A critical look at prescription drug direct-to-consumer advertising

Direct-to-consumer advertising (DTCA) of prescription drugs has been a source of debate since its US approval by FDA in 1997. A primary source of debate among experts is the methods advertisers use to attempt to influence the consumer and the consumer's subsequent reaction. Despite the controversy, authors of a recent content analysis of televised DTCA say there has been no systematic analysis of DTCA's influence on consumers to date.

In the study published in the Annals of Family Medicine, the authors coded ads based on the types of factual claims made about the target condition and the types of appeal used (rational, positive emotional, negative emotional, humor, fantasy, sex, and nostalgic), and how the medication and lifestyle behaviors were portrayed in the lives of characters.

The sample of 103 recorded ads consisted of 31 unique product claim ads, which are required to include more detailed information about the drug than product reminder ads, and 7 unique product reminder ads (some ads were recorded >1 time) collected during peak television viewing times ( 8:00 PM–11:00 PM) and during the most popular evening news broadcasts (ABC, CBS, NBC, and Fox); recording occurred for 4 weeks (June 30, 2004–July 27, 2004), with samples gathered from each day of the week for each network. The sample contained ads for 7 of the 10 top-selling prescription drugs in 2004.

Both product claim ads and product reminder ads were included in the appeal analysis, which demonstrated that positive emotional appeal was the most prevalent (95.1%), followed by rational (86.4%), negative emotional (68.9%), humor (32%), fantasy (20.4%), sex (5.8%), and nostalgia (3.9%).

Average ad length was 44.9 seconds (SD=18.6 seconds, range 14–62). Three story structures were identified: ads showing characters before and after taking the product (44.7%), ads showing characters only after taking the product (39.5%), and ads showing characters only before taking the product (7.9%); 3 ads (7.9%) did not use characters or clearly portray whether the characters had taken the product.

Lifestyle portrayals were identified in all ads. A total of 56.3% showed the product enabling healthy or recreational activities, 26.2% portrayed the condition as interfering with healthy or recreational activities, 19.4% showed lifestyle change adjunct to the product, and 18.4% portrayed lifestyle change as insufficient. None of the ads portrayed lifestyle change as an alternative to product use.

The authors identified 7 medication portrayals used in the ads: regaining control as a result of product use (85.4%), social approval as a result of product use (77.7%), loss of control by condition (58.3%), breakthrough in medical science or condition treatment/cure (58.3%), distress caused by condition (47.6%), increased endurance as a result of product use (17.5%), and protection as a result of product use (9.7%).

The authors said they had concerns about the lack of information regarding healthy behaviors as an alternative to product use. They also noted ambiguity "about whether viewers might legitimately need the product." The ads thereby implicitly focus on "convincing people they may be at risk for a wide array of health conditions that product consumption might ameliorate, rather than providing education about who may truly benefit from treatment." They also suggested the addition of more information about risks associated with the advertised products.

The authors acknowledged several limitations to the study, including the subjective nature of advertising and the limited sampling. They suggested future studies to examine characteristics of DTCA throughout the year and at various times of the day to assess differences in relation to the target demographics.

In a related editorial, David A. Kessler, MD, and Douglas A. Levy, MD, said they are concerned about the consequences of DTCA. The editorial stated: "Patients learn for the first time about conditions they never worried about and ask physicians for new medicines by trade name because they saw it on television." They cited FDA survey data that found that 22% of primary care physicians and 13% of specialists felt pressured to prescribe a drug when a patient requested it.

Drs Kessler and Levy noted the lack of effective, consistent information about risks and benefits and said that new advertising guidelines promising more of this type of information, while welcomed, are not enough: "Although these efforts may be a step in the right direction, physicians, consumers, and policy makers must take further action so that the facts about medicines are not lost in the advertising fog."

SOURCES Frosch DL, Krueger PM, Hornik RC, Cronholm PF, Barg FK. Creating a demand for prescription drugs: A content analysis of television direct-to-consumer advertising. Ann Fam Med. 2007;5:6–13.

Kessler DA, Levy, DA. Direct-to-consumer advertising: Is it too late to manage the risks[editorial]? Ann Fam Med. 2007;5:4–5.