US Pharm. 2007:32(7):1.

I don't watch a lot of television, but it seems an evening doesn't go by that I am not exposed to a direct-to-consumer (DTC) ad for a prescription medication. Like many other pharmacists, I probably view these ads a little differently than the average consumer. When DTC advertising started airing more than a decade ago, I remember just shaking my head and saying they wouldn't last. I just didn't believe that physicians would change their prescribing habits as a result of the ads, and I certainly didn't believe consumers would pay much attention to the very sketchy clinical information that was being presented. But that all changed in 1997 when the FDA eased up on some of the restrictions attached to DTC advertising, and the ads became more creative and appealing to consumers. Obviously, I was very wrong about them going away, because they only increased in frequency. So, to answer my own question, I have to draw the conclusion that pharmaceutical manufacturers would not be spending the multimillions of dollars on these ads if they did not produce the desired result: more prescriptions written for the products being advertised.

When these ads first started being aired, I asked some of the people who created the ads and others who paid for them what their expectations were. Many at the time said they simply served an educational purpose. I suppose to a limited extent they did then and still do today, but I had no way of proving it. However, several months ago I came across an interesting piece of research published in the Annals of Family Medicine. The authors of this paper set out to see if DTC prescription advertising messages were prompting consumers to request medication that might be "clinically inappropriate or more expensive than equally effective alternatives."

It's a lengthy paper with very good information, which makes it impossible to include all the results here, but I found some of the findings fascinating. The researchers claim that American television viewers see as many as 16 hours of DTC ads a year. They conclude that most of the advertising (82%) made "some factual claims" and "rational arguments" (86%) for product use. But only about a quarter of them described condition causes (26%), risk factors (26%), or prevalence (25%). Instead, virtually all of them played on consumers' emotions (95%). None of the ads mentioned lifestyle change as an alternative to taking the medication, but some (19%) connected lifestyle changes as an adjunct to the medication being advertised. One particularly interesting fact was that almost 60% of the ads portrayed the advertised product as a medical breakthrough.

Perhaps you've noticed that there are basically two kinds of consumer prescription ads running on TV these days: those that make claims about the product and reminder ads. As you would expect, the claims ads require more information, including the name and indication of the drug, as well as a major statement of product risks, and then must point the consumer to another source, like the Internet, a toll-free phone line, or a magazine ad for a detailed summary of those risks.

While the controversy continues to swirl around DTC Rx advertising and whether they serve the purpose of educating the consumer, one thing is for sure: it means the pharmacist must answer many more questions from consumers about prescription products that many of them can hardly pronounce. I am all for an educated consumer, but I am not in the camp that believes the purpose of these ads is to educate consumers about their medical condition orthe products they may be taking; it is about selling the product. The only reliable source of disease state information is from a licensed physician, not an actor who plays one on TV. Drug information should come from a pharmacist, not a 45-second TV ad.

Harold E. Cohen, R. Ph.

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