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Direct-to-Consumer Advertising of Pharmaceuticals
(Released March, 2008)

 
  by Amy Shaw  

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  1. Consumer opinion and effectiveness of direct-to-consumer advertising

    Deborah F. Spake and Mathew Joseph.

    Journal of Consumer Marketing, Vol. 24, No. 5, 2007, pp. 283-292.

    Purpose: The purpose of the paper is to look at the relationship between attitudes toward direct-to-consumer (DTC) advertising and its impact on consumer requests for a particular drug. Design/methodology/approach: A sample of 154 consumers completed the survey on-site at a pharmacy while waiting for their prescription(s) to be filled. Based on exploratory research (focus groups), survey items were developed to capture opinions of pharmaceutical advertising as well as the influence of DTC advertising on consumer behavior. Findings: The findings show that consumers are skeptical of DTC advertising and believe that not enough information is provided about these products. Despite the high level of exposure and the opinions that these ads were effective and informative, few respondents believed that the ads motivated them to request these drugs or put them on a more equal footing with their physician. Practical implications: The results provide useful information to policy makers, drug companies and researchers. Even though consumers appear to be critical of DTC advertising oversight, these ads appear to motivate consumers to seek more knowledge about drugs or medical conditions mentioned in the ads and request prescriptions from physicians. Originality/value: This research fills an identified gap in the literature on DTC advertising and its impact on consumer decision making. Limited research has been done on the relationship between consumer perceptions of DTC advertising and its impact on consumer requests for pharmaceutical products. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

  2. Creating demand for prescription drugs: A content analysis of television direct-to-consumer advertising

    Dominick L. Frosch, Patrick M. Krueger, Robert C. Hornik, Peter F. Cronholm and Frances K. Barg.

    Annals of Family Medicine, Vol. 5, No. 1, Jan-Feb 2007, pp. 6-13.

    [Correction Notice: An erratum for this article was reported in Vol 5(2) of Annals of Family Medicine (see record 2007-07757-007). Some authors were given incorrect affiliations. The correct affiliations appear in the erratum.] Purpose: American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year, yet no research has examined how television ads attempt to influence consumers. This information is important, because ads may not meet their educational potential, possibly prompting consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives. Methods: We coded ads shown during evening news and prime time hours for factual claims they make about the target condition, how they attempt to appeal to consumers, and how they portray the medication and lifestyle behaviors in the lives of ad characters. Results: Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%). No ads mentioned lifestyle change as an alternative to products, though some (19%) portrayed it as an adjunct to medication. Some ads (18%) portrayed lifestyle changes as insufficient for controlling a condition. The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%). Products were frequently (58%) portrayed as a medical breakthrough. Conclusions: Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

  3. A decade of direct-to-consumer advertising of prescription drugs

    Julie M. Donohue, Marisa Cevasco and Meredith B. Rosenthal.

    New England Journal of Medicine, Vol. 357, No. 7, Aug 2007, pp. 673-681.

    Background: Evidence suggests that direct-to-consumer advertising of prescription drugs increases pharmaceutical sales and both helps to avert underuse of medicines and leads to potential overuse. Concern about such advertising has increased recently owing to the withdrawal from the market of heavily advertised drugs found to carry serious risks. Moreover, the Food and Drug Administration (FDA) has been criticized for its weak enforcement of laws regulating such advertising. Methods: We examined industry-wide trends in spending by pharmaceutical companies on direct-to-consumer advertising and promotion to physicians during the past decade. We characterized the drugs for which such advertising is used and assessed the timing of advertising after a drug is introduced. Finally, we examined trends in the FDA's regulation of drug advertising. Results: Total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. Although during that time spending on direct-to-consumer advertising increased by 330%, it made up only 14% of total promotional expenditures in 2005. Direct-to-consumer campaigns generally begin within a year after the approval of a product by the FDA. In the context of regulatory changes requiring legal review before issuing letters, the number of letters sent by the FDA to pharmaceutical manufacturers regarding violations of drug-advertising regulations fell from 142 in 1997 to only 21 in 2006. Conclusions: Spending on direct-to-consumer advertising has continued to increase in recent years in spite of the criticisms leveled against it. Our findings suggest that calls for a moratorium on such advertising for new drugs would represent a dramatic departure from current practices. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

  4. Direct-to-consumer (DTC) branded drug web sites

    Kim Bartel Sheehan.

    Journal of Advertising, Vol. 36, No. 3, Fal 2007, pp. 123-135.

