Monday, September 18, 2006

Advertisers Don't Know How DTC Works. Say wha?

Practically every direct-to-consumer (DTC) ad on TV and in print prominently includes a statement such as "Ask Your Doctor if [BRAND X] is Right for You!" Advertisers call this the "Call to Action," which is the linchpin of all advertising; ie, get your target audience off its butt to take the next step toward the purchase of your brand!

Several studies have shown that this call to action of DTC works. In 2003, for example, the FDA released preliminary results from a physician survey it conducted (see "
Results from FDA Physician Survey on DTC Advertising"). The survey profiled 250 GP's and 250 specialists (dermatology, allergy/pulmonology, endocrinology, and psychiatry) from a random sample of the AMA Physician Masterfile, which includes a list of all U.S. medical school graduates.

One question the FDA survey asked was:

"Think about the most recent interaction you've had with a patient ... Can you think of a patient who initiated a discussion about a prescription drug they saw advertised?"
Ninety-two percent (92%) of the physicians surveyed said "Yes". (You can find this study here.)

Surveys of consumers seem to confirm the FDA's study results. According to eMarketer:

Much of the growth in DTC advertising is driven by one thing: consumer behavior. Of the 546 US adults surveyed online by MRxHealth and Medical Marketing & Media in March, 87% said they had requested and received a specific prescription drug from their doctor. -- "Pharmaceuticals Online: Direct-to-Patient Becomes a Reality", August, 2006. eMarketer
Contrarian View
CommonHealth, arguably part of the world's leading healthcare-communications network (ie, pharmaceutical advertising agency), filed research with the FDA this past July on direct-to-consumer (DTC) advertising that challenges the effectiveness of DTC's Call to Action.


In a nutshell, CommonHealth claims that DTC advertising is rarely referenced by patients when visiting physicians.
Their study says this happens only in 0.6% of visits! (See "CommonHealth Releases Compelling Results of Independent Large-Scale Study on DTC Advertising".)

How can the FDA and CommonHealth be so far apart on this issue (92% vs. 0.6%)? It's like they are on different planets!


Well, the methodologies they used are different: FDA asked physicians what they thought they heard, CommonHealth recorded actual patient-physician conversations and did a linguistic analysis looking to see if the patient said something like "I saw/heard this ad and want this prescription drug".

According to CommonHealth:

"What has not been available are data derived from direct recording and analysis of actual physician-patient visits --– and so, in a real sense, both supporters and critics of DTC advertising have been 'flying blind'."
I haven't been able to get hold of the report that CommonHealth submitted to the FDA, so I cannot critically analyze their methodology. The report hasn't been posted to the FDA Web site and CommonHealth refused to give me a copy. The FDA official who received the report from CommonHealth also could not give a copy when I asked her. The only way to get it is to visit the FDA Dockets Management branch in Bethesda, MD and ask to see Docket No. 2005N-0354; Consumer-Directed Promotion of Regulated Medical Products; Part 15 Public Hearing; EMC 590 CommonHealth Vol #: 12. Maybe I'll submit an FOIA request. Good luck on that!

I was able to speak to Brad Davidson, Ph.D., a vice president at MBS/Vox and lead researcher for the study (I may report on this in an upcoming issue of
Pharma Marketing News).

It's apparent from my conversations with Dr. Davidson and from press releases, that the purpose of the study was to refute "many of the assumptions of both academic and public policy critics of DTC" and support the positive impact of DTC.

"We know that DTC has an effect on physician-patient interactions because other studies have shown that DTC drives patients into the office and raises awareness of both conditions and medications," said Davidson. "What our study uncovered is that DTC does not have the negative impact on the actual dialogue that many people allege."
FDA was definitely not one of these people. It concluded from its study -- despite the 92% number contradicting CommonHealth -- that DTC has had a positive impact!

Anyway, CommonHealth -- among the best advertising minds in the world -- leaves us with this insight from its study:

"We know DTC advertising works ... we may not know how."
This is an incredible admission! It's as if they are saying that advertising exists on a higher plane where it is impossible to analyze what works and what doesn't a priori. You might as well trash focus groups that ask consumers if, after seeing a drug ad, they would ask for the drug when they next visit their doctors. Yeah, I'm sure that would happen!

6 comments:

  1. Because the questions are different and because they are talking to two different populations, the data are not necessarily inconsistent.

    Let's suppose an MD in the FDA panel could remember only the last 500 visits when she answered the question. And, 0.6% of visits would mention a DTC product. Well, 99.4% of visits would not, and for the doctor to be completely free of DTC mentions 500 times in a row, that is like drawing from the 99.4% visits 500 times. If we calculate the probability that is .994^500=0.049, or about 5%. The MDs recall 92%, which is probably within the 4-5% sampling error of this probability. If the assumption of recall of the last 500 visits is correct, then I do not see evidence that the findings are inconsistent.

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  2. Chris,

    Thanks for the analysis. I'll have to defer to mathematicians to determine if your math is correct.

    However, I think it is mute, since the FDA asked each physician to think of the "last recent interaction they had with a patient" not the last 500 visits.

    Anyway, to say the "we don't know how DTC works" based upon these data is a remarkable statement. So, I remarked on it ;-)

    --John

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  3. Kathy O'Neill12:37 PM

    It's apples and kiwis, guys!

    docs were asked "Can you think of a patient who initiated a discussion about a prescription drug they saw advertised?" and 92% of docs said yes.

    that doesn't even mean the patient asked for an Rx - it could have been "what is that new Zetia all about doc?"

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  4. That's correct and it points out a fundamental flaw in the CommonHealth analysis.

    To be counted in their study -- if I understand the methodology -- a patient would have to mention BOTH a brand name AND that he or she read about it or saw it advertised on TV.

    If the consumer said "What about Viagra? Is that OK for me?", the CommonHealth study would not count this, whereas the FDA study may.

    In this day and age (of ubiquitous DTC advertising) it is redundnat for anyone to say "What about Viagra, which I saw advertised?"; the simple version, "What about Viagra?", implies that the patient heard about the drug via DTC advertising either directly or indirectly.

    --John

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  5. From a 2002 GAO analysis ("FDA Oversight of Direct-to-Consumer Advertising Has Limitations" see http://www.gao.gov/new.items/d03177.pdf):

    "Surveys conducted by FDA and private organizations consistently show that DTC advertisements have an impact on whether consumers request and receive a specific brand-name prescription from their physician. (See app. II for a list of consumer surveys.) In several of these surveys, consumers were asked whether they had seen an advertisement for a prescription drug and whether seeing the advertisement resulted in discussing the medication with their doctor and receiving the prescription.

    Most consumers (65 to 85 percent) remembered seeing a DTC advertisement. A subset of consumers who saw an advertisement discussed the medication with their doctor. The percentage of patients asking their physicians about a prescription for a specific drug was consistent across studies, about 30 to 35 percent of those who remembered seeing a DTC advertisement. One study estimated that the 32 percent of consumers in a 2001 survey who had discussed a DTC advertisement with their doctor translated into approximately 61.1 million consumers asking about specific medications. In the consumer surveys we examined, the percentage of consumers who, in response to a DTC advertisement, requested and received a prescription from their physician for a drug they were not currently taking was generally about 5 percent (ranging from 2 percent to 10 percent). By our estimate, this means that about 8.5 million consumers received a prescription after viewing a DTC advertisement and asking their physician for the drug in 2000."

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  6. Anonymous1:19 PM

    We know drugs work... we may not know how

    Who learnt from whom?

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