Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising

I did enjoy reading this article: "Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising." Its interesting that not only the demand is created we now have a different kind of patient population.All the symptoms described in those 20 seconds influences our patients so much that 15 minutes visit turns into 30 minute discussion.Its only beneficial when we actually find a problem and address it ,not create a New problem .Patients insist on getting the medicine they saw on TV because it worked well on the sister or some other relative. My nine year old daughter told me that she has Restless Leg Syndrome because she saw that lady rubbing her legs when she watches TV or goes to bed.The more I asked her the more she acted like that lady in that add.Are we creating awareness or just making “Hypochondriacs”?

I agree with Frank J Domino that there is tremendous value in D.T.C. advertising;it raises awareness about previously difficult to discuss issues like depression and erectile dysfunction . But I would prefer not to see the ENZYTE Fella and his ridiculous smile when kids are watching TV with us.

I agree that it’s the clinician who writes the “ purple pill” But when patient calls you every day requesting that particular pill you can’t do anything.Some of them would not even fill the prescription or buy OTC medicine and tell us that its not working with a “ I told you so” face. Some do this because the medical card /Medicaid /Medicare would cover the medication cost.On the other hand for OTC medicines they have to pay out of their pocket, others just believe that drug shown on TV is the best out there!

I partially agree with the conclusion the article provides: "limited educational value”.It has provided consumer with many choices... from OTC analgesics to prescription sleep aids .It does provide some information to those who are not very computer savvy and do not browse Internet looking for information about a particular problem and medications available.

Competing interests:   None declared

I read with interest the prior comments about Direct-to-Consumer advertising (DTCA). In a truly perfect free market, where everyone possesses the same amount of information, advertising would have little effect, since supply and demand are well matched. However, the medical and pharmaceutical market has many aberrations that prevent it from being a perfect free market – there is considerable information asymmetry and a tendency for supply to induce demand. Health economists have long struggled to decide whether advertising of pharmaceutical products constitutes a moral hazard i.e. does it lead to over utilization and waste of resources or does it benefit patients and contribute to patient welfare by increasing diagnosis of otherwise unrecognized conditions. While the jury is still out on this issue, intuitively, it is hard to believe that pharmaceutical companies spend billions of dollars on DTCA without any demonstrable benefit to their bottom line. And, if one reviews the SEC filings of some of these companies – they all appear to have a very healthy bottom line that is growing robustly.

Another area that was mentioned and needs to be explored is direct-to -doctor advertisement. Not only does the pharmaceutical industry employ armies of sales representatives, who knock on our doors daily, we are also subject to a variety of other tactics. Some of the culprits are our own brethren, fellow physicians who act as advisors and consultants to industry and, for a fee, are willing to present pharma-created materials at dinner meetings and national presentations, sign their names to publications and consensus statements generated by pharmaceutical companies etc etc. That there exists an entire industry dedicated to “healthcare communications”, millions of dollars are spent to develop messaging targeting physicians and CME programs, armies of medical writers spend their days developing manuscripts for publication with the ‘appropriate’ message, is reason enough to believe that there must be considerable return on any monies invested in direct to doctor advertisement. In some way, our interaction with pharmaceutical industry is almost similar to an addiction, we start small with pens and pads and graduate to bigger enticements such as speaker fees and stock options. So like any other addiction recovery, we must start with the first step - let us all acknowledge that we have a problem!

Competing interests:   None declared

Readers may be interested in a piece I wrote in 2002 on the subject of Direct to Consumer Advertising. It was published in the British Journal of General Practice, Br J Gen Pract. 2002 February; 52(475): 170–171. The following web address- http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1314228&blobtype=pdf --- will take you to the free, full-text article, in which I describe concerns about newspaper drug advertising, and an 11-year-old boy's response to television ads for a drug.

