Leading large scale change: a life at the interface between theory and practice
Direct to consumer pharmaceutical advertising
1. Pharmaceutical Marketing -
Direct to Consumers or Not?
Facts and Figures:
DTCPA: DTCPA can be defined as an effort (usually via popular media) made by a
pharmaceutical company to promote its prescription products directly to patients
Annual Spending on DTCPA is $4 Billion and spending on new drug promotions is
$25 Billion
Before 1997, Pharma ads and promotion focused on Physicians by detailing with
samples
After 1997, FDA relaxed advertising rules and companies nowadays shifted to DTCPA
Pharmaceutical Companies should influence prescription choices via the
Physician or the Patient?
2. Type of Ad Requirement
Product claim ad It mentions the product and its indication and includes efficacy or safety claims
Reminder ad
includes the product name; this type may provide information about strength,
dosage form, or price, but it doesn’t mention the indication or make any claims.
Help-seeking ad
Provides only information about a medical condition and encourages patients to
contact their physician but doesn’t mention a product
Types of DTCPA
Media used for DTCPA
Television, newspaper, magazine, radio, Web sites, Online display advertising, Search engine
marketing, Social media campaigns and Mobile advertising
3. Arguments in Support of DTCPA
• Informs, educates, and empowers
patients (48.6% patients goes online first and
then discuss with physician)
• Encourages patients to contact a clinician
(A 2004 FDA consumer survey found that
exposure to DTCPA prompted 27% of Americans
to make an appointment)
• Promotes patient dialogue with health
care providers (In the 2004 FDA survey, 53% of
physicians said DTCPA led to better discussion
with patients and 73% believed that consumer
drug advertising helped patients ask more
thoughtful questions)
• Strengthens a patient’s relationship with a
clinician (DTCPA) reinforced the patient–
clinician relationship)
• Encourages patient compliance (In the 2004
FDA study, 33% of physicians reported that
DTCPA increased patient adherence)
• Reduces under diagnosis and under
treatment (Epoetin alpha, Procrit, Ortho
Biotech)
• Removes the stigma associated with
certain diseases (Erectile Dysfunction and BPH:
Finasteride, Proscar, Merck)
• Encourages product competition and
lower prices of conditions
4. Arguments Opposing DTCPA
• DTCPA affects physician prescribing
behavior and consumer ads prompt
patients to seek medications they do not
need
• DTCPA benefits the market leader because
that company can afford to spend the most
on advertising and then gains sales from
new patients seeking treatment
• Promotes new drugs before safety profiles
are fully known (The safety problems with
rofecoxib (Vioxx, Merck) are perhaps the
most frequently cited example regarding
this issue)
• Manufactures disease and encourages
drug over-utilization (DTCPA has been
criticized as contributing to the “medicalization”
of natural conditions, resulting in an
overmedicated society)
• Leads to inappropriate prescribing (Study
results suggest that brand-specific requests were
more powerful for a questionable, rather than
“standard,” indication)
• Strains relationships with health care
providers
• Wastes appointment time (16 and 21 minutes)
• DTCPA is driving up prescription costs
leads to higher individual drug prices as
companies seek to cover expensive
advertising costs.
5. Suggested Remedies
• Delay Advertising for New Products (12 to 15 months)
• Ban Product-Specific Ads (Rather inspire to visit doctors)
• Require Pre-clearance by the FDA (Reviews 30,000 to 40,000 ads per annum)
• Establish Regulations for Online Advertising
• Include Quantitative Information (Reference of study needed)
• Improve Patient Comprehension (should be given as eighth grade literacy level)
• Include Drug Cost Information (if other generic alternative is present)
6. Financials
10.0%
14.5%
Year 2001 Year 2012
Prescription Drug Spending
45%
Gr.
Conclusion
The Effect of DTCPA on consumers is both positive and negative. An increased understanding of the effects of DTCPA
will have important implications for public health in the regulated or non regulated countries. Remedies that will
maximize the benefits and minimize the risks of DTCPA are more frequently proposed. It is hoped that these
measures will allow this controversial, but powerful, medium to be better utilized for the improvement of public
health by the pharmaceutical companies.