    Direct-to-consumer (DTC) branded drug Web sites inform consumers of certain specific facts, including risk information, about drugs. Prominently displayed risk disclosures can reduce the potentially misleading aspects of advertising information and encourage a deeper level of consumer processing. Although previous studies of DTC Web sites have examined the presence and absence of risk information, no research to date has evaluated the placement of risk information relative to benefit information on DTC Web sites or whether risk information is presented consistently in the DTC category. Bettman, Payne, and Staelin (1986) suggested that "the same information presented in different formats can result in different decisions" (p. 2). Schema theory can guide Web site development, as it suggests that consistency of information presentation in an on-line environment can help consumers maximize their ability to utilize information at the site. In addition, current regulatory practices (Food and Drug Administration [FDA] guidelines for fair balance in DTC ads, the Federal Trade Commission [FTC] "clear and conspicuous" standards for television and Web site disclaimers) suggest that consistency in information presentation can also help consumers comprehend information. This study, then, examines whether risk information presentation is consistent across DTC Web sites, and serves as a first step in the process of understanding what guidance might be necessary at DTC Web sites. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

  5. Understanding the impact of direct-to-consumer (DTC) pharmaceutical advertising on patient-physician interactions: Adding the web to the mix

    Sejung Marina Choi and Wei-Na Lee.

    Journal of Advertising, Vol. 36, No. 3, Fal 2007, pp. 137-149.

    As a growing number of people go on-line for health- and drug-related information, pharmaceutical companies devote significant resources to direct-to-consumer (DTC) promotions on the Web. Little is known about how DTC advertising of prescription drugs on the Web impacts patient-physician interactions, however. This study identified and investigated the influence of credibility perception of the Web for information related to prescription drugs, overall attitudes toward DTC advertising, and age on consumers' inquiries and requests for prescription drugs advertised on the Web. Findings of this study suggest that Web credibility and attitudes toward DTC advertising in general exert significant influence on consumer response to DTC advertising on the Web in the form of patient-physician interactions. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

  6. If direct-to-consumer advertisements come to Europe: lessons from the USA

    Jonathan M. Metzl.

    Lancet, Vol. 369, No. 9562, Feb 24 2007, pp. 704-706.

  7. Presumed influence of DTC prescription drug advertising: Do experts and novices think differently?

    J. Huh and R. Langteau.

    Communication Research, Vol. 34, No. 1, 2007, pp. 25-52.

    Davison's original third-person-effect proposal notes that experts, because of their special knowledge, may exhibit a greater third-person effect than do nonexperts. To gather empirical evidence on this notion, this research investigates whether experts perceive a greater influence of direct-to-consumer (DTC) advertising on others than do novices. The expert-novice distinction is made in the following two ways: (a) physicians versus consumers, based on objective knowledge of prescription drugs and (b) consumer experts versus consumer novices, based on familiarity with DTC advertising. Results show that consumer experts clearly exhibit greater perceived DTC advertising influence on others than do novices, and the differences between experts and novices vary by presumed DTC advertising influence dimensions. Future research is advocated on expert views in presumed media influence studies.

  8. Study affirms PhRMA's influence on physicians

    John Dudley Miller.

    Journal of the National Cancer Institute, Vol. 99, No. 15, Aug 1 2007, pp. 1148-1150.

  9. Evaluating the welfare effects of drug advertising

    W. David Bradford and Andrew N. Kleit.

    Regulation, Vol. 29, No. 1, Spring 2006, pp. 58-62.

    Reviews the history of direct-to-consumer drug advertising, presents theoretical arguments for and against it, and critiques direct-to-consumer advertising research focused on survey results and advertising content analysis. The authors' research, evaluations of detailed, patient-level information, is then discussed.

  10. A History of Drug Advertising: The Evolving Roles of Consumers and Consumer Protection

    Julie Donohue.

    The Milbank quarterly, Vol. 84, No. 4, 2006, pp. 659-699.

    Direct-to-consumer advertising (DTCA) of prescription drugs in the United States is controversial. Underlying the debate are disagreements over the role of consumers in medical decision making, the appropriateness of consumers engaging in self-diagnosis, & the ethics of an industry promoting potentially dangerous drugs. Drug advertising & federal policy governing drug advertising have both responded to & reinforced changes in the consumer's role in health care & in the doctor-patient relationship over time. This article discusses the history of DTCA in the context of social movements to secure rights for health care patients & consumers, the modern trend toward consumer-oriented medicine, & the implications of DTCA & consumer-oriented medicine for contemporary health policy debates about improving the health care system. Figures, References. Adapted from the source document.

  11. Prescription Drugs: Improvements Needed in FDA's Oversight of Direct-to-Consumer Advertising

    United States Government Accountability Office.

