could result in the imposition of
discuss a drug with their physician’ while restrictions that would reduce the utility
76 per cent (314) agreed somewhat or of DTCA as a commercial or public
strongly that DTCA ‘does not give patients policy instrument.
enough information about the possible risks This negative view possibly results from
and benefits of using the drug’. the manner in which DTCA is currently
More than half of the physicians practiced. For example, new industry
believed that DTCA leads to patients guidelines ask marketers to delay using
asking for and receiving unnecessary DTCA until an adequate amount of time
prescriptions, and an even greater has been spent educating health
percentage believed that DTCA created a professionals about a new medicine. In
preference for brands where a generic addition, marketers have been criticised for
would be sufficient: Fifty-three per cent of not adequately addressing disease awareness
doctors surveyed (222) agreed strongly or programming and for focusing their ads
somewhat that DTCA led to patients on promoting their brands.
getting unnecessary prescriptions from
their doctors. It is important to note that
66 per cent of doctors surveyed (275) felt CONCLUSIONS
that DTCA created an incorrect Table 3 summarises the major study
preference for brands in cases where a questions and issues as well as answers
generic would be sufficient. Such a based on findings provided by this study.
displacement of generics could be a source Some of the benefits envisioned in the
of considerable ill will from payors and early days of DTCA have been realised.
cost-conscious doctors. Notwithstanding Patients have become more informed and
these views, when a patient makes a empowered. They are seeing doctors for
request, more than 45 per cent of doctors treatment as a result of DTCA, thus
surveyed will respond with the requested reducing the incidence of under-treatment.
brand more than 50 per cent of the time It, however, remains unclear whether
(172 of 392 respondents). DTCA has improved the delivery of value
DTCA creates tension between patients in healthcare. More research needs to be
and physicians, and a majority of done to quantify the benefits of DTCA,

40 Journal of Medical Marketing Vol. 7, 1 33–44 © 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Physicians’ attitudes toward DTCA

Table 3: Summary of responses to major questions/issues regarding physicians’ attitudes towards DTCA for
prescription drugs
DTCA questions and issues Study finding

1 Is the information content of DTCA adequate? Physicians generally do not think so.
(a) Does DTCA provide sufficient information on 76% of physicians feel DTCA does not provide
risks and side effects? sufficient information on risks and side effects.
(b) Does DTCA provide sufficient information 27% of physicians feel DTCA does provide
to enable patients to decide whether to sufficient information to enable patients to
discuss a drug with their physicians? decide whether to discuss a drug with their
physicians.
(c) Does DTCA help patients make better 19% of physicians feel DTCA does help patients
decisions about their health? make better decisions about their health.
(d) Does DTCA confuse patients? 78% of physicians feel DTCA does confuse
patients.

2 DTCA influence on the patient/physician roles and


behavior?
(a) Does DTCA help make patients aware of new 78% of physicians feel that DTCA does help
drugs? make patients aware of new drugs
(b) Does DTCA cause tension between the 43% of physicians feel that DTCA does cause
physician and the patient? tension between the physician and the patient
(c) Does DTCA lead patients to inappropriately 72% of physicians feel that DTCA does lead
pressure physicians to prescribe patients to inappropriately pressure
unnecessary drugs? physicians to prescribe unnecessary drugs
(d) Does DTCA encourage consumers to seek 64% of doctors feel that DTCA does
medical advice for conditions that might encourage consumers to seek medical
otherwise go untreated? advice for conditions that might otherwise go
untreated.

3 How has DTCA influenced on prescribing behav-


ior?
(a) Does DTCA promote compliance with their 13% of physicians feel that DTCA does promote
treatment regimens? compliance with their treatment regimens
(b) Does patient awareness created by DTCA 54% of physicians feel that DTCA does
accelerate the adoption of new drugs? accelerate the adoption of new drugs.
(c) Does DTCA lead to patients getting Yes. Physicians do frequently respond to patient
unnecessary medications? requests, and DTCA often creates a prefer-
ence for brands where a generic would be
sufficient.
(d) Will physicians respond to patient requests When a patient makes a request, more than
for specific brands? 45% of doctors will respond with the request-
ed medicine more than 50% of the time.
(e) Does DTCA create an incorrect preference 66% of physicians feel that DTCA does
for brands, in cases where generics would create an incorrect preference for brands, in
be sufficient? cases where generics would be
sufficient.
Does DTCA cause patients to ask for 86% of physicians feel that DTCA does cause
unnecessary prescriptions? patients to ask for unnecessary prescriptions.
Does DTCA promote compliance with Only 13% of physicians feel that DTCA
patient’s treatment regimens? promotes compliance.

