Examining arguments for and against Pharma DTC advertising

Since its introduction into the mainstream in 1997, Direct-to-Consumer (DTC) marketing has been a subject of debate. Only the US and New Zealand permit it, and recent congressional efforts aim to restrict it. Despite the ongoing controversy, it's essential to examine the arguments for and against Pharma DTC advertising. Before Pharma DTC avertising, patient education and healthcare primarily occurred in the doctor's office, leading to confusion about healthcare problems and treatments. Tests and medicines were mysteries to many patients. With limited information, healthcare professionals (HCPs) took the lead, and the prevalent belief was "The doctor knows best." Over the past 20 years, addressing these issues has been crucial. Here are some benefits of DTC adverting.

DTC Advertising Increases Disease Awareness

Since the introduction of Pharma DTC advertising, patient awareness of potential healthcare issues has increased significantly. This encourages patients to proactively engage in discussions with HCPs about their health. We see this in areas like irritable bowel syndrome (IBS), depression, sleep disorders, STDs, migraines, erectile dysfunction, etc.  Here, the proactive approach can expedite the diagnosis and treatment by years. In critical cases like cancer, it can be life-saving A survey conducted in 2010 by Prevention Magazine found that Pharma DTC marketing triggered a huge number of patients to talk with doctors about conditions that otherwise would not have come up (unless the doctor specifically probed them about it). In many categories, like mental health, this resulted in a huge increase in diagnosis (as stigma was reduced). The marketing almost surely saved thousands of lives.

It Enriches Discussions with Doctors

In the early days of DTC marketing, the FDA conducted a study that showed that it helps patients have better discussions with their physicians. This is because it provides greater awareness of how specific medications can help them to treat health issues they are facing. And perhaps just as importantly, physicians agreed that patients could make the connection between an advertised brand and the condition that it treats. Another key finding is that empowered patients are more likely to have an active discussion with doctors. While some HCPs may find this annoying, the same FDA study found that nearly half of all physicians prefer a discussion with patients that are informed by DTC information. A study conducted by Auburn University found that with more information, patients and doctors become more like partners in determining appropriate action. They concluded that patients "should have the right to make their own decisions about their health with a doctor’s counsel and appropriate information."

It Addresses Stigma Related To Some Conditions

DTC information humanizes and destigmatizes conditions like erectile dysfunction, diabetes, multiple sclerosis, and HIV. This can change the way these conditions are viewed by society, and it can change the likelihood that patients will seek help.

It Provides Specific Information to Patients

Once diagnosed, patients now have access to much more information about their condition. They can learn about treatment options, lifestyle issues, financial support programs, etc. DTC education is an excellent source of information for patients. While more than half (53%) consider their provider’s suggested treatment as a top source of information, 45% believe the web is an important source too, according to research by digital healthcare marketing platform DeepIntent. It encourages the development of patient advocacy and support groups for patients that can improve their quality of life. It also improves compliance with medications, leading to better healthcare outcomes. So now let’s consider the other side of the debate. Ralph Nader was and continues to be a strong detractor of this type of advertising. He asserts that DTC marketing increases the costs of medication and does not add value to healthcare. Other organizations like the Public Library of Science (PLOS) took a similar stand. Below is the list of drawbacks that PLOS identified in 2006, along with our counter arguments:

What are the assertions against DTC Marketing

  • They claimed that DTC marketing provides misleading information to patients. Even at the time of this claim, it did not ring true. Because DTC marketing is tightly regulated by the FDA, any information given in an ad must be supported by clear clinical data. Regulations by the FDA are even tighter now than they were in the early days.
  • It places a disproportionate emphasis on drug benefits of the brands being advertised. The FDA mandates an equal emphasis on Drug Benefit and Fair Balance information. So no marketing can talk more about benefits than side effects.
  • It complicates the fragile patient-doctor relationship. Yes, “fragile” is the word they used. It is hard to imagine doctors that feel bullied by patients. It is their job to guide the selection of the right treatment for a condition. An FDA survey from 2013 found that nearly half of all doctors believe that DTC ads "inform, educate, and empower" patients. This study indicated that DTC advertising enhances patient engagement and improves patient-physician communication..
  • To be fair, a study conducted by the Journal of American Medical Association found that doctors do feel frustrated by the impact of DTC marketing. Many feel that DTC increases the demand for inappropriate or unnecessary treatments. We believe there is an answer to this problem. With the changing dynamics of patient-physician discussions, we see value in incorporating this issue into HCPs' training.  We believe that the days of "passive patients" are over.
  • It increases the market cost of pharmaceuticals. It is true that marketing contributes to the sales of medication in a category. However, multiple studies have shown that in categories with effective generic options, DTC marketing increases usage of the generics as much if not more than the branded product. Thus, in categories like statins, where there is a branded option and many effective generic options, doctors (influenced by payers) will make an informed suggestion to patients. Ultimately, the doctor can decide which statin they should use use—if it is needed to treat their condition.

Good Patient Communication Supports Doctor/Patient Discussion

While many in the medical community are accepting the new reality of DTC marketing, some are still trying to stop it. Among them, Mike Schatzlein, MD and CEO of St. Vincent's HealthCare says:  "Our preferred way of educating patients is by healthcare providers—doctors,, pharmacists, mid-levels". He goes on to say that, "The main reason is because they are motivated by the best interest of the patients. The DTC pharma ads are run for the purpose of selling more drugs. So in no way can they be objective, and certainly they don't have access to the medical history or physical information on a patient because they are spraying these ads to the entire population." On the flip side, Debbie Landers, SVP at Jarrard Phillips Cate & Hancock, a DTC marketing agency, points out that, "The physician is the one who ultimately decides whether or not to prescribe the medication, and if the drug is not necessary, the physician must know how to politely but effectively convey why he or she will not prescribe it.” The patient/doctor dynamics are changing. Whereas in the past, patients were mainly passive in their healthcare, they can now take a more active role.  For all of the reasons given above, we believe that DTC marketing (on the whole) is beneficial to society. And we are sure that it is not going away.