Competing interests:   None declared

As patients transition to other insurances around the turn of the year, they become perplexed as we do with the changes in their formularies. Recently, I had a patient who was denied the statin she'd been taking for three years, because of this change. She called her new insurance company and was told: "Medications marketed on the TV are not part of our formulary, so we will not be paying for any medications you view on the TV." What better criteria, I have not heard for choosing a medication!

Competing interests:   None declared

There are 2 very important comparisons which are missing and therefore misleading in this study.

(1) Public health messages play on the very same methods that the pharmaceutical industry is using for DTCA. The oft misquoted statistic that a woman's chance of having breast cancer is 1 in 9 is an example of an effective public health message (encouraging mammograms) which incorrectly states facts, does not educate women on true risks, does not provide alternative ideas, and uses emotion to motivate asymptomatic women to be screened for cancer. I just saw an ad for heart disease which uses the same tactics: "red dress day" is Feb. 14th, red dresses representing hearts, bleeding, disease, and women. Smoking cessation ads are rampant these days, and use the same effective advertising techniques.

While the pharmaceutical sponsorship (as opposed to state-sponsored public health messages) has different motivation, one could easily argue that ultimately the motivation is similar and relates to money (i.e. increased public support for mammograms, more government funding and private donations). The line which separates private from public funding (and advertising) is a fine one.

Admittedly, Big Pharma advertises things which don't have significant public health value, i.e. improved mortality. However, for all the antihistamines and erectile dysfunction cures advertised, there are as many or more ads on hyperlipidemia treatment, osteoporosis, diabetes care, and smoking cessation. I would gladly trade a few patients in my office demanding the latest greatest non-sedating allergy drug if it also meant a good number of couch potatoes who came in to have their cholesterol checked and to quit smoking. Thanks, Big Pharma, for bringing those people in, and for benefitting our public health agenda despite the antagonism of doctors.

(2) Direct-to-DOCTOR advertising needs to end. Consumer ads have pros and cons, as I've alluded to above, but DTDA is much more potent, driving up costs, and adding little or no benefit to our public's health. I would like to see a similar study to Frosch et al which sorts out the methods of advertising to doctors: the glossy paper, free lunch, drugs in the sample closet. DTCA motivates people to change, to seek help, to recognize underlying illness. But advertising to doctors is the real culprit: use Drug A instead of Drug B, prescribe name-brand instead of generic, and prescribe as much as you can whether your patient really needs it or not.

Competing interests:   None declared

I enjoyed reading the article: "Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising." in the current issues of Annals of Family Medicine, but feel the need to assert a different view.

There is tremendous value in D.T.C. advertising; it raises issues that were previously difficult to discuss (depression, erectile dysfunction) and encourages patients to "ask their doctor" about concerns they may have. If nothing else, consider the frequency of ED discussions now and in 1995.

I do not agree with the conclusion they provide: "limited educational value." While I don't like their pandering for greater medication use and lack if issues like lifestyle and personal accountability, I do believe they have done more "good" than harm.

It is the clinicians who writes for the “purple pill” rather than tell the patient to use an OTC product that may need the educational intervention. We don't blame our patient's obesity on GM for their new SUV commercial. The accountability for this problem lies in our hands.

Maybe we should support the company that encourages acetaminophen and ibuprofen for ear pain, and should laud the diet and exercise commercials. I am happy tobacco and alcohol are off the TV, but have found real benefit to D.T.C.

Now, if they would just stop mentioning “4 hour erections” during my daughter’s favorite show…

Competing interests:   None declared

DTC advertising seems to be successful in making patients aware of a drug, and often in promoting requests for it. Often, however, patients decline the drug if they are informed of how expensive it is, particularly if the treatment is purely elective (eg. Lamisil for onychomycosis). If patients knew how much a drug would cost, and could form their own impression of its value for money in some way, they may be less ready to request it. I have previously submitted a docket to the FDA suggesting that DTC ads be required to state the cost of a usual course of the drug, and I think this would be valuable for patients.

DTC advertising also seems to promote excessive awareness of unusual side effects. I have lost count of the number of patients who are reluctant to take statins because or risks of liver damage, for example.

