Healthy Skepticism Library item: 6863

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

Lexchin J.
Direct-to-consumer advertising: impact on patient expectations regarding disease management
Disease Management & Health Outcomes 1999; 5:273-283

Abstract:

Spending on DTCA in the United States is increasing rapidly from $150 million in 1992 to an expected $1.3 billion in 1998. Despite this level of expenditure, there is no literature on how DTCA affects patients’ level of knowledge about medications, physicians’ prescribing behaviour or health outcomes. It seems certain that DTCA will affect patients’ expectations of care in disease management, but without answers to the questions outlined above, the direction of that effect is unclear. This paper will approach this topic by analyzing existing quantitative literature. Two reviews have documented that many DTC ads do not give an accurate picture of the products they are promoting. Although there are arguments in favour of leaving out risk information they are far from proven. Surveys have looked at how DTCA effects consumers’ attitudes towards medication and care seeking behaviour. Consumers feel that DTCA will enhance the doctor-patient relationship but physicians believe the opposite. Many consumers respond to DTCA by calling or visiting a health professional to discuss either medications or health problems. A sizeable minority ask for drugs by brand name. These products tend to be newer, more expensive ones where safety information may be incomplete because they are early in their life cycles. Not only are consumers asking for such medications but in a substantial number of cases they are receiving them. If they do not, then up to one third of patients say they would switch doctors. Responding to these requests does not necessarily lead to greater patient satisfaction and may result in inappropriate prescribing. On the whole it is likely that DTCA will have negative consequences for patients’ expectations of disease management. Patients may ask for and receive more expensive and newer products that have less well defined safety characteristics than older drugs. They may switch doctors if they do not receive the medications that they request and transfer negative feelings about denial of therapy to the disease management setting. Good communication necessary for disease management may suffer. Finally the clash between patients’ and doctors’ expectations about how DTCA will affect the doctor-patient relationship may erode patients’ confidence in their physicians and the system they are working in.

Keywords:
*nonsystematic review/United States/direct-to-consumer advertising/DTCA/promotion costs and volume/safety & risk information/quality of information/broadcast advertisements/print advertisements/new drugs/ consumer behaviour & knowledge/ patient demands/ quality of prescribing/ regulation of promotion/ FDA/ Food and Drug Administration/disease management/ATTITUDES REGARDING PROMOTION: CONSUMERS/PATIENTS/ATTITUDES REGARDING PROMOTION: HEALTH PROFESSIONALS/EVALUATION OF PROMOTION: DIRECT-TO-CONSUMER ADVERTISING/EVALUATION OF PROMOTION: DRUG SAFETY/EVALUATION OF PROMOTION: PRINT AND BROADCASE ADVERTISEMENTS/INFLUENCE OF PROMOTION: CONSUMERS AND PATIENTS/INFLUENCE OF PROMOTION: PRESCRIBING, DRUG USE/PROMOTION AS A SOURCE OF INFORMATION: CONSUMERS AND PATIENTS/REGULATION, CODES, GUIDELINES: DIRECT GOVERNMENT REGULATION/VOLUME OF AND EXPENDITURE ON PROMOTION