Annals Writers Assail Direct-To-Consumer Advertising

Direct-to-consumer, or DTC, advertising by pharmaceutical companies has led to many family physicians having to deal with patients who demand medications that may not be appropriate for their conditions. Now, in the January/February issue of Annals of Family Medicine, researchers are looking at the ads themselves to see if the message they deliver to consumers is appropriate.

"Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising" presents a study of 38 pharmaceutical ads shown at peak television viewing times in 2004. According to the authors, led by Dominick Frosch, Ph.D., assistant professor in the Department of Medicine at the University of California, Los Angeles, DTC advertising "implicitly focuses on convincing people that they may be at risk for a wide array of health conditions that product consumption might ameliorate, rather than providing education about who may truly benefit from treatment."

The authors state that although most ads included some facts and rational arguments for using a product, few described causes of the condition, risk factors or prevalence. "Emotional appeals were almost universal (95 percent)," say the authors. They also note that no ads talked about lifestyle changes instead of the medication, although some mentioned such changes in addition to taking the medication. Additionally, "the ads often framed medication use in terms of losing (58 percent) and regaining control (85 percent) over some aspect of life and as engendering social approval (78 percent)."

Although the authors note that the Pharmaceutical Research and Manufacturers of America, or PhRMA, recently issued guiding principles (PDF file: 11 pages / 70 KB. More about PDFs.) on DTC advertising, "Compliance with the guidelines is voluntary," they point out. According to Frosch and the other authors, "Congress could pass legislation that requires specific content in pharmaceutical ads, including clearly specifying who may be at risk of the disease, detailing nonpharmacological treatment options and describing the likely efficacy of alternative treatments."

The authors assail DTC advertising for often attempting to persuade viewers on grounds other than rational consideration of medical costs and benefits. They conclude, "Our findings suggest the need to reconsider the distinction between selling soap or other consumer products and selling prescription drugs. Poor judgment among soap brands may have few consequences; DTC advertising influence on drug preferences and the resultant importuning of physicians to prescribe cost-ineffective (or even inappropriate) drugs are a much more substantial concern for health care expenditures and population health."

Former FDA Commissioner David Kessler, M.D., dean of the medical school at the University of California, San Francisco, and Douglas Levy, J.D., communications director in the dean's office at the UCSF medical school, say in an accompanying Annals editorial, "As Frosch et al. show in this issue, nearly all pharmaceutical ads are based on emotional appeals, not facts. … There is nothing wrong with pharmaceutical companies communicating directly with consumers, but they should adhere to the standards and ethics of medicine, not the standards and ethics of selling soap or some other consumer product that presents minimal risks."

Kessler and Levy also note the PhRMA advertising guidelines but advise, "Although these efforts may be a step in the right direction, physicians, consumers and policy-makers must take further action so that the facts about medicines are not lost in the advertising fog. As Frosch et al. correctly point out, the consequences of poor judgments are quite different for drugs than they are for soap."

Annals editor Kurt Stange, M.D., Ph.D., says in another editorial in the same issue that DTC ads "suck precious time, motivation and energy from the patient visit, forcing clinicians to educate patients about why a slickly promoted drug is not as important as a less sexy lifestyle change or even a cheaper but equally effective alternative medication."