Both the issue of cost and side effects leads to a waste of time in primary care consultations.

Competing interests:   None declared

Dear Editor,

We would like to clarify one statement in Dr. Frosch's reply (1), in which he states that the accuracy of advertisements awaits further investigation. Regarding Zoloft advertisements, as we pointed out in our letter, they have already been investigated. In our study, we compared statements in these advertisements to the scientific literature and found a substantial disconnect between the two (2), an unchallenged finding echoed throughout the scientific literature. The issue is best summarized by NIMH researchers who stated, “[T]he demonstrated efficacy of selective serotonin reuptake inhibitors…cannot be used as primary evidence for serotonergic dysfunction in the pathophysiology of these disorders” (3). Other researchers have reached similar conclusion (4-6). The Irish Medical board specifically prohibits claims such as those made in the Zoloft advertisements based on the scientific data. Wayne Goodman, the chair of the FDA psychopharmacological advisory committee, recently stated that the serotonin theory of depression was a "useful metaphor." (7).

Given these data, the fact that Frosch et al. categorize the unfounded claims of serotonergic dysfunction in social anxiety disorder as ‘factual claims’ without further analysis is problematic. It potentially infers that providing inaccurate factual claims is superior to making emotional appeals.

Our recommendation was not that future research should study the veracity of consumer advertising, but that any content analysis of consumer advertising is quite incomplete without inclusion of the existing literature.

References

1. Frosch, DL. Author reply. Annals of Family Medicine, 7 Feb 2007

2. Lacasse JR, Leo J (2005) Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Med 2:e392 DOI: 10.1371/journal.pmed.0020392

3. Murphy DL, Andrews AM, Wichems CH, Li Q, Tohda M, et al. (1998) Brain serotonin neurotransmission: An overview and update with emphasis on serotonin subsystem heterogeneity, multiple receptors, interactions with other neurotransmitter systems, and consequent implications for understanding the actions of serotonergic drugs. J Clin Psychiatry 59:4–12.

4. Delgado P, Moreno F (2000) Role of norepinephrine in depression. J Clin Psychiatry 61:5–11.

5. Healy, D. (1997) The antidepressant era. Cambridge, MA: Harvard.

6. Stahl SM (2000) Essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge: Cambridge University Press.

7. Television adverts for antidepressants cause anxiety. New Scientist (12 November 2005). Available online at http://dtca.net/media/11.12.2005.htm

Competing interests:   None declared

Competing interests:   None declared

The comments in response to our article highlight the question of “what next?” Although the New Zealand government is considering a ban of direct-to-consumer advertising (DTCA), it is unclear whether this is feasible in the United States (1). This leaves regulation of DTCA by the FDA, which surely could be modified and improved. The Pharmaceutical Research and Manufacturers of America (PhRMA) argues that our study is invalid because it was based on a sample of advertisements recorded before their new guiding principles were released. PhRMA asserts that the educational potential of the ads is much better now, though no evidence to back up this assertion is provided. The question of accuracy of educational information in ads raised by Mr. Lacasse was not addressed in our study and is waiting to be investigated. Studies of ads targeted at physicians have shown that these often contain inaccurate factual claims and numeric distortions (2;3).

But even if the educational potential of some ads has improved, this is just part of the story. As suggested by Dr. Scott, the effectiveness of the ads in creating demand for prescription drugs probably hinges more on the manipulation of consumer emotions than education. Following implementation of its new guidelines, PhRMA solicited comments about prescription drug advertisements and summarized these in a report available on its website (4). A substantial number of comments concerned principle #12 – DTCA should “respect the seriousness of the health conditions and the medicine being advertised”. Writers apparently expressed concern about “creative aspects of advertisements”. According to the report, member companies responded by sending replies explaining “the consumer testing process that surrounds development of new advertisements”. So much for industry self-regulation.

