Direct to Consumer Advertising: An Information Gateway or Misleading Advertising?

A hundred thousand dollars is a lot of money, especially if you are only getting thirty seconds of time for that amount. This is how much pharmaceutical companies are spending airing their commercials on television aids during prime time hours (Weissman). It isn't so much the price the companies are paying that shock consumers, but the fact that those high prices are being passed onto patients and insurance companies. These new advertisements that you see on television, in magazines, on billboards, and even on the internet are a form of advertising called Direct to Consumer. It focuses on appealing to consumers directly, and is mainly used in pharmaceutical campaigns.

This technique has been around since the early 60's and was focused on doctors and pharmacists and only directed towards patients in newsletters (Weissman). Recently though this new technique has grown into a multimillion dollar mass media campaign. There are doubts about whether this is an effective way to gain the attention of the consumers. Insurance companies, activist groups, patients, and even doctors attribute DTC marketing strategies to the high cost of prescription drugs and medicare. Also the attitude about prescription drugs have changed from informing consumers to advertising free drug trials and other questionable marketing practices; such as, gift giving of merchandise to consumers and doctors. FDA regulations are being questioned to whether they are protecting the consumers or giving advantages to marketing corporations.

While the other side of DTC advertising comes from the pharmaceuticals companies who say they are informing consumers about new drugs out there, they say that their marketing has made illnesses; such as depression, better understood and people are seeking more treatment. Has Direct to Consumer advertising made the American people a society of pill pushers or are we attaining new knowledge about prescriptions that could change our way of life? I think Direct to Consumer advertising has some questionable attributes, especially when pertaining to their policies about gift giving and the way they portray their new drugs to the public. I believe the government should control prices of prescription drugs and not allow companies to spend millions of dollars advertising and then pass costs onto consumers.

A New York research firm, TNS Media/Intelligence/CNR, which tracks advertising spending on fourteen media platforms, conducted its annual research in 2005. It found that total advertising spending in the United States rose 6.1% from 2004-2005 to a total of 128.3 billion dollars (Rubin). Internet advertising increased the most, to 15.7% (Rubin). Cable advertising rose 5.6% and newspaper advertisements grew 13.4% (Rubin). Although these figures include all of advertising, pharmaceutical companies make up a large chunk of these numbers. Advertising spent by prescription drug companies grew by 21% from 2004-2005 to a total of 3.43 billion (Rubin). This is just the beginning of DTC advertising, and money spent on marketing is expected to increase over the years. The concept of advertising to consumers is still a young concept that companies are taking full advantage of and has become a bigger element in sales growth of a pharmaceutical company.

It takes hundreds of millions of dollars per year to advertise products to consumers, but companies are receiving pay off for their investments. According to a survey done by the General Accounting Office, 8.5 million American's request a prescription drug they see or hear on ads (Rubin). These statistics show that Americans are paying attention to the new prescriptions in the media. An unfortunate side effect of these promotional campaigns is the high cost of prescriptions. Since the companies spend so much on advertising the cost is put on the consumers. Promotional campaigns of generic companies are often unavailable, brand name companies don't want to lose business, and generic brand names don't advertise to keep down costs of the drugs (Rubin). Side effects of the high costs of advertising are put on consumers and insurance companies, and this affects everyone. Insurance companies end up raising prices of deductibles and programs offered. This in turn takes money out of patient's pockets. Receiving good medical coverage is expensive as is, but with new costs it will be even more. Some of the people most affected by this are those living on fixed incomes, especially the elderly. Many consumers that are growing older and retiring are forced to live on a fixed budget. The final decision for most of these people is deciding between good health care and paying other necessities, such as utility bills and groceries. Another downfall for consumers and insurance companies is that the government doesn't negotiate with pharmaceutical companies on prices, so there is no guarantee about how high prices will be raised (Sasich).

The other side of the topic comes from advertising companies and pharmaceutical companies. They say that the new technique of advertising has made the public more aware that their health care is now in their hands (Casella). It allows patients and consumers to become aware of new types of treatment out there. Illnesses such as depression and erectile dysfunction have become household illnesses that can be treated and being ashamed of them is no longer an issue (Weissman). Also direct to consumer advertising allows people to learn more about the new drugs on the market, instead of relying on your doctor for information you can call a toll free number or go online and find out information for yourself. Pharmaceutical companies say that they have made coping with an illness easier and have made public new drugs that can make their life easier.

Billy Tauzin, president and CEO of the Pharmaceutical Research and Manufacturers of America, says, "[Direct to Consumer Advertising] can be a valuable tool for helping patients learn about diseases and treatment options" (Kastellec). And it is true, the advertising style used by these companies brings a human- like life style into its campaigns. The illness is brought to life and makes it relatable and that is why the advertising is so effective. Although sometimes the educational purposes of the advertisements is unclear, new guidelines have been published on the principles of direct to consumer advertising. Following these guidelines have shown to improve the educational content in ads, and twenty-seven leading pharmaceutical companies have agreed to take the guidelines into consideration (Kastellec).

