By Mary Gabb ([email protected])

Obnoxious, annoying, Big Pharma strikes again – these are just some of the sentiments heard when encountering a direct-to-consumer (DTC) advertisement, the myriad commercials on radio or television, or adverts in magazines, newspapers, or on the internet, promoting prescription drugs to consumers. The pros and cons of DTC advertising have been bandied about since the inception of this marketing platform more than a decade ago. DTC advertising is currently permitted only in the United States and New Zealand, but Canada and/or Europe may follow suit as pressure to allow this form of advertising increases.

Arguments against DTC advertising are familiar – it increases the cost of medications, it has created a society of hypochondriacs, it reinforces that “quick fix” so many in modern society seek, instead of the lifestyle changes necessary to address some diseases, and it reinforces the sinister concept of Big Pharma.

The arguments in favour of DTC advertising are less well known, but still important to consider. First, DTC advertising helps to make patients aware of their treatment options, such as new drugs for a particular disease, and the potential side effects of taking the drug. DTC adverts also help to destigmatise and raise awareness of certain disorders, prompting patients to seek medical attention when they might not have otherwise. In short, patients become more motivated to take control of their healthcare and become more active partners in the patient-doctor relationship.

The extent to which the pros outweigh the cons (or vice versa) has been argued in recent years, as long-term studies have followed the effects of DTC advertising – the percentage of marketing budgets spent on DTC advertising, the effect on the number of prescriptions written, surveys of physicians on the extent to which DTC has affected the doctor-patient relationship and prescribing habits, the spread of costs across healthcare delivery (eg, fewer hospitalisations with increased use of prescription drugs).

Supporters of DTC advertising are also facing criticism of poor oversight of the ads by the FDA. The recent decision by Pfizer to pull their Lipitor ads featuring Dr. Robert Jarvik only highlight such scepticism. (With pressure from the US Congress, the Jarvik Lipitor ads were deemed to be misleading, for several reasons: Dr. Jarvik is not a licensed physician, he is not a cardiologist, and some of his colleagues are debating whether he should receive sole credit for [or even be credited at all with] inventing the artificial heart.)

Although the ads may seem to be ubiquitous, the number and type of drugs advertised to consumers is small, and the ads focus on new drugs to treat chronic diseases and diseases for which patients can recognise the symptoms (eg, depression, dyslipidaemia, obesity, allergies, osteoporosis, arthritis, asthma, and diabetes). Also, DTC advertising still occupies a relatively small portion of marketing budgets for those drugs that are advertised. The New England Journal of Medicine reported that while spending on DTC advertising rose 330% between 1996 and 2005, it made up only 14% of total promotional expenditures in 2005. Advertising to doctors is still one of the biggest drivers in marketing budgets.

Ultimately, the effect of DTC advertising will depend on the individual patient – his interest in and capacity to understand his disease and the drug, including its benefits and risks.