The Risks and Benefits of Direct-To-Consumer Advertising of Pharmaceuticals

We've all seen the ads on television telling us to be ready when the moment is right, to guard against the evils of HPV and cervical cancer, to talk to our doctor about Plavix, and on and on and on. In America -- and with the exception of New Zealand, only in America -- television commercials are pushing prescription drugs at us promising to fix just about everything. How well the drugs themselves are working for people is something of an unknown. How well the ads are selling the drugs is pretty obvious: They work....well. If they didn't, the pharmaceutical companies wouldn't keep running the ads all the time. After all, those things cost a lot of money. So, it's safe to say that we're spending more -- at least for certain drugs -- than we would be if they weren't being shown on our TV sets in between episodes of Community and The Office. Whether that's a good thing or a bad thing isn't immediately clear, however.

Thanks to a solid piece of analysis by Dominick Frosch and colleagues appearing in the January 2010 issue of the American Journal of Public Health, we're a little bit closer to an answer on the risks and benefits of direct-to-consumer advertising of prescription drugs. First, the benefits: To the extent that the ads provide good information on a particular disease or disorder and the appropriate uses of the medication being marketed, they can be viewed as empowering patients to take on a more active role in their own health care. That's a good thing. For patients already taking a certain drug, seeing it advertised on TV may serve as a reminder to take the medication -- leading to an increase in patient adherence to prescribed dosing. That's a good thing, too.

On the other hand, if patients are given faulty or misleading information, subsequently request a prescription, and are not denied the prescription by their physician (for a host of possible reasons), then it's possible that people will be getting the drug who don't need it, and the consequences of that run the gamut from wasteful to contraindicated and life-threatening. That's a bad thing, obviously.

What Frosch and colleagues find isn't terribly surprising. The information provided in ads is typically quite oversimplified and vague. That makes sense, because -- like the "psychic" who says "I'm getting a 'Jim' or 'John' or maybe a 'J' name. Do you know who that might be?"--the wider the net you cast, the more fish you catch. And, of course, your average television viewer isn't likely to pick up on things like efficacy in a 30-second ad spot. Websites are more thorough with the information they provide, but you have to jump through a lot more hoops to find out about the risks of a medication, while the benefits are plastered all over the homepage. Long story short, the ads aren't doing that much educating of the public. There is, however, some evidence that the ads improve patient adherence slightly.

As for the risks, well, they're there, too. Frosch and colleagues find that -- not surprisingly -- the drug ads lead to an increase in prescribing. What's more they find that the increase in prescribing includes both appropriate and inappropriate prescriptions. They hesitate, however, to draw any conclusions about whether the increase in inappropriate prescriptions outweighs the increase in appropriate prescriptions.

Overall, it seems that direct-to-consumer advertising of prescription drugs is a tricky issue. On the one hand, it has the potential to benefit patients. On the other hand, it has the potential to harm them -- and to waste precious resources in the process. Striking a balance between these risks and benefits will require deft maneuvering on the part of the FDA, because the pharmaceutical industry has only one concern, and that's selling as many drugs as it can.

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