Some doctors have come to like the new style of advertising. They say it helps inform consumers, it helps them realize that I'm not the only one with this problem and it also helps promote overall health (Sasich). When patients enter the doctors office they already have a background of what is wrong and what needs to be done to improve their life and they have knowledge about some of the drugs on the market. This new informative style of marketing can cut down on doctor patient time, instead of going over every medicine on the market, the consumer comes in with some knowledge and allows more time to talk about drugs, lifestyle changes, and other topics that couldn't be discussed due to the hectic schedules of many doctor's offices. Doctors, patients, and pharmaceutical advocates state that direct to consumer advertising has changed the way we look at healthcare and illnesses, it has informed the public and is here to stay.
There has been a change in the marketing of drugs over the years. Once the FDA allowed DTC marketing in the United States in 1980's the young technique of marketing has changed the way consumers think about prescription drugs (Jaffe). The new law allowed companies to advertise directly to patients, instead of older versions of marketing that only were viewed by physicians. The new technique has been under scrutiny ever since the law was passed and the ethical nature of the advertisements have brought mixed feelings about what is informing and what is alluding. Direct to consumer advertising is not allowed in other western countries, such as Europe, and people wonder if we are taking a step in the right direction (Sasich).

A question asked by many doctors and activists against direct to consumer advertising is, when will it be time to revisit the law? Is the informed consumer better off today, or was the United States better off when medical professionals handled the decision about what drug prescription should be used? (Springen) According to IMS Health, a pharmaceutical information and consulting company, 15.9 billion dollars is spent on free drug trials alone and7.3 billion on sales representative contacts. These sales and representative contacts include things like free lunches and other merchandise like pens, brochures, pads of paper, and everything else the company puts its name on (Rubin). Do the free gifts benefit the consumer or is it buying the consumer?

A step against the freebies given by pharmaceutical companies is starting to grow, many medical centers and individual physicians are banning the companies gifts. Some of these include Chicago's North Western Memorial Hospital and Stanford University (Springen). The Dean of Students of Standford's School of Medicine, Dr. Phillip Pizzo, states, "There is a naive assumption on the part of all of us that we are immune to influence, that gifts don't make a difference" (Springen). Dr. Eric Mizuno, a doctor at Chicago's North Western Memorial Hospital, have also banned the gifts given by companies (Springen). He says the ban reduces the number of sales representatives in the reception area and also "that there was a time when there where literally more reps in the office than patients" (Springen). These are steps that many doctors have taken, an ethical choice, which allows them to make the informed choice about what drugs their patients need. It is a step in the right direction, although you may not think a free pen will influence your decisions about patient healthcare, you really can not be sure.

I have had a personal contact with some of the representatives of pharmaceutical companies. I work in at a restaurant part-time as a waitress. We often host large parties for pharmaceutical companies. The last party we hosted I was the waitress for the company. Before the guests arrived, I helped make gift baskets with the representative. We talked about the purpose of the gift baskets and the meeting in general. The spokeswoman said that the gathering was for a number of physicians in Colorado Springs to inform them of the new drug, Boniva. The gift baskets were freebies that the company provided for all representatives hosting meetings, and they were meant to inform the consumer about the new drug. Inside the basket were free drug trials, pens, pads of paper, a dictionary containing the modern physiatric's definition of clinical diseases, and other gadgets pertaining to the new drug. Personally I thought it was demeaning to give out all these free gifts because deep down I knew that the company was trying to buy the influence of the doctors attending the meeting. At the meeting the guests arrived and were seated. On top of their plates were the gift bags, the guests ate dinner with the company and also watched a 45 minute presentation by the companies representative. At the end of the meeting the company payed for everything, the meal, drinks, and desserts. I left the party happy because I had made a good tip, but also about the ethical nature of the business and the doctors that attended the meeting. I thought to myself, is this how I want my doctors to get information on a new drug, over martinis and a meal hosted by a pharmaceutical company? It seemed wrong to me, it felt like the company was buying the influence of the doctors, by providing them with gifts and a meal. The experience I had with the pharmaceutical company was not the only one, nation wide lawsuits are being filed against the ethical nature of pharmaceutical companies.

In 1996 a lawsuit was filed against a pharmaceutical company, Warner-Lamb, by Dr. Franklin (Rubin). Franklin worked for the company for four months, but quite because of moral reasons. He alleged Warner gave financial incentives to hundreds of physicians to prescribe Neurotic, a drug used for pain management, psychotic disorders, migraine headaches, and a condition related to diabetes (Rubin). The company was alleged to have also invited doctors and physicians to dinners and weekend trips to resorts (Rubin). Franklin revealed that doctors were paid 350 dollars a day to let allow sales people from Warner watch while they examined patients (Rubin). This is not the first time that physicians have been put under the light and scrutinized. Other lawsuits against doctors have been about there personal reasons for prescribing certain drugs over others. Some found that if they sell X number of a certain drug, they get financial and other types of rewards, such as free vacations (Rubin). These lawsuits show the influence that pharmaceutical companies have over physicians. Although not all doctors have been jaded by the companies, the ethical standards about what is acceptable has changed over the years.
In a survey compiled by the FDA, 500 physicians were asked to answers questions about doctors prescribing drugs to patients (Rubin). In a question about brand name drugs and how patients respond to them, 59% said that if a patient were to ask for a specific brand name drug they would get it (Rubin). The shocking part of the survey was a question about the patient's knowledge about the risks and side effects based on advertisements seen. Only 40% said that patients actually understood the other side effects of the drug (Rubin). This shows the companies are making there product aware on the market, but are not informing consumers about the possible side effects and risks that there drug might have. Doctors now have to be able to help patients understand that they have to weigh all the risks involved in taking certain medication.

