Healthy Skepticism Library item: 19603

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Khosla P, Khosla A
Direct to consumer advertising of prescription drugs on internet: A Boon or a Curse
Indian J Pharmacol 2011 July 22; 43:(4):483-484
http://www.ijp-online.com/article.asp?issn=0253-7613;year=2011;volume=43;issue=4;spage=483;epage=484;aulast=Khosla

Notes:

References

1. Frosch DL, Grande D. Direct-to-consumer advertising of prescription drugs. LDI Issue Brief 2010;15:1-4.

2. Findlay SD. Direct-to-consumer promotion of prescription drugs. Economic implications for patients, payers and providers. Pharmacoeconomics 2001;19:109-19.

3. Mansfield PR, Mintzes B. Direct to consumer advertising is at the crossroads of competing pressures from industry and health needs. BMJ 2005;330:5-6.

4. Lal A. Pharmaceutical drug promotion: How it is being practiced in India? J Assoc Physicians India 2001;49:266-73.

5. Donohue JM, Berndt ER, Rosenthal M, Epstein AM, Frank RG. Effects of pharmaceutical promotion on adherence to the treatment guidelines for depression. Med Care 2004;42:1176-85.

6. Hansen RA, Chen SY, Gaynes BN, Maciejewski ML. Relationship of pharmaceutical promotion to antidepressant switching and adherence: A retrospective cohort study. PsychiatrServ 2010;61:1232-8.

7. Liu Y, Doucette WR. Does direct-to-consumer advertising affect patients’ choice of pain medications? Curr Pain Headache Rep 2008;12:89-93.

8. Murthy MB, Krishnamurthy B. Authenticity of claims made in drug promotional literature. Indian J Pharmacol 2010;42:57-61.

Full text:

Sir,

Advertising is the structured and composed non personal communication of information, usually paid for and usually persuasive in nature, about products (goods, services, and ideas) by identified sponsors through various media. Direct to Consumer Advertising (DTCA) involves promoting products directly to consumers by the use of popular media. Historically, advertisers have used the traditional mass media – radio, television, newspapers, magazines, and billboards- to send their messages. But these are largely being replaced by Internet advertising. In today’s world, advertising has a profound impact on the society of which consumer is a part. It is a powerful force that shapes the attitudes and behavior of the people. As advertising gives high returns in terms of money, pharmaceutical companies are spending more on medical drug advertising than on research and drug development. [1]

Prescription drugs are the drugs which are required to be dispensed under the supervision of a physician. On the other hand, over the counter drugs can be sold directly to the consumers / patients without any doctor’s prescription. The traditional pharmaceutical media for exposing and raising the product message of prescription drugs are professional journals, magazines or newspapers, direct mail, convention or hospital displays and service items such as educational films, medical illustrations and photographs, office supplies, text books, exhibitions and the like. For years pharmaceutical companies did most of their prescription drug marketing only to physicians, either through their sales force or by advertising in medical journals. However, in 1997 the Food and Drug Administration (FDA) issued new guidelines making it easier for pharmaceutical companies to advertise prescription drugs on television, print media as well as on the Internet. With the change in guidelines, the promotion of prescription only medicines using direct to consumer advertising is increasingly being used by the pharmaceutical industry as a means of enhancing market share. [1] Brand name of prescription drugs such as Prozre, Viagra and Claritin have become as well known to consumers as brands of soft drinks.

The pharmaceutical companies note that the increased spending on medicine advertising on Internet is a boon. It has helped to educate consumers about their options and has caused people to see doctors about medications who might not have done so otherwise. It is thought to be source of quality patient information. DTCA can act as a tool to launch health communication and make an informed treatment choice. However, a number of physicians, consumer and health care groups have expressed concern over the increase in drug advertisement for several reasons. A major concern of these groups is whether advertisements on Internet are accurate, fair, balanced, truthful and whether these inform consumers of all the risks associated with taking the drug. According to them prescription drug advertising on Internet is a curse. It promotes inappropriate use of prescription drugs, or diverts consumers from better alternatives. [1] It can cause damage by instigating rapid, widespread stimulation of use of new drugs before harmful effects are fully known. Advertisements exaggerate treatment benefits and use emotive messages to target people with milder health problems, many of whom are unlikely to benefit from the drugs advertised. Another concern over the increase in prescription advertisement is that the advertisement of medicines on Internet is driving up costs of health care. It is argued that advertising is expensive thus adding to the costs of medicine and that it also encourages consumers to request the higher cost brand name rather than less expensive generic alternatives. Further, advertising leads to higher medicine costs and overall health care costs through substitution of new, expensive drugs without treatment advantages. [2] Many experts feel that drug companies should pay attention to the concerns being raised over their rapid increase in advertising expenditure. However, most drug companies say that they have no plans to cut back on their direct to consumer advertising costs as they need to educate consumers regarding their products. [3]

Due to these burning issues, advertising of prescription drugs is currently allowed only in the USA and New Zealand. [3] The European Parliament has emphatically opposed advertising to patients in line with the “precautionary principle”. In India, direct to consumer (DTC) promotion is mainly in the sphere of social marketing i.e. on family planning initiatives, health awareness, hygiene and disease awareness. DTC product promotion is permitted for Ayurvedic proprietary medicines and for homeopathy drugs. DTC product promotion is prohibited for Schedule H and Schedule X drugs. Manufacturers cannot advertise prescription only drugs directly to the public because of their toxicity and the potential for harm from medically unnecessary or inappropriate use. It is prohibited as a health protection measure. However, this scenario is changing with the trends of an open society, liberal attitudes, fast access to world class information through the telecom – internet revolution, greater patient empowerment, and integration of Indian medical sector with the global market. Due to free access to Internet, the Indian population is being increasingly exposed to advertising for prescription drugs also. DTCA of prescription drugs still persists despite legal prohibitions. [4]

Recent reports implicate that if properly used, DTCA of prescription drugs can lead to early diagnosis, better therapy and improved patient compliance in the acute phase as well as in the continuation phase of the treatment. [5],⁶ So there is need to maximize the informational benefits of such advertising while minimizing potential misleading or confusing messages that could be contained in such advertising. [7] Therefore, as a health protection measure, health care providers (including doctors, nurses, pharmacists etc.) should be made aware of the health care information that is being disseminated to their patients through Internet advertising. Increased awareness about information provided in advertisements might not only equip health care providers to better answer patients’ queries about advertising of medicines but also increase their awareness of any false and/or misleading claims in advertisements on internet to which their patients may be exposed. There is need to inculcate the art of critical appraisal amongst medical practitioners [8] as well as patients. A multi prong strategy involving government, pharmaceutical industry, doctors, medical associations and consumers is urgently required. [4]

In conclusion, Internet transcends country boundaries and it is more difficult to control and regulate. So there is an urgent need to increase vigilance with respect to any inappropriate use of DTCA on internet. The doctors and consumers are required to be educated on the promotional practices and abuses committed by the pharmaceutical companies and different ways to tackle those through publicly funded and accountable drug information services and health campaigns should be identified. There is a strong need to closely monitor the range, availability, clarity and particularly the quality of independent and unbiased information regarding prescription drugs on Internet. Phamacovigilance centres established under National Pharmacovigilance Program can play an important role in this regard. Only a vigilant today could lead to a safe tomorrow.