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P E R S P E C T I V E 
D T C  A D V E R T I S I N G
W E B  E X C L U S I V E   

28 April 2004  
  

DTC Advertising’s Benefits 
Far Outweigh Its Imperfections

A drug industry executive supports this growing practice.

By Pat Kelly

ABSTRACT:

Direct-to-consumer (DTC) communication about pharmaceutical products enables consumers to take a hands-on interest in their own health care. A growing body of research and expert opinion supports the view that the information presented in DTC communications informs patients’ decision making and leads to more productive physician/ patient encounters. Arguments that DTC advertising leads doctors to write unnecessary prescriptions and increases costs are unfounded. Criticism of the practice may also be shortsighted, because outpatient drug treatment can substitute for more costly therapies and hospitalizations. Public debate should focus on making information clear and comprehensible so that consumers can get maximum value.

Even the most thoughtful observers can disagree on whether direct-to-consumer (DTC) communications about prescription drugs contain too much information or too little, as the papers by Joel Weissman and colleagues and by Steven Woloshin and colleagues attest.¹ Our position as a pharmaceutical company is plain: We believe that any health information for consumers that is accessible, accurate, and motivating is beneficial if it leads to more, and more productive, physician/patient encounters. A growing body of research shows that DTC advertising, for all of the controversy, is having precisely that effect.²

Indeed, since the U.S. Food and Drug Administration (FDA) relaxed its restrictions on such communications in 1997, Americans have seen what amounts to one of the largest and most successful public health campaigns in history, in the form of prescription drug advertisements. DTC communications serve as a catalyst for people to take a hands-on interest in their own health care and for companies to make their health communications for consumers as understandable as possible.

The patient power revolution. Health care has undergone a transformation, and most adults now recognize the need to play an active role in managing their own care. Widely available health information for consumers facilitates this empowerment. While DTC advertising alone cannot provide all of the information necessary to justify a particular treatment, it motivates consumers to consult their doctors and other resources, and to learn more about the benefits and risks of treatment alternatives.³ Moreover, information directed at consumers helps people develop a partnership with their doctors and deepens the physician/patient relationship.⁴

Recent research supports the view that consumers and health care providers value DTC advertising as a resource for keeping up to date on new treatment options, and it could also be a positive force in reducing racial and ethnic disparities in health, as minority populations in particular welcome the information it provides.⁵

DTC advertising not only informs consumers, it motivates them to contact their doctors, engage in thoughtful dialogue about health concerns, and receive appropriate treatment. As a result, millions of Americans are now being treated for conditions that might have gone undiagnosed if not for a DTC advertisement.⁶ Moreover, more than one-third of physicians serving a predominantly minority population report that patients have come into their offices solely because of DTC ads.⁷

This ability to draw the public to health care extends to those who are otherwise most underdiagnosed and undertreated. The FDA found that 30 percent of physicians surveyed said that DTC ads persuade hard-to-reach patients to come into their offices for treatment.⁸ Often these visits result in new diagnoses, frequently involving serious health issues. As the Weissman paper reports, 25 percent of ad-driven conversations resulted in new diagnoses, 30 percent of which were for “high-priority” conditions.

According to the FDA studies, in 88 percent of cases in which patients asked about a drug, physicians determined that the person had the condition that the drug treated.⁹ Moreover, once a patient has received a prescription for drug treatment, continued exposure to DTC advertising improves compliance with treatment regimens, a view confirmed by consumer and physician surveys and the FDA.¹⁰

With innovation comes criticism. The leading arguments raised against DTC advertising are that it leads doctors to write unnecessary prescriptions under pressure from patients and that it increases the cost of prescription drugs. Yet the majority of physicians do not feel that DTC advertising has pressured them to prescribe inappropriate medications—or, indeed, that it has pressured them to prescribe at all.¹¹ Most consumers who consult their doctor about an advertised drug are not even seeking a specific prescription. They want information about an underlying condition and available treatment.¹² It appears that critics are confusing “patient pressure” with patient participation.

As for increasing costs, sellers typically engage in advertising to increase sales—and when that occurs, the cost of advertising is spread over a larger pool of sales units, thereby reducing per unit overhead costs accordingly.¹³ In 2002 the average sales price of top-selling prescription drugs promoted through DTC advertising was $102, while the average sales price of such products not promoted through DTC advertising was $127.¹⁴

DTC advertising operates as a beneficial market-expanding mechanism, spreading awareness of newly available drug therapies.¹⁵ We firmly believe that improving the health of more consumers is a social benefit, not a social cost—especially when outpatient drug treatment can substitute for more costly therapies and hospitalizations.

Making a good thing better. The paper by Woloshin and colleagues makes some intriguing suggestions.¹⁶ But it also shows that many consumers lack the context required to judge if a medicine that reduces overall mortality over five years from 4 percent to 3 percent is a medical miracle or a waste of money. Clearly, more understandable and accessible health information for consumers is needed, not less.

Recently released FDA guidance should be considered a foundation to build on. We need to communicate risks as well as benefits better and more clearly and place them in a context that people can understand. That means communicating medically sound information in intelligible language—with both words and images—that engages consumers while it informs.

Consumers want and need clear, comprehensible information about health issues and treatments, and studies show they will use this information to engage in thoughtful dialogue with their physicians. Last year, for example, more than sixty million such dialogues occurred, prompting twenty-five million people to speak to their doctor about a condition they had never mentioned before.¹⁷ That’s a health benefit we can’t afford to forgo.

