Discussion
The results of our study inform policy discussions on the appropriateness of DTC prescription drug advertising. Although content analyses of drug advertisements appearing in medical journals have been reported, our investigation is the first systematic content analysis of DTC drug advertisements. Similar to previous reports on advertising expenditures, our study reveals that DTC pharmaceutical marketing has increased substantially over the years. Furthermore, DTC advertising has been used to promote drugs for serious conditions; 30% of brands represented in the sample were for such life-threatening conditions as asthma, cancer, cardiovascular disease, diabetes, and HIV infection.
This dramatic increase underscores the need for research on the effects of DTC advertising on drug costs. It is still unclear whether such expenditures are passed on to the consumer through higher prices or promote competition that lowers prices.21,22 We suspect that advertising-induced increases in demand for a drug may raise costs substantially when alternative treatments are not available or are substantially less effective. Conversely, promotion may spur competition on the basis of price within therapeutic categories when several treatment options are available. Of course, even expensive drugs can lower total health care expenditures if they provide effective treatment for costly conditions.
Although the breadth of prescription treatments advertised to consumers is impressive, the vast majority of drugs have not been promoted in this manner. Clearly, treatments for certain kinds of conditions are more likely to be advertised to consumers. Most of the drugs advertised are for common chronic conditions (approximately three fourths of the brands in Table 1. Drugs for conditions that may not be recognized as pathologic or treatable by consumers (eg, toenail fungus), under treated ailments (eg, hypertension, depression), and conditions not previously treatable with medication (eg, erectile dysfunction) are also well represented. Advertisements for treatments of acute conditions were rare (eg, antibiotics).
We also investigated the kind of inducements used to promote prescription drugs to consumers. The most common inducement was the offer of additional information. More than one third of the advertisers extended an invitation to the reader to request further information about the drug or condition in print or audio/video form. DTC advertising has often been justified on the grounds that it offers a valuable opportunity to educate the public about diseases and treatments. Future research should determine if these brochures and tapes provide quality education or simply try to sell the product.
Slightly less than 1 in 5 advertisements offered a monetary incentive to the reader for using the promoted drug. We believe that such incentives may be inappropriate when issued to people who have not had a diagnosis of the indicated condition.23 These inducements also create the potential for antagonism between the patient who feels denied a bargain and the physician who believes that the drug is not indicated.
Our final objective was to describe the types of appeals used to sell prescription drugs to consumers. This analysis highlights areas in which the industry’s advertising requires careful monitoring. We are troubled, for instance, by the finding that two fifths of these advertisements made claims of “innovativeness.” Since advertisers often use “new and improved” claims to sell consumer products, it is not surprising that this heuristic phrasing is used to market pharmaceuticals. In truth, when it comes to drugs, what is new is not necessarily better. Most new drugs offer few advantages over older drugs and have less understood safety profiles.
Also of concern is the infrequency with which appeals to cost savings are used. Such appeals were found in only 1 out of every 20 advertisements. The provision of price information, including comparisons of costs with competing drugs, has been mentioned as one mechanism by which price competition could be fostered. We question whether such comparisons would improve the economic and physical health of patients but believe it is disingenuous for proponents of DTC advertising to advance this argument when cost information is seldom provided.
Limitations
Our study has limitations. Most notably, content analysis by its very nature seeks to explicate message form and content, not message effects. Policy discussions must be based on careful analyses of what the drug industry is telling consumers, but such analyses need to be augmented with data that show the effects of DTC advertising on patients’ drug information-seeking, physicians’ prescribing decisions, and ultimately on health outcomes. We also focused exclusively on the text of these advertisements; visual arguments are often used in advertising, including DTC drug advertising.24 Finally, our sample was restricted to advertisements appearing in US magazines.
Conclusions
The pharmaceutical industry has turned to consumer-targeted prescription drug advertising to increase Americans’ demand for many of its products. If the current trend continues, such advertising could become the major source of information through which consumers learn about prescription drugs. As such, it is imperative that family physicians take an occasional look at the magazines in their own offices to keep abreast of the specific drugs being promoted to their patients. If DTC advertising is to be regulated properly, there is much we will need to learn about how these advertisements are influencing consumers and what impact they have on the physician-patient relationship