Direct-to-Consumer Advertising: Public Perceptions of Its Effects on Health Behaviors, Health Care, and the Doctor-Patient Relationship

Abstract

Purpose: To determine public perceptions of the effect of direct-to-consumer advertising (DTCA) of prescription medications on health behaviors, health care utilization, the doctor-patient relationship, and the association between socioeconomic status and these effects.Methods: Cross-sectional survey of randomly selected, nationally representative sample of the US public using computer-assisted telephone interviewing. Main outcome measures: numbers and proportions of respondents in the past 12 months who, as a result of DTCA, requested preventive care or scheduled a physician visit; were diagnosed with condition mentioned in advertisement; disclosed health concerns to a doctor; felt enhanced confidence or sense of control; perceived an effect on the doctor-patient relationship; requested a test, medication change, or specialist referral; or manifested serious dissatisfaction after a visit to a doctor.Results: As a result of DTCA, 14% of respondents disclosed health concerns to a physician, 6% requested preventive care, 5% felt more in control during a physician visit; 5% made requests for a test, medication change, or specialist referral, and 3% received the requested intervention. One percent of patients reported negative outcomes, including worsened treatment, serious dissatisfaction with the visit, or that the physician acted challenged. Effects of DTCA were greater for respondents with low socioeconomic status.Conclusions: DTCA has positive and negative effects on health behaviors, health service utilization, and the doctor-patient relationship that are greatest on people of low socioeconomic status. The benefits of DTCA in terms of encouraging hard-to-reach sections of the population to seek preventive care must be balanced against increased health care costs caused by clinically inappropriate requests generated by DTCA. (J Am Board Fam Pract 2004;17:6 -18.)

Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising

“…To date, no one has analyzed systematically what television ads claim about health conditions, how they attempt to appeal to consumers, or how they portray the role of lifestyle behaviors and medication in achieving good health. These questions are critically important given evidence that DTCA prompts consumers to request prescriptions for advertised products from their physicians, 14,15 and that many of those requests are fulfi lled despite being judged clinically inappropriate. 16 The goal of our study was to analyze the content of television DTCA messages to lay the foundation for future studies that examine the consequences of DTCA exposure.…”

Beyond Rhetoric in Debates About the Ethics of Marketing Prescription Medicines to Consumers: The Importance of Vulnerability in People, Situations, and Relationships

“…Consumers have consistently expressed a desire for information on indications and drug side effects (Foley and Gross 2000;Tucker and Smith 1987;Woloshin et al 2004;Young et al 2005). In opinion and attitude research, consumers have generally been found to have 'neutral' or 'positive' attitudes to consumer marketing of medicines as a source of information (Alliance for Access to Medical Information (AAMI) 2002; Bell et al 1999a;Beltramini 2006;Gonul et al 2000;Herzenstein et al 2004;Hoek et al 2004;Huh et al 2004a;Huh et al 2004b;Miller and Waller 2004;Murray et al 2004;National Consumers League 2003;Perri and Nelson Jr. 1987;Robinson et al 2004;Vatjanapukka 2004). However exposure to consumer marketing of medicines does not appear to improve the accuracy of consumers' knowledge about drugs (Brodie 2001;Hoek 2007;Kaphingst et al 2005), and consumers generally express skepticism about the quality and credibility of information provided by such marketing and conflicting, diverse or inconsistent attitudes on the benefits and risks posed by it (Alperstein and Peyrot 1993;Foley and Gross 2000;Herzenstein et al 2004;Marinac et al 2004;Miller and Waller 2004;Robinson et al 2004;Young et al 2005b).…”

Time to Ban Direct-to-Consumer Prescription Drug Marketing

“…10 DTC ads have the potential to increase the appropriateness of prescribing among those who have a condition for which medication is underprescribed, 11,12 but the (potentially adverse) effect on the many who see the message but who do not have the condition is inherently harder to measure. 7,13 Together, these sources show an emerging public health tragedy that is happening so surreptitiously that we are blind to the magnitude of the encroaching effect on the quality of health care and the health of Americans.…”

“…The process 4,13 and consequences 10,[13][14][15] of DTC ads are complex, infl uenced by a multifaceted interaction between the prevalence and severity of the condition to be treated, the effectiveness of the treatment, the severity and frequency of side-effects, and the degree to which the condition is over-or undertreated in the population. 2,16 The public health impact of the ads on diverse individuals also depends on intricately interrelated characteristics of the DTC advertisement.…”

“…10 DTC ads distort the relationship between patients and clinicians. 13,17,18 DTC ads manipulate the patient's agenda and steal precious time away from an evidencebased primary care clinician agenda that is attempting to promote healthy behavior, screen for early-stage treatable disease, and address mental health. The negative consequences of this manipulation of the public, the patient, the clinician, and their relationship are subtle but pervasive.…”