Direct to Consumer Advertising: Drugs, Hospitals, Research….

A very contentious health policy issue is that of advertising.  Usually the specific topic is the advertising of medicines directly to patients – known as “Direct to Consumer Advertising.”  There have been proposals to limit or ban this activity, and some states have, (or have proposed), limiting or requiring disclosure of other marketing activities by pharmaceutical companies – such as marketing directly to doctors and hospitals.

However, I’ve found it intriguing that many other components of the healthcare industry advertise directly to patients.  For example, the Boston area free daily paper, Metro, contains lots of ads recruiting people to participate in medical research trials.  There are also many ads in the newspapers and on the radio about local hospitals – generally touting their expertise in one area or another that is lucrative for the hospital, such as joint replacement surgery.  And unlike pharma products, these other types of advertising aren’t regulated by the FDA – although they may be overseen by other Federal or State agencies.

Another very large vat of health related advertising is done by the herbal and nutritional supplement industry. This is a huge area of medical related advertising.  It is overseen by the FDA and FTC, but I have an entire talk about how this type of advertising fits in with the other information patients receive about their illnesses.  So I’m not going to expand upon this area here – perhaps in another blog posting.

And of course physician advertising was generally seen as unethical until about 10-20 years ago. But now, while still uncommon, (I’m not counting web-sites for physicians offices that tell people the address and phone number, and describe the clinical service the practice offers), it is not unknown for physician practices to advertise.  (Some physician related advertising is also probably partly incorporated into that done by hospitals and others.)

Issue Advertising
Another form of advertising that is quite prolific is issue advertising directed toward policy makers.  Although health care can’t seem to break out of 3rd place in the public opinion polls about the Presidential election, the healtcare industry is still paying about $10,000 per page for advertising in publications like National Journal.  And while the pharmaceutical industry certainly accounts for a portion of these ads, many other groups with healthcare interests are doing this too.  For example, flipping through some recent issues of National Journal I found ads from the following organizations (in alphabetical order) with these headers:

  • American Academy of Family Physicians – “If you health care isn’t working, neither are your employees”
  • American Health Care Association – “Home is not just where you live.  It is where people care for you”
  • American Vetinary Medical Association – “Isn’t a child’s health worth more than a penny?”
  • AstraZeneca – “What does AstraZeneca stand for? Patients”
  • BlueCross BlueShield Association- “When you cover one in three Americans you don’t just offer coverage, you offer solutions”
  • National Association of Realtors – “Soaring Health Care Costs Have America’s Small Businesses on Life Support”
  • Novartis – “People say driving a truck is dangerous.  What about high blood pressure?”
  • Office of National Drug Control Policy – “Rebuild After Meth”
  • Pfizer – “Working together to improve the health of individuals, and the health coverage of the nation”
  • Pfizer helpuful answers – “Prescription assistance for uninsured Americans, from sea to shinging sea”
  • Science Applications International Corporation – “He tells cancer cells to starve themselves to death”
  • SEIU & Greater NY Hospital Association – “Our Nation’s Teaching Hospitals”

Conclusions
I wish I had a simple set of solutions for what troubles people about about both issue advertising and healthcare organizations advertising directly to consumers.  My one overarching conclusion is that assessing the impact of paid advertising directed at patients and policy makers needs to be done in the context of what other information they are being bombarded with from healthcare professionals, the media, family, friends, academic and policy researchers, and others.  Examining the influence of one area of information without evaluating what other types of information may be effecting patients’ and policy makers’ attitudes and actions is like blaming the ocean for hurricane Katrina’s  devastating flooding – I’m not a meteorologist, but I think the wind and atmospheric pressure had something to do with it too.

4 thoughts on “Direct to Consumer Advertising: Drugs, Hospitals, Research….

  1. Very interesting and well written article. I found your blog on Google and read a few of your other posts. I just added you to my Google Reader. Keep up the good work! – Shane

  2. Endocrinology and metabolism states: “we use our know-how to help you reach the industry’s thought leaders and maximize your return”. The NEJM states “Place your ad in the New England Journal of Medicine and make our relationship with the medical community yours”. The BMJ states “We protect our reputation by careful balance of editorial and advertising, which means your messages will always stand out”.

  3. Diane – thanks for your comment. Your perspectives are very common, but don’t reflect the reality of the pharmaceutical industry. If companies couldn’t advertise directly to patients they wouldn’t have any reason to lower the prices of medicines. Prices reflect how much value the medicine provides to patients and society relative to other treatment options – and in this sense they also reflect the old axiom that prices are set at what the market will bear. Many economists point out that insurance makes health care a very skewed market since patients aren’t really seeing the actual costs of care, but that’s another topic. And it is also important to remember that the unbiased studies (including those from the FDA and the Kaiser Family Foundation), have shown that DTC advertising has many different positive and negative effects (from societal, clinical and economic perspectives) that on balance seem to come out as a wash, or slightly positive. For example, they remind people to take medicines, get refills, and call their doctors for appointments. They also make people more aware that medicines have serious side effects. They also can irritate doctors whose patients come in asking for a specific medicine. Overall, I think DTC advertising can be a good thing – but again, it needs to be looked at within the entire context of all the information patients are getting about their medical problems.

  4. I believe that the cost to pharmacy companies of advertising prescription drugs is the main cause of the huge increase in the drugs’ cost to patients. We lived many years without advertising prescription drugs and patients did just fine by relying on their doctors and/or nurses to tell them about any medicine that might help them. If the pharmacy companies were not allowed to advertise, we might see more reasonable prices for their drugs.

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