Thursday, August 14, 2008

Rethinking the Value of DTC Advertising

Direct-to-Consumer (DTC) advertising is often defended by the drug industry as beneficial to the public's health because it motivates people to visit their doctors. Peter Pitts, president of the Center for Medicine in the Public Interest (a pro-drug industry think tank), for example, said: "The most important thing that DTC advertising does is drive people to their doctor's office to talk about a condition" (see "FDA to Test Risk Info with Mock Ads").

PhRMA, the US drug industry trade organization, says in its DTC Guiding Principles: "DTC advertising of prescription medicines can benefit the public health by increasing awareness about diseases, educating patients about treatment options, motivating patients to contact their physicians and engage in a dialogue about health concerns, increasing the likelihood that patients will receive appropriate care for conditions that are frequently under-diagnosed and under-treated, and encouraging compliance with prescription drug treatment regimens."

It sounds like a compelling argument until you look at the numbers and data supplied by pro-industry groups:

Pitts, for example, cites these numbers from FDA studies in a recent Drug Wonks blog post:
  • 6% [of] all doctors’ appointments are scheduled because a consumer saw a DTC commercial [which means 94% are NOT driven by DTC], and
  • in 6% of those DTC-generated office visits, a previously undiagnosed condition was discovered [which means that only 3.6 out of 1,000 office visits result in discovering an undiagnosed condition as a result of DTC advertising]
Add to this results of a CommonHealth study claiming that DTC advertising is rarely referenced by patients when visiting physicians. This study says this happens only in 0.6% of visits! (See "Advertisers Don't Know How DTC Works. Say wha?").

Keep in mind that not all those undiagnosed conditions will be treated by the advertised brand -- there may be generic brands available or the brand may not be appropriate for a particular patient or the condition may not lend itself to treatment by any drug at all!

If you think about it, all this means that DTC advertising is a terribly inefficient method of getting people diagnosed and treated with the products that are advertised.

Why then does the drug industry spend $5 billion annually on DTC advertising?

Considering that some of the best minds in DTC advertising claim that they do not know how DTC works, I'd like to offer this:
DTC is not an efficient means for generating new prescriptions. It really is a compliance tool! That is, DTC works by convincing people to continue taking the brand advertised. It may also be effective in encouraging people to switch brands, which is something I've often thought about when I see DTC ads.
[Note that this role for DTC was hinted at in the PhRMA statement quoted above, which mentioned compliance at the end of its long list of DTC benefits. My point is that compliance should be put at the beginning of the list of DTC benefits, not at the end.]

Whenever compliance issues are discussed in trade publications and at conferences, DTC advertising is often criticized as being too focused on gaining new scripts and not focused enough on compliance. Yet DTC may be the greatest compliance tool there is! [BTW, that's not saying much. The current rate of compliance -- about 50% -- stinks!]

1 comment:

  1. Alex Sicre11:10 AM

    John:

    Thanks for the great post. I had no idea DTC advertising had such little influence on patients' doctor's visits. I was under the impression that the number was at least 15%.

    My impression was that when people hear the symptoms in the ads, they think, "huh, I feel this way, so I might have that". Didn't DTC ads drive Ambien and Lunesta sales?

    I believe the greatest achievements for DTC advertising is brand awareness, followed by drug switching (which can cause more problems), and sometimes informational (think Vytorin 2 causes campaign).

    As far as compliance, are you thinking that when a patient sees an ad, they respond, "wow, I'll keep taking this because this brand is spending money on ads, so it must work"? Or are that the ads are a reminder or a trigger for the patient to take their meds?

    Unfortunately I was diagnosed with high triglycerides and high cholesterol in December of 2006. I was prescribed Tricor, then a few months later Niaspan. I have never seen any ads for these drugs, but I take them because I trust my doctor.

    I do sometimes think, "hey maybe I should try X cholesterol drug", due to DTC ads, but I still believe that my PCP knows best!

    Be well,
    Alex

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