Healthy Skepticism Library item: 5690

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

Kimanani E, Stypinski D, Curtis G, Stiles M, Heessels P, Logan S, Nelson K, St Germain E, Boswell G.
A contract research organization's response to the new FDA guidances for bioequivalence/bioavailability studies for orally administered drug products.
J Clin Pharmacol 2000 Oct; 40:(10):1102-8

Abstract:

The purpose of this research project was to determine the attitude of the Canadian physician towards direct-to-consumer (DTC) advertising of prescription drugs. While it was expected to have an overall or general negative attitude towards DTC advertising, the objective of this research was to identify areas of contention or support for DTC advertising. To perform this objective a 52 item questionnaire was designed andmailed to a random sample of 1500 physicians across Canada. The sample was composed of general pracitioners, dermatologists adn cardiologists of which 293 completed questionnaires were received (19.5% response rate).
The variable of primary interest to this research was the dependent variable, physicians’ general attitude toward DTC advertising. The independent variables used studied seven key dimensions identified as the main areas affecting the attitude of physicians towards DTC advertising. These are: consumer health care awareness; how well the physician feels he/she is adequately informing the patient; DTC advertising used for education; direct pitch of a brand name drug for treatment of a disease; DTC used for price comparisons; DTC effect on the physician/patient relationship; and DTC effect on drug prices/consumption. One moderating dimension identified, which could moderate the physicians’ attitudes towards DTC, is the standards developed to ensure ethical use of DTC advertising.
The results show, 74.4% of physicians disagreed with the use of DTC advertising and only 15.3% were in support of DTC advertising. This result alone would suggeset the fate of DTC advertising, however, when the individual dimensions are studied on their own the picture does change for the better. While the individual dimension results do not necessarily show acceptance in all areas, the outcomes are much less pronounced. Physicians’ attitudes to the questions ended up neutral in many cases and in some, even agreeing to the use of DTC advertising.
The results from a multiple regression showed that 63.9% of the variance in the attitude of physicians towards DTC advertising was explained by nine independent variables, and that DTC advertising promoting a drug for approved indications, which includes the product summary, was the most significant predictor of the physican’s attitude.
DTC advertising is a highly controversial topic and in being so it was expected that almost all of the physicians would ahve had an opinion on most of the issues. However, there was a high proportion of neutral responses to the questions suggesting that many physicians only have a basic understanding of the concept of DTC advertising and its implications.
Profile differences between sex, language, specialty and age were tested for using pooled t-tests and oneway analysis of variance. The major relevant results showed that overall cardiologist disagreed to all the tested dimensions of DTC advertising. There were no relevant sex differences found between physicians. From the language differences, french physicians felt that a larger proportion of their patients would go to another physician if their requests were not granted and DTC would not open up the dialogue between them and their patients. Unexpectedly, older physicians were more positive towards direct brand name advertising for a disease with or without a product summary. More older physicians feel most patients would accept their decision if there is a conflict about which drug should be prescribed, whereas the younger physicians are neutral.
Nine DTC advertisement standards were suggested, while most of the standards were agreed upon the question with the strongest opinion on the whole questionnaire was whether newly approved drugs not yet evaluated by physicians should be restricted. Overwhelmingly, 91.3% of the physicians agreed that DTC advertising for newly approved drugs should be restricted.
Given the strong overall negative reaction to DTC advertising it is recommended that the pharmaceutical industry proceeds with extreme caution in implementing DTC programs. To this end, the industry should use a step approach to implementation. The areas where physicians see a benefit to DTC advertising should be used first. Start with DTC advertising campaigns used for education of diseases only to show the benefits of DTC advertising and limit controversy. Later, DTC advertising can be expanded to more “hard sell’ types of advertising.
Further recommendations would include:
Educating the physicians on all aspects (negative and positive) of DTC advertising;
Perform more detailed studies on areas where physicians were negative towards DTC advertising to be able to fully address their concerns;
Work with the government and physicians to progress towards new regulations which will ensure the proper use of prescription medications is encouraged, abuse is discouraged and misleading advertising is prevented;
Delay the start of any DTC advertising campaigns for at least 6 months (or until all targeted physicians have been seen by a sales representative) post launch to give physicians time to become informed on the drug.
Currently, measuring the benefit of DTC advertising programs is difficult and the outcome is questionable (overall benefit). If approached in the wrong fashion the negative response from the physician might far outweigh the possible gains to be made from using DTC advertising.

Keywords:
*analytic survey/Canada/DTCA/direct-to-consumer advertising/doctors/attitude toward promotion/quality of information/doctor-patient relationship/marketing strategies/ATTITUDES REGARDING PROMOTION: HEALTH PROFESSIONALS/EVALUATION OF PROMOTION: DIRECT-TO-CONSUMER ADVERTISING/INFLUENCE OF PROMOTION: DOCTOR-PATIENT RELATIONSHIP/INFORMATION FROM INDUSTRY: PATIENTS AND CONSUMERS/PROMOTION AS A SOURCE OF INFORMATION: CONSUMERS AND PATIENTS/PROMOTIONAL STRATEGIES: INDUSTRY/REGULATION, CODES, GUIDELINES: INDUSTRY SELF-REGULATION