    United States Government Accountability Office, 2006, ii+47p.

    A study of Food and Drug Administration (FDA) oversight of direct-to-consumer (DTC) advertising of prescription drugs found a large increase in drug company spending on DTC advertising and evidence that this advertising has increased drug spending and utilization; but FDA reviews lack documentation criteria for prioritization, systematic applications of criteria, and tracking of information on its reviews; there are fewer draft and review regulatory letters issued than in the past; and the effectiveness of the letters at halting the dissemination of violative DTC materials has been limited. Tables, Figures.

  12. Direct-to-consumer advertising of prescription drugs: Help or hindrance to the public's health?

    Greg Finlayson and Ross Mullner.

    Journal of Consumer Marketing, Vol. 22, No. 7, 2005, pp. 429-431.

    Purpose: The purpose of this paper is to review the issues regarding direct-to-consumer advertising that have been identified in the literature from the perspective of consumers, consumer groups, physicians, the medical profession and the pharmaceutical industry. Design/methodology/approach: Literature from international sources was reviewed to identify themes relating to direct-to-consumer advertising. Findings: Direct-to-consumer advertising is expressly permitted in only two developed countries (USA and New Zealand). All other countries place various limitations on the practice. The debate surrounds whether or not the advertising provides a public health benefit. Originality/value: The debate over direct-to-consumer advertising continues in jurisdictions around the world. This paper identifies and summarizes the issues that are being considered. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

  13. Does DTC mean "direct to court"

    Donna J. Cunningham and Rajesh Iyer.

    Journal of Consumer Marketing, Vol. 22, No. 7, 2005, pp. 412-420.

    Purpose: The purpose of this paper is to investigate the changing legal landscape associated with the growth of advertising of prescription drugs directly to the consumer, and makes recommendations designed to assist advertisers in avoiding legal liability based on those advertisements. Design/methodology/approach: This study investigates the phenomenal growth of DTC advertising since 1997, when a profound change in the FDA regulations took effect. These changes permitted advertisers significantly more flexibility in providing information about the advertised drug directly to the consumer. Since then, however, DTC advertising has repeatedly come under attack. A review of the literature, changing law, and other factors, reveals the primary criticisms of DTC advertising, and its tendency to expose pharmaceutical advertisers to legal liability. Findings: The paper recounts the development of the law concerning pharmaceutical advertising, and particularly, the application of the Learned Intermediary Rule. Previously, this Rule operated to shield pharmaceutical companies for liability by passing liability on to the physician who wrote the prescription for the drug. Now, that law is changing, with resulting liability for pharmaceutical advertisers. Practical implications: The study recounts the primary criticisms of DTC advertising, and provides a number of steps that can be taken to help avoid legal liability for pharmaceutical companies that engage in DTC advertising. Originality/value: The study looks at DTC advertising from both a marketing and a legal perspective, and combines those disciplines to draw conclusions helpful to DTC advertisers. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

  14. Direct-to-consumer pharmaceutical advertising: physician and public opinion and potential effects on the physician-patient relationship

    Andrew R. Robinson, Kirsten B. Hohmann, Julie I. Rifkin, et al.

    Archives of Internal Medicine, Vol. 164, No. 4, Feb 23 2004, pp. 427-432.

    BACKGROUND: Previous studies have shown that direct-to-consumer (DTC) pharmaceutical advertising can influence consumer behavior and that many physicians have negative views of these advertisements. Physician and public opinions about these advertisements and how they may affect the physician-patient relationship are not well established. METHODS: Mail survey of 523 Colorado physicians and 261 national physicians and telephone survey of 500 Colorado households asking respondents to rate their agreement with statements about DTC advertising. RESULTS: Most physicians tended to view DTC advertisements negatively, indicating that such advertisements rarely provide enough information on cost (98.7%), alternative treatment options (94.9%), or adverse effects (54.8%). Most also believed that DTC advertisements affected interactions with patients by lengthening clinical encounters (55.9%), leading to patient requests for specific medications (80.7%), and changing patient expectations of physicians' prescribing practices (67.0%). Only 29.0% of public respondents agreed that DTC advertising is a positive trend in health care and 28.6% indicated that advertisements make them better informed about medical problems; fewer indicated that advertisements motivated them to seek care (10.5%) or led them to request specific medications from their physicians (13.3%). CONCLUSIONS: Most physicians have negative views of DTC pharmaceutical advertising and see several potential effects of these advertisements on the physician-patient relationship. Many public respondents have similarly negative views, and only a few agree that they change their expectations of or interactions with physicians. While these advertisements may be influencing only a few consumers, it seems that the impact on physicians and their interactions with patients may be significant.

