BACKGROUND: The case for direct-to-consumer (DTC) prescription drug advertising has often been based on the argument that such promotions can educate the public about medical conditions and associated treatments. Our content analysis of DTC advertising assessed the extent to which such educational efforts have been attempted.
METHODS: We collected advertisements appearing in 18 popular magazines from 1989 through 1998. Two coders independently evaluated 320 advertisements encompassing 101 drug brands to determine if information appeared about specific aspects of the medical conditions for which the drug was promoted and about the treatment (mean k reliability=0.91). We employed basic descriptive statistics using the advertisement as the unit of analysis and cross-tabulations using the brand as the unit of analysis.
RESULTS: Virtually all the advertisements gave the name of the condition treated by the promoted drug, and a majority provided information about the symptoms of that condition. However, few reported details about the condition’s precursors or its prevalence; attempts to clarify misconceptions about the condition were also rare. The advertisements seldom provided information about the drug’s mechanism of action, its success rate, treatment duration, alternative treatments, and behavioral changes that could enhance the health of affected patients.
CONCLUSIONS: Informative advertisements were identified, but most of the promotions provided only a minimal amount of information. Strategies for improving the educational value of DTC advertisements are considered.
The appropriateness of direct-to-consumer (DTC) prescription drug advertising has been a topic of heated discussion in recent years.1,2 This debate is likely to intensify as the drug industry’s advertising expenditures continue to increase3,4 and the marketing channels employed expand to include television, which may not lend itself to highly informative messages, and the Internet, which is difficult to regulate.5 Ironically, DTC advertising proponents and opponents have most often based their positions on assumptions about the informational value of such promotions.6 However, empirical data on this issue are sparse.
The opponents of DTC advertising argue that the objectives of drug promotion and health education are inherently at odds.7 It has been noted that the aim of DTC advertising is to increase sales, not optimize health care.8,9 It has been presumed that the profit motive discourages the provision of complete and accurate information about pharmaceuticals.10 Reports have documented violations of the public trust11 and the dissemination of misleading information to health care professionals.12,13 If even highly trained physicians are prone to influence by commercial rather than scientific sources of pharmaceutical information,14 how can consumers protect themselves from misleading claims? To make matters worse, the public may be ill equipped to fully understand such advertising, no matter how accurate its content might be.7,15
Defenders of DTC advertising counter these arguments by suggesting that selling and educating are not necessarily incompatible goals16 and that it is in the industry’s self-interest to be truthful with consumers.17 Although instances of misleading DTC advertising can be identified, such cases are said to be rare.5 Proponents of DTC advertising typically attribute greater sophistication to the public than critics do,16 rejecting the notion that consumers cannot comprehend such advertising.18 In any regard, misunderstandings can be corrected by the physician, in whom the power to prescribe ultimately resides.1 Although many physicians oppose DTC advertising, a majority feel that such advertisements might help patients become better informed about drugs,19 conjecture that has empirical support.20
We have attempted to contribute to the debate on the value of DTC advertising by describing its content. In a recent JFP article,21 we documented the types of appeals and inducements used in these promotions. In this article we describe the scope of the educational efforts represented in advertisements appearing in consumer publications from 1989 through 1998. After identifying basic issues that most DTC advertisements should address to have educational merit, we examined the extent to which such promotions provide consumers with information about medical conditions, including their symptoms, precursors, and prevalence. It has been argued that DTC advertising increases the public’s awareness of these aspects of diseases and other health conditions. This kind of patient education is said to help people to take responsibility for their health by teaching them how to recognize disease and motivating them to seek medical attention for conditions that might otherwise be left undiagnosed and untreated.1,22-24
We then examined the extent to which DTC advertising incorporates information about treatments for those conditions. It has been said that consumer-targeted prescription drug advertising provides the public with valuable information about available treatments that leads to a better match between patients’ needs and available drugs.25 Specifically, we examined the extent to which DTC advertising offers details about promoted drugs’ mechanisms of action, the duration and success of advertised treatments, behavioral modifications that can improve the patient’s health independently or in concert with drug treatment, and competing treatments.