The benefits of patient marketing have been debated since it was first introduced into the mainstream in 1997. Just last year, Congress the latest bill was introduced to restrict patient marketing. Having spent the past 20 years working on Direct to Consumer (DTC) marketing, we thought it would be helpful to review the arguments on both sides.
Prior to the introduction of DTC communication, medical treatment and healthcare treatment revolved almost exclusively around the doctor’s office. Patients were poorly informed about their health. While the doctor would ask questions about symptoms, the patient was not every involved in diagnosis or treatment decisions. The doctor was in the driver seat. This created serious problems that are addressed in part by DTC information.
In the debate about DTC Communication, the debate generally focuses on the following benefits and drawbacks.
Benefits:
- Patients can be alerted early to conditions that they are experiencing and they can initiate conversations with Healthcare Providers (HCPs). In some cases (such as Irritable Bowel Syndrome) this can accelerate diagnosis of the condition by years. In other cases (such as cancer) it can save lives
- Empowered patients are more likely to question doctors about their decisions. While some HCPs may find this annoying, a FDA study found that nearly half of all physicians prefer a discussion with patients that is informed by DTC information
- DTC information humanizes and destigmatizes conditions like erectile dysfunction, depression and overactive bladder. Patients feel more comfortable talking with their doctor about issues that may not have been addressed in the past. In the area of mental health alone, patient diagnosis and treatment has increased dramatically, improving and even saving the lives of many 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.
- It supports the development of patient advocacy and support groups for patient populations
- It improves compliance with medications, leading to better healthcare outcomes
So now let’s consider the other side of the debate. In the early days of DTC marketing (2006), the Public Library of Science suggested the following as problems with DTC marketing. We'll itemize these drawbacks along with the Pharma response to them.
Drawbacks:
- It provides misinformation to patients: Because DTC marketing is tightly regulated by the FDA, this is extremely rare (although it has happened briefly once or twice). Any claim made in an ad must be supported by clear clinical information
- 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 ad can talk more about benefits than side effects
- It complicates the fragile patient-doctor relationship: Yes, “fragile” is the word they used in their criticism. It is hard to imagine doctors that feel bullied by patients. It is their job to guide the selection of appropriate the right treatment for a condition. A study published in the Journal of General Internal Medicine in 2018 found that a majority of patients and physicians believed that DTC advertising provided useful information about health conditions and treatment options. The study suggested that DTC advertising can help patients become more engaged in their own care and improve patient-physician communication
- To be fair, another study found that doctors do feel frustrated by the impact of this marketing. The majority of physicians believed that DTC increased demand for inappropriate or unnecessary treatments, and many expressed concerns about the accuracy and balance of information presented in ads.
- 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, patient 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
A few voices are in the medical community as still trying to stop this form of communication. Among them, Mike Schatzlein, MD and CEO of St. Vincent's HealthCare aays: "Our preferred way of educating patients is by healthcare providers — doctors, pharmacists, mid-levels," says Dr. Schatzlein. "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 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. We are already seeing huge benefits from this approach.
A 2019 survey published in JAMA Network Open found that among a nationally representative sample of 1,000 practicing physicians in the United States, only 27% had a favorable view of DTCA. The majority of physicians (69%) believed that DTCA increased demand for inappropriate or unnecessary treatments, and many expressed concerns about the accuracy and balance of information presented in ads.