The benefits of Direct to Consumer (DTC) marketing have been debated since it was first introduced into
the mainstream in 1997. Only two countries in the world allow it, the US and New Zealand. Plenty of people criticize it. Just last year, another bill was introduced in Congress to restrict it. So, what makes us think that Direct to Consumer (DTC) communication benefits patients? In light of the continued controversy, we think it is a good time to go over the arguments for and against DTC marketing.
Prior to the introduction of DTC marketing, patient education and healthcare treatment revolved almost
exclusively around the doctor’s office. Many patients were confused about healthcare problems and the treatments for health conditions. Tests and medicines used to help them were a mystery. Lacking information that could inform a more productive discussion, healthcare professionals (HCPs) were in the driver’s seat. Most patients would agree, “The doctor knows best.” This created some serious problems that have been addressed in the past 20 years. Here are some of the benefits of DTC marketing:
It Increases Disease Awareness
Since DTC marketing's introduction, patient awareness of health issues has increased many times over. With greater disease awareness, patients are now more likely to initiate discussions with HCPs about their health. In some cases (such as irritable bowel syndrome, depression, sleep disorders, STDs, migraines, erectile dysfunction, etc.), this can accelerate diagnosis and treatment of the condition by years. In other cases (such as cancer), it can save lives. A survey conducted in 2010 by Prevention Magazine found that DTC advertising 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:
PLOS Assertions:
- 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 suggested that DTC advertising can help patients become more engaged in their own care and it thus 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 dynamics of patient/physician discussion shifting, we believe that it will be useful for this issue to be addressed in the training of HCPs. 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.
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.