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Magazine ads for prescription drugs are high on emotional appeal, but short
on evidence that they work.
Urging consumers to help their children fight allergies or to question
whether their memory lapses might be Alzheimer's, most drug ads favor "vague"
claims over clinical data.
Looking at ads in 70 issues of 10 leading US consumer magazines, researchers
found that 87% chose "vague, qualitative terms"
to describe the medication's benefits rather than providing research evidence.
These advertisements rarely quantify a medication's expected benefit, and
instead make an emotional appeal. This
strategy probably leaves many readers with the perception that the drug's
benefit is large and that everyone who uses the drug will enjoy the benefit.
The authors also argue that a key danger is that many of these ads may
"medicalize" run-of-the-mill problems in the public's mind. A runny nose
all of a sudden becomes allergic rhinitis.
The first direct-to-consumer advertisement for a prescription drug appeared
in Reader's Digest in 1981 in USA. Over the next few years, other such advertisements
were published, and the US Food and Drugs Administration (FDA) became worried
that little was known about the potential effect of such advertisements
on the public.
Consequently, in 1983, the FDA initiated an advertising moratorium while
it studied the issues and considered the regulatory options. Although they
concluded that "direct to the public prescription advertising was not in
the public interest," the FDA lifted the moratorium in 1985 because of concerns
about freedom of speech and a general consensus that regulations already
in place were sufficient to protect the consumer.
After the moratorium had been lifted, direct- to-consumer advertising was
permitted provided that the advertisements met certain criteria; specifically,
that they presented true
and balanced information about the side-effects of the drugs,
and their contraindications and effectiveness. The FDA monitors compliance
with these criteria. However, prior approval of drug advertisements is not
required.
Opponents of direct-to-consumer advertisements are worried that direct-to-consumer
advertisements might inappropriately increase patient demand for specific,
and generally costly, agents, and that this demand might have a negative
effect on medical practice and on the physician-patient relationship.
Pharmaceutical companies spent $1.8 billion on direct-to-consumer
advertisements for prescription drugs in 1999.
Concurrently, many pharmaceutical companies have reduced the amount spent
on direct-to-physician advertising, which suggests a tactical shift in their
focus from physicians to patients. Last year, for example, drug companies
spent more on advertisements in newspapers and popular magazines than they
did in medical journals ($685 million vs $473 million, respectively) (www.imshealth.com
accessed on Aug 25, 1999).
Direct-to-consumer advertisements are common in popular magazines, particularly
in those aimed at women. Furthermore, they all share a similar
structure: they link the advertised product with its target condition and
invite consumers to share in their own health management.
Although most advertisements addressed the relief of common symptoms that
many consumers would normally treat themselves with over-the-counter remedies
(eg, runny nose), a substantial number targeted more complex treatment decisions
usually made by physicians (eg, choice of antibiotic or type of insulin).
Additionally, many of the advertisements presented quantitative data about
potential side-effects, but very few provided any such data about benefit.
In a nationally representative survey, two thirds of adult Americans recalled
seeing a prescription advertised, and about 10% asked their doctor for that
prescription (of these, 73% said the prescription was made).
Direct-to-consumer advertisements for prescription drugs undoubtedly help
to educate consumers about available options. At the same time they encourage
consumers to believe that a problem might exist where they previously would
not and that a pharmacological solution is the appropriate way to deal with
it.
The Lancet October 6, 2001;358:1141-1146
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