4 Opinions
(a) Do physicians feel that DTCA is useful, 23% agree somewhat or strongly that DTCA is
and why? a good thing.
20% agree somewhat or strongly that they like
seeing DTCA.

including whether it has improved drug relationship. Physicians report that patients
treatment and compliance, and what effect pressure them to prescribe inappropriate or
it has had on the physician/patient unnecessary drugs, that patients are confused

© 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 1 33–44 Journal of Medical Marketing 41
Friedman and Gould

by DTCA and that DTCA does not provide ratio of DTCA. The reasons for this are as
adequate information on risk and benefits. follows: (1) the interactive nature of the
It has also been argued DTCA increases internet enables marketers to design
patient risk from new drugs. audience-specific information and to
The task of marketers and policy makers quickly move to relevant information for
will be to refine DTCA to improve its different audiences; (2) the internet is a
effectiveness as a commercial and health growing source of information for
policy tool. Given the image and past consumers and is already a significant
practices of the pharmaceutical industry, this source of information for physicians and
is a formidable task. In light of this, the pharmacists and (3) the functionality of
industry must consider whether this form the internet enables perceptual and
of advertising is worth its cost. learning processes that are not available in
Without confirmation that patients, current television and magazine formats.
physicians, pharmacists and payors believe This is probably due to the fact that most
that DTCA contributes to public health, it of the drugs advertised through DTCA
is unlikely that DTCA, as we know it, will are the high-volume maintenance drugs
be allowed to continue. Members of prescribed by family and general practice
Congress are questioning the value of doctors. As a result, these are the doctors
DTCA, and without meaningful change who are likely to be facing most of the
they or the FDA may take action to stop patient questions, challenges and pressures
or severely curtail it. Recent self-imposed from their patients.
industry guidelines may be the beginning This study also identifies specific
of such positive change. shortcomings and concerns that could
It is also important to consider that be addressed by DTCA marketers. For
advertisers and regulators may be asking example, many physicians feel that DTCA
DTCA to accomplish more than is is confusing patients and contributing to
possible. In this context, the industry tension in the doctor’s office. Marketers
and the FDA need to decide whether could implement programmes to educate
it is practical to provide adequate risk and patients and physicians on the role of
benefit information in the space or DTCA and better integrate physicians
time allowed for an advertisement. into their programming, thereby
Perhaps the goal should be simpler. For reducing tension or pressure in the
example, to inform the patient about a new doctor’s office.
treatment for a disease, to provide some The majority of physicians do
limited information about the disease and not believe that DTCA provides
to stimulate people to see their doctors. adequate information on the risks and
This study indicates that the internet is benefits of advertised products. Marketers
a growing source of prescription drug could study ways of improving the
information for physicians. The industry manner in which this information is
should examine the growing importance presented and implement changes to
of the internet and its utility as a tool for ensure better comprehension and
communicating detailed information that retention. Such changes would have to
meets physicians’ needs (and consumers’ be developed in collaboration with
needs) at all levels of education, as well as the FDA.
FDA requirements for communication of Physicians may be negative about
risks and benefits in fair balance. DTCA because they believe that it
It may be that the internet will provide contributes to rising healthcare costs. This
a vehicle for improving the risk/benefit notion is supported by the survey findings

42 Journal of Medical Marketing Vol. 7, 1 33–44 © 2007 Palgrave Macmillan Ltd 1745-7904 $30.00
Physicians’ attitudes toward DTCA

that DTCA causes consumers to make prescriptions. This is consistent with the
appointments they would not otherwise acknowledgement by a large proportion
make, to obtain prescriptions they would of the doctors surveyed that patients will
not otherwise obtain and to ask physicians frequently get what they request.
for branded products in cases where (2) If DTCA creates a preference for brands
lower-cost generics would be satisfactory. where a generic would be sufficient,
More than half of the physicians polled it would be adding unnecessarily to
believe that DTCA led to patients getting the cost of prescription drugs for the
unnecessary prescriptions from their population at large. The extent of
doctors, and an even greater percentage unnecessary prescribing and replacement
(68 per cent) believed that DTCA created of lower-cost generics caused by DTCA
a preference for brands where generics needs to be better understood.
would be sufficient. (3) DTCA does cause some consumers to
While these findings may lead one to visit doctors. It is unclear whether these
conclude that DTCA raises drug costs, visits contribute to the general health
especially if people are prescribed drugs and well being of society or are just
they do not need, it is unclear whether on costing money.
the whole DTCA contributes to increased
healthcare costs. A study of all the
information necessary to make such a
Possible beneficial aspects of DTCA
determination is beyond the scope of this
requiring further study are:
study.
This study does not include data (1) The degree to which DTCA helps or
for offsetting savings to the healthcare informs patients to make better decision
system or other benefits arising from about their health
circumstances in which (1) a patient (2) Benefits of increased use of medications
became aware of a medical problem and to avoid other more costly treatments
sought early treatment as a result of and
viewing DTCA; (2) a patient was given a (3) Benefits of early intervention in some
more appropriate, modern medicine as a diseases where patients visit physicians as
result of viewing DTCA and asking a a result of DTCA.
doctor, (3) early use of medicine resulted
in avoidance of costs for more expensive
therapy and (4) use of medicine enabled Increasingly negative physician attitudes
a patient to resume work and other toward DTCA suggest the need for
activities earlier than might otherwise have further study. For example, why do
been the case. physicians feel that DTCA is causing
tension in the doctor’s office? What can
be done about this?
The manner in which to best address
FUTURE RESEARCH concerns regarding the adequacy of
The risk/cost benefit relationship of DTCA to communicate required
DTCA needs to be better understood. information, especially on risk and
Issues requiring further study on the risk benefits, needs further study.
side are as follows:
Disclaimer: This paper reflects findings
(1) Many physicians believe that DTCA from this study and not necessarily the
leads to patients getting unnecessary opinions of Purdue Pharma.

© 2007 Palgrave Macmillan Ltd 1745-7904 $30.00 Vol. 7, 1 33–44 Journal of Medical Marketing 43
Friedman and Gould

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44 Journal of Medical Marketing Vol. 7, 1 33–44 © 2007 Palgrave Macmillan Ltd 1745-7904 $30.00