This is just the beginning of some interesting facts about how far companies will go to get their information out to the public. A Florida production company called, WJMK, hired popular newscasters from CNN and the CBS news, like Walter Cronkite and Aaron Brown to broadcast company products on air in a news like setting (Rubin). Viewers of the show thought it was a news channel, but actually it was a type of advertisement. The pharmaceutical companies were paying WJMK about 15,000 dollars to show their prescriptions and information about them (Rubin). Many heads were turned when this information was found out. Is this type of show ethical, the company used people that the public thought were informers of the news not advertisers of a product, and no where in the program did it say that the show was sponsored by the pharmaceutical company (Rubin). An advocate of WJMK said that, "the shows were meant to be educational and not promotional" (Rubin). They compare themselves to a show that appears on PBS an educational show sponsored by the public, while in fact they were seemingly taking money under the table.

Regulations about the way advertise's are allowed to portray their products to consumers have changed over the years. The law regulates the way people advertise to consumers, especially when dealing with health care and new drugs on the market. The FDA regulates the law on advertising and some think these laws are not enough, and are to easy to get around and break the rules with just a slap on the wrist. Direct to consumer advocates say that the laws keeping DTC in order are too strict and don't allow them to inform the consumers effectively.

Regulations that the FDA enforces are about the proper labeling and information the advertisement is giving (Jaffe). The regulation includes approval of prescription drug labeling that provides information about the use of the drug (Jaffe). It regulates the content of the advertisement, but not the medium of which it is portrayed. The FDA regulates advertisement that is misleading or false, that prescription drugs are not omitting any facts and must present a fair balance between benefit and risk information (Jaffe). Also it regulates specifics in types of media; for example, in print advertisements there must be a brief summary of risks (Jaffe). In broadcasting they must disclose the most significant risks that appear in the labeling of the drug and must also contain a brief summary of all necessary information related to side effects (Jaffe). The FDA does not review advertisements before being viewed by consumers and also does not address the issue of pharmaceutical coverage by insurance companies or drug product price (Jaffe).

Advocates that want to see a change in the way the FDA deals with this type of advertising say that they should review most of the content before it is viewed by the public. Companies that don't adhere to the regulations get a slap on the wrist and have there ads taken off of the medium they were using. Also they would like to see a budget plan that advertisers can use which controls the way advertisers give out free drug trials and other gifts. Another change they would like to see is the governments control on the prices of certain medications.

In conclusion, the battle between large pharmaceutical companies and people against them still continues. I would like to see a change in the ethical nature of many advertising campaigns, but it is a hard business to regulate. One thing for sure is that direct to consumer marketing is going to be around as long as there is money to be made; and the door is now wide open on how large of a profit the company will attain. The difficult answer to many of the questions are, how far are we willing to go to inform the public and regulate large corporations? And has advertising become so powerful that we are unable to regulate it?

Work Cited

Casella, Jim. "Pill Pushing." New Scientist Magazine. August 2006: 7.
Jaffe, Daniel L.; Kamp, John F.; Lom, Thomas P. "FDA Public Hearing: Direct to Consumer Promotion." U.S. Food and Drug Administration. Published: 18 October 1995. 24 October 2006. http://www.fda.gov/cder/dclmac/DTCPANEL5.htm
Kastellec, John. "Lawsuit alleges Schering Overstated Claritin Effectiveness." Kaiser Network. Publication: 10 August 2001. 23 October 2006. http://www.kaisernetwork.org/Daily_reports/rep_index.cfm?DR_ID=6311
Rubin, Allan. "Prescription Drugs and the Cost of Advertising them." The Rubins. Published: 02 February 2005. 23 October 2006. http://www.therubins.com/geninfo.advertise.htm
Sasich, Larry D. "FDA attitudinal and Behavioral Effects of DTC advertising of Prescription Drugs." Public Citizen. Published: 28 Sept 1998. 24 Oct 2006. http://www.citizen.org/publications/release.cfm?ID=6658
Springen, Karen. "Saying No to Big Pharma." Newsweek. 06 Oct. 2006.
Weissman, Joel S.; Blumenthal, David; and Silk, Alvin J. "Consumers' Reports on The Health Effects of Direct To Consumer Drug Advertising." The People to People Health Foundation. 26. February 2003. Http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.82v1/DC1