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Am Fam Physician. 1998;57(7):1499

to the editor: I have become increasingly concerned about the newest type of pharmaceutical advertising that is targeted directly to the consumer, mostly through television commericals and advertisements in popular magazines. A new strategy of pharmaceutical companies is to encourage the general public to dial a toll-free number for information or to ask their doctor about a new prescription drug.

Usually, the specific drug is not even mentioned. The toll-free number may be listed as a source for more “information” on the disease in question, but the sponsor invariably markets a drug treatment for the condition. In one commercial, an advertiser tells people to phone a toll-free number if their blood sugar level is greater than 140.

Often, a slickly-produced “Madison Avenue” image is created, much in the way that other advertisers attempt to woo customers into trying a new soft drink or buying a new car. I have seen advertisements of this type for asthma, migraine, diabetes, allergies, herpes, acne, nail fungus, smoking cessation, depression and weight loss.

As with any advertiser, the drug companies' sole purpose is to sell the product. However, the pharmaceutical industry—by virtue of its regulation, patent protection, impact on individuals' health and the need for a doctor's prescription—does not respond to the same economic forces as do other companies that sell consumer perishables by mass marketing. The drug manufacturers are attempting to ignore the “therapeutic marketing equilibrium”1 that drives the ultimate supply and demand for pharmaceutical products, which is based on efficacy and true value of a drug's overall benefit. Past evidence indicates that advertising expenditure has little or no long-term effect on the success or failure of a prescribed drug.2

The advertisements' effects during a patient visit can be cumbersome. The patient may ask, “What about that new drug for asthma?” If the physician responds in a way inconsistent with the image shown in the advertisement, then he or she may appear uninformed, rigid, uncooperative or unconcerned, even though the patient may already be on an ideal regimen.

I am completely in favor of informed and open dialogue between patients and their doctors, as well as patient education, but in the current managed care environment the efficient use of time during a patient visit is critical. What if the patient is being prescribed medicine from a preapproved formulary, and the advertised drug is not on the list? These newer drug advertisements do not represent the “tried and true” standbys, but are generally the newer “me too” drugs, vying for market share. This would also be a potential source of unnecessary frustration: telling patients that the product being promoted is not available under their managed care plan.

In my opinion, the benefit to the health of a patient population from this type of direct marketing will be neglible. If this were the only outcome, then I would simply gripe that the drug companies should put their money to better uses. Unfortunately, I do not believe their message to be this benign. In effect, the pharmaceutical manufacturers are saying, “If we cannot get the doctors to sell our drugs, we will sell them directly to the consumer.”

The pharmaceutical industry should concentrate its efforts on educating physicians about its new products, not coercing patients to put pressure on physicians to make decisions that may not be necessary, beneficial or cost-effective.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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Copyright © 1998 by the American Academy of Family Physicians.

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