  15. Medicalization, markets and consumers

    Peter Conrad and Valerie Leiter.

    Journal of health and social behavior, Vol. 45 Suppl, No. , 2004, pp. 158-176.

    This paper examines the impact of changes in the medical marketplace on medicalization in U.S. society. Using four cases (Viagra, Paxil, human growth hormone and in vitro fertilization), we focus on two aspects of the changing medical marketplace: the role of direct-to-consumer advertising of prescription drugs and the emergence of private medical markets. We demonstrate how consumers and pharmaceutical corporations contribute to medicalization, with physicians, insurance coverage, and changes in regulatory practices playing facilitating roles. In some cases, insurers attempt to counteract medicalization by restricting access. We distinguish mediated and private medical markets, each characterized by differing relationships with corporations, insurers, consumers, and physicians. In the changing medical environment, with medical markets as intervening factors, corporations and insurers are becoming more significant determinants in the medicalization process.

  16. The medicine cabinet: what's in it, why, and can we change the contents?

    Thomas W. Croghan and Patricia M. Pittman.

    Health affairs (Project Hope), Vol. 23, No. 1, Jan-Feb 2004, pp. 23-33.

    The failure of the pharmaceutical industry to produce drugs for common chronic diseases, emerging diseases, and the potential threats of bioterrorism or the spread of tropical diseases contrasts sharply with the industry's output of lifestyle and "me-too" drugs. In this paper we review the decision-making process that resulted in our current portfolio of medicines and offer several alternatives to better align business incentives with medical need.

  17. Truth in advertising: Rx drug ads come of age

    Carol Rados.

    FDA consumer, Vol. 38, No. 4, July/August 2004, pp. 20-27.

    Examines the debate over direct-to-consumer pharmaceutical advertising of prescription medication in the US, including their impact, attitudes of physicians, and regulatory issues.

  18. Direct-to-consumer advertising: physicians' views of its effects on quality of care and the doctor-patient relationship

    Elizabeth Murray, Bernard Lo, Lance Pollack, Karen Donelan and Ken Lee.

    The Journal of the American Board of Family Practice / American Board of Family Practice, Vol. 16, No. 6, Nov-Dec 2003, pp. 513-524.

    BACKGROUND: The objective of the study was to determine physicians' views of the effects of Direct-to-Consumer Advertising (DTCA) on health service utilization, quality of care, and the doctor-patient relationship. METHODS: Cross-sectional survey of a nationally representative sample of US physicians to determine their perceptions of the effects of patients discussing information from DTCA on time efficiency; requests for specific interventions; health outcomes; and the doctor-patient relationship. RESULTS: Physicians reported that more than half (56%) of patients who discussed information from DTCA in a visit did so because they wanted a specific intervention, such as a test, change in medication, or specialist referral. The physician deemed 49% of these requests clinically inappropriate. Physicians filled 69% of requests they deemed clinically inappropriate; 39% of physicians perceived DTCA as damaging to the time efficiency of the visit, and 13% saw it as helpful. Thirty-three percent of physicians thought discussing DTCA had improved the doctor-patient relationship; 8% felt it had worsened it. The effect on the relationship was strongly associated with doing what the patient wanted. CONCLUSIONS: DTCA can have good and bad effects on quality of care, the doctor-patient relationship, and health service utilization. The benefits might be maximized, and the harms minimized, by increasing the accuracy of information in advertisements; enhancing physicians' communication and negotiation skills; and encouraging patients to respect physicians' clinical expertise.

  19. Direct to consumer advertising is medicalising normal human experience: for and against

    S. N. Bonaccorso and J. L. Sturchio.

    British medical journal, Vol. 324, No. 7432, 13 Apr 2002, pp. 910-911.

    In direct to consumer advertising, drug companies target advertisements for prescription drugs directly at the public. Barbara Mintzes argues that this type of advertising risks medicalising normal human conditions, with the drug companies raking in increasingly healthy profits. Silvia N. Bonaccorso and Jeffrey L. Sturchio argue that, through advertising, drug companies can enable patients to make better informed choices about their health and treatment. (Original abstract)

  20. Prescription drugs: FDA oversight of direct-to-consumer advertising has limitations: report to congressional requesters

    United States. Gen. Accounting Office.

    United States General Accounting Office, 2002.

    Evaluates pharmaceutical companies' spending on DTC advertising compared to research and development, effect of consumer advertising on prescription drug use, and Food and Drug Administration oversight since issuing its 1997 draft guidance for broadcast advertisements. Also available in print.