NOTES

1. J.S. Weissman et al., “Physicians Report on Patient Encounters Involving Direct-to-Consumer Advertising,” Health Affairs, 28 April 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.219 (28 April 2004); and S. Woloshin et al., “The Value of Benefit Data in Direct-to-Consumer Drug Ads,” Health Affairs, 28 April 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.234 (28 April 2004).
2. See, for example, E. Slaughter, “Consumer Reaction to DTC Advertising of Prescription Medicines, 1997 to 2002,” Presentation at Food and Drug Administration (FDA) public meeting on direct-to-consumer promotion, Washington, D.C., 22–23 September 2003, slide 21, www.fda.gov/cder/ddmac/P1Slaughter/index.htm (13 April 2004); K. Aikin, “The Impact of Direct-to-Consumer Prescription Drug Advertising on the Physician-Patient Relationship,” Presentation at FDA public meeting, 22–23 September 2003, slides 11, 18, 19, and 20, www.fda.gov/cder/ddmac/aikin/index.htm (13 April 2004); and M. Magee, “Physician-Patient Relationships, Patient Empowerment, and the Role of Information,” Presentation at FDA public meeting, 22–23 September 2003, Slides 9, 10, and 13, www.fda.gov/cder/ddmac/p6magee/index.htm (13 April 2004).
3. Slaughter, “Consumer Reaction to DTC Advertising,” slide 8.
4. Magee, “Physician-Patient Relationships,” slides 3, 4, and 13.
5. K. Aikin, “Direct-to-Consumer Advertising of Prescription Drugs: Patient Survey Results,” Presentation before the FDA, Office of Medical Policy, Division of Drug Marketing, Advertising, and Communications, 19 September 2002, slide 20, www.fda.gov/cder/ddmac/Presentations/KitHMCC2002Out/ (31 March 2004); G. Kassan, “Compliance, Caregivers, and the Consumer: New Perspectives on Health Management,” Presentation at FDA public meeting on direct-to-consumer promotion, 22–23 September 2003, slide 19, www.fda.gov/cder/ddmac/p7kassan/index.htm (31 March 2004); and Sharon Allison-Ottey, Koshar Medical Inc., remarks at Public Meeting, FDA, Center for Drug Evaluation and Research, 22 September 2003, Hearing Transcript, page 56, www.fda.gov/cder/ddmac/DTCmeetingTranscript.doc (31 March 2004).
6. Slaughter, “Consumer Reaction,” slide 16.
7. S. Allison-Ottey, “DTC and the AA Physician and Patient,” Presentation at FDA public meeting on direct-to-consumer promotion, 22–23 September 2003, slide 18,
www.fda.gov/cder/ddmac/P1AllisonOttey/index.htm (31 March 2004).
8. Aikin, “Direct-to-Consumer Advertising,” slide 49.
9. Ibid., slide 34.
10. C. Thumma, “DTC Benefits Consumers All Along the Treatment Path” (Unpublished report, Global Market Analytics, Pfizer, Inc., November 2002); L. Golodner, “Consumer-Directed Promotion, Public Meeting, Docket no. 2003N-0344,” Presentation at FDA public meeting on direct-to-consumer promotion, 22–23 September 2003, slides 8 and 19, www.fda.gov/cder/ddmac/P1golodner/index.htm (31 March 2004); Allison-Ottey, “DTC and the AA Physician and Patient,” slide 40; Aikin, “Direct-to-Consumer Advertising,” slide 49; and Weissman et al., “Physicians Report on Patient Encounters.”
11. Aikin, “Direct-to-Consumer Advertising,” slides 30, 43, and 44; and Allison-Ottey, “DTC and the AA Physician and Patient,” slides 24 and 25.
12. Aikin, “Direct-to-Consumer Advertising,” slide 34; H.N. Young et al., “Does Direct-to-Consumer Advertising (DCTA) Promote Shared Decision Making? A Preliminary Study,” Presentation at FDA public meeting on direct-to-consumer promotion, 22–23 September 2003, slide 15, www.fda.gov/cder/ddmac/p3young/index.htm (31 March 2004); Golodner, “Consumer-Directed Promotion,” slide 14; and Allison-Ottey, “DTC and the AA Physician and Patient,” slide 38.
13. P.H. Rubin, “The Economics and Impact of Pharmaceutical Promotion,” Economic Realities in Health Care Policy (December 2003): 9, note 9.
14. N. Masia, “Economic Impact of DTC Advertising,” Presentation at FDA public meeting on direct-to-consumer promotion, 22–23 September 2003, slides 6 and 10, www.fda.gov/cder/ddmac/p4masia/index.htm (31 March 2004).
15. B.W. Rein et al., “Washington Legal Foundation, Proposed Limits on Prescription Drug Ads: A Constitutional Analysis” (Working paper, Washington Legal Foundation, July 2002).
16. Woloshin et al., “The Value of Benefit Data.”
17. See Slaughter, “Consumer Reaction,” slides 16 and 21.

Read related papers by Joel Weissman et al., Steven Woloshin et al., David Riggs et al., James Jeffords, Henry Waxman, and Peter Pitts.

Pat Kelly (pat.kelly{at}pfizer.com) is president, U.S. Pharmaceuticals, Pfizer Pharmaceuticals Group, and vice president of Pfizer Inc. in New York City.

DOI: 10.1377/hlthaff.W4.246
©2004 Project HOPE–The People-to-People Health Foundation, Inc.