Consumer or patient participation in clinical decision-making is generally a good thing. Studies have found that health outcomes can be improved by activating patients in clinical care (5). Studies of patient decision aids, which provide an unbiased review of all options available for a given clinical decision, find that users have more realistic expectations for medical interventions and often choose more conservative approaches to clinical problems (6). But current prescription drug ads are not decision aids. As Dr. Kravitz suggests, the industry likes to narrowly focus the debate about DTCA on education, despite its poor record. This obscures that manipulation of consumers’ emotions by DTCA is also a form of information that contributes to consumer beliefs that can drive requests for prescriptions. Legislators are right to be concerned about DTCA, both to protect public health and tax dollars that pay for a substantial amount of prescription drugs.

Dr. Step suggests that patient requests for medication are an opportunity to educate consumers. In principle this makes sense, but in practice attempts to do this often collide with the reality of too little time and too many competing demands. Several studies find that a significant number of physicians at times acquiesce to patient requests for prescriptions, even when the request is clinically inappropriate (7;8).

Some thought that the Vioxx debacle would lead to a decline in DTCA. But a recent report by the Government Accountability Office suggests that spending on consumer-targeted advertising may in several years even surpass physician detailing (9). The gap between the two has already narrowed substantially, with DTCA spending growing twice as fast as promotional spending on physicians. Some medical schools have recently banned pharmaceutical detailing from their campuses and clinics. A ban of DTCA may not be possible, but improvement of the content of these ads is urgently needed. There certainly is potential for prescription drug advertising to have positive effects, as noted by Kravitz. Public health campaigns are most effective when the target audience is repeatedly exposed to a health message (10). Agencies that design and disseminate public health messages probably wish they had the budget that pharmaceutical companies have at their disposal to get their message out. If DTCA continues to focus substantially on conditions that contribute little to overall disease and mortality burdens, perhaps companies could contribute into a fund to pay for other urgent public health messages. Reminding patients to take their effective inexpensive generic anti- hypertensives would be a great start.

(1) Wilkes MS, Bell RA, Kravitz RL. Direct-to-consumer prescription drug advertising: trends, impact, and implications. Health Aff (Millwood ) 2000; 19(2):110-128.

(2) Cooper RJ, Schriger DL, Wallace RC, Mikulich VJ, Wilkes MS. The quantity and quality of scientific graphs in pharmaceutical advertisements. J Gen Intern Med 2003; 18(4):294-297.

(3) Wilkes MS, Doblin BH, Shapiro MF. Pharmaceutical advertisements in leading medical journals: experts' assessments. Ann Intern Med 1992; 116(11):912-919.

(4) See http://www.phrma.org/office_of_accountability/

(5) Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions. American Journal of Preventive Medicine 1999; 17(4):285-94.

(6) O'Connor AM, Stacey D, Entwistle V et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2003;(2):CD001431.

(7) Kravitz RL, Epstein RM, Feldman MD et al. Influence of patients' requests for direct-to-consumer advertised antidepressants: a randomized controlled trial. JAMA 2005; 293(16):1995-2002.

(8) Murray E, Lo B, Pollack L, Donelan K, Lee K. Direct-to-consumer advertising: physicians' views of its effects on quality of care and the doctor-patient relationship. J Am Board Fam Pract 2003; 16(6):513-524.

(9) See page 13, http://www.gao.gov/new.items/d0754.pdf

(10) Hornik R. Public health communication: Making sense of contradictory evidence. In: Hornik RC, editor. Public health communication: Evidence for behavior change. Manwah, NJ: Lawrence Erlbaum Associated, 2002: 1-19.

Competing interests:   None declared

The paper by Frosch et al. shines a bright light on the stratagems employed by the pharmaceutical industry in promoting prescription drugs directly to consumers. The conclusions may not be surprising to any of us closet channel surfers, but they are still alarming. In an accompanying editorial note, Kurt Stange points out how the hidden harms of direct-to- consumer (DTC) advertising -- particularly anxiety, misdiagnosis, and overtreatment -- can easily escape notