With spending on prescription drugs the fastest-growing component of the health-care budget, physicians and policy makers are concerned about the potential for direct-to-consumer advertising to accelerate this growth.
In an analysis of direct-to-consumer advertising, researchers at the School of Public Health (SPH), Harvard Medical School, and the Sloan School of Management, Massachusetts Institute of Technology, have found that such advertising increased threefold between 1996 and 2000. Still, direct-to-consumer advertising accounted for only 15 percent of drug promotion by pharmaceutical companies and was highly concentrated among a small group of products. Personal visits by pharmaceutical company representatives to office and hospital-based physicians, free samples left with physicians, and advertising in medical journals accounted for more than 80 percent of promotional spending.
The study, “Promotion of Prescription Drugs to Consumers: A Look at the Numbers,” was led by Meredith B. Rosenthal, assistant professor of health economics and policy in the Department of Health Policy and Management at SPH. The study appears in the Feb. 14, 2002, issue of The New England Journal of Medicine. Two related editorials accompany the study.
Proponents of direct-to-consumer advertising for prescription drugs argue that the practice leads to better-informed consumers and improved quality of care. Critics feel it causes physicians to waste valuable time during patient visits and encourages use of expensive and sometimes unnecessary medications.
The researchers found that the greatest percentage increase in direct-to-consumer advertising has been in television ads, which increased more than sevenfold between 1996 and 2000, with a surge taking place before the Food and Drug Administration clarified its broadcast guidelines. But unlike promotion to health professionals, which occurs for nearly all branded drugs, direct-to-consumer advertising spending is concentrated among a few products. In 2000, the top 20 prescription drugs ranked by direct-to-consumer advertising spending accounted for about 60 percent of such spending.
The industry spends most on consumer ads for prescription drugs used to treat chronic conditions and drugs with a low occurrence of mild side effects – probably because less risk information needs to be conveyed to consumers. Some of the most highly promoted prescription drugs in 2000 were Vioxx, an anti-inflammatory ($161 million), Prilosec, an anti-ulcer drug ($108 million), the antihistimine Claritin ($100 million), the antidepressant Paxil ($92 million), the cholesterol-lowering drug Zocor ($91 million), and Viagra for erectile dysfunction ($90 million). Total drug promotion for 2000 topped $15 billion – and represented 14 percent of sales.
“The ratio of overall spending on promotional efforts to sales has changed little over time,” wrote the researchers. “The increase in direct-to-consumer advertising spending represents a shift in the particular combination of marketing tools rather than an increase in the intensity of the total promotional effort …. The relatively modest emphasis on direct-to-consumer advertising by the pharmaceutical industry contrasts with the apparent degree of concern about it among physicians and policy makers.”
Said Rosenthal: “The perception that direct-to-consumer ads have become the principal marketing approach for prescription drugs may be because the recent increase in direct-to-consumer spending has been on TV ads, which are highly visible. Also, the apparent targeting of high-cost prescription drugs raises concerns about the potential impact of this advertising on health care spending.”