7. THANK YOU
NAZMUL HASAN MAHMUD
Email: nhmshuvo@gmail.com
LinkedIn: http://bd.linkedin.com/in/nhmshuvo
Web: www.skfbd.com
Editor's Notes
PART 1-CRITICAL THINKING CASE: Pharmaceutical Marketing—Direct to Consumers or Not?
There is growing controversy over the estimated $4 billion the pharmaceutical industry spends annually on direct-to consumer (DTC) advertising. Prior to 1997, pharmaceutical advertising and promotion focused on physicians. Companies advertised their products in professional medical journals and sent sales personnel to visit doctors (referred to as “detailing”) and provide them with free samples, which were then passed on to their patients. Since 1997, however, when the Food and Drug Administration (FDA) relaxed pharmaceutical advertising rules, companies have been shifting advertising dollars toward DTC advertising. The marketing issue boils down to whether pharmaceutical companies should influence prescription choices via the physician or the patient. According to estimates pharmaceutical companies spend close to $25 billion a year on promoting new drugs in the United States. With an estimated 80,000 drug company representatives visiting physicians every day, detailing accounts for around $5 billion of this amount, and free drug samples account for slightly over $16 billion. An estimated 80–95 percent of medical doctors see drug company representatives on a regular basis. Nevertheless, research has shown that such marketing tactics have little impact on the prescribing behavior of physicians. The question, however, is whether DTC advertising affects physician prescribing behavior. Critics say that it does and that consumer ads prompt patients to seek medications they do not need. Additionally, they argue, advertising benefits the market leader because that company can afford to spend the most on advertising and then gains sales from new patients seeking treatment. Some research indicates that doctors comply with patient requests for drugs 85 percent of the time—drugs the patients learned about via DTC ads. At the same time, critics say, creating brand awareness for a particular product makes it more difficult for physicians to prescribe equivalent drugs and plays on consumers’ lack of knowledge instead of the physician’s level of expertise. In addition, critics claim, ads may encourage overconsumption of some drugs by creating a false impression of a drug’s capabilities and exaggerating its effect on the disease or illness. Opponents also argue that DTC advertising is driving up prescription costs leads to higher individual drug prices as companies seek to cover expensive advertising costs. Proponents of DTC pharmaceutical advertising contend that it offers several benefits. First, they say, the changing role of information in the health-care system has created a need for DTC advertising. Patients have much greater access to health-care information (via the Internet) and are entering into a patient-doctor relationship empowered by this information. Thus, advertising, as a major means of mass communication, is a primary form of information dissemination. In particular, sufferers of certain diseases and medical conditions benefit from the advertising. For example, disease awareness ads help patients recognize symptoms at an early stage when the disease can still be treated. Ads can help remove the stigma of some illnesses, particularly mental illness. Thus, ads can serve to educate the public. Another benefit of drug advertising is that encourages compliance. Many conditions (e.g., high cholesterol) do not exhibit outward signs of improvement when the patient takes the medication. These conditions require medical monitoring to determine if the drug is working. Ads can help remind patients to take their medication and to have prescriptions refilled. Furthermore, these proponents point out, there does not appear to be a direct correlation between advertising expenditures and product price, and the annual growth in marketing expenditures has remained relatively constant—although there has been a shift of funds from doctor-focused to patient-focused. Pharmaceutical advertising is regulated by the FDA’s Division of Drug Marketing, Advertising, and Communications. Division employees review between 30,000 and 40,000 ads a year. Although the annual number of complaints received by the FDA has remained about the same since DTC advertising began in 1997, the number of citations issued to drug manufacturers has dropped about 80 percent during this same time period. Prescription drug spending is projected to be one of the fastest-growing segments of health-care costs. It is estimated that, by 2012, prescription drugs will account for14.5 percent of the $3.1 trillion that the United States spends on health care (compared to 10 percent in 2001). Is marketing the reason behind the increased expenditures? Or are knowledgeable consumers taking more drugs and thereby avoiding other health-care costs?
