Direct-to-Consumer Advertising: Is It Too Late to Manage the Risks?

As an opponent of the negative influences of the pharmaceutical industry, I am still surprised by attacks on direct-to-consumer advertising (DTCA). Drs. Kessler and Levy(1) warn us of the “likelihood” that our patients who see television ads will demand unnecessary medicines and avoid lifestyle changes. This is supported by various surveys, and by Frosch et al(2) whose not unbiased coding of advertisements conclude that they are of limited educational value.

Big Pharma has successfully done what we as public health professionals have tried to do for decades: to motivate the asymptomatic patient. Where previously only the well-educated and well-insured patient had the knowledge and access to see a physician, now every couch potato in the country is familiar with hyperlipidemia and hypertension. How can we chide ourselves for the staggering percentage of untreated chronic illness, then turn around and complain that the drug companies got millions of people to pay us a visit? U.S. clinical medicine uses a high -risk strategy to treat patients who are either symptomatic or have easy access to health care. DTCA is helping us convert to a population strategy to overcome our prevention paradox.

One of the critiques of 60-second ads is their “limited information about risk factors, prevalence…or the subpopulations at greatest risk.”(2) The ads “do not effectively or consistently convey important information about product risks and benefits.”(1) We desperately lack controlled data to prove that a 10-minute office visit with an intimidating over-educated white-coat doctor is a more effective means of communication in these factors. In fact there is much evidence to suggest otherwise: patients don’t hear what we say. We lack the “positive emotional appeals,”(2) and the music, and the color screen.

DTCA is criticized for suggesting that “nonpharmacological approaches were almost futile.”(2) Yet as practicing physicians we see this on a daily basis: dietary changes will only drop your cholesterol and hypertension a few points. This is sometimes physiologically true, and in other patients relates to psychological or lifestyle factors, but in either case it’s a fact strongly supported by the literature.

Our bashing of the devilish pharmaceutical industry will return to haunt us. Rather than cut down the Big Pharma forest, I suggest we make stronger efforts to team up for the public good. Our interest might not be in “lifestyle drugs,” but I would trade a few of these to motivate “millions more… diagnosed and… treated for diabetes or heart disease.”(1)

Sir Thomas More, from A Man For All Seasons(4) by Robert Bolt

ROPER: So now you'd give the Devil benefit of law!

MORE: Yes. What would you do? Cut a great road through the law to get after the Devil?

ROPER: I'd cut down every law in England to do that!

MORE: (Roused and excited) Oh? (Advances on ROPER) And when the last law was down, and the Devil turned round on you-where would you hide, Roper, the laws all being flat? (He leaves him) This country's planted thick with laws from coast to coast-man's laws, not God's-and if you cut them down-and you're just the man to do it-d'you really think you could stand upright in the winds that would blow then? (Quietly) Yes, I'd give the Devil benefit of law, for my own safety's sake.

1. Kessler DA, Levy DA. Direct-to-consumer advertising: is it too late to manage the risks? Ann Fam Med 2007:5:4-5.

2. Frosch DL, Krueger PM, Hornik RC, Cronholm PF, Barg FK. Creating demand for prescription drugs: a content analysis of television direct-to- consumer-advertising. Ann Fam Med. 2007;5(1):6–13.

3. Rose G. The strategy of preventive medicine. Oxford: Oxford University Press, 1992

4. Bolt R. A Man For All Seasons. Accessed online 2/2/07 at: http://www.cooper.edu/humanities/classes/coreclasses/hss2/library/man_for_all_seasons.html.

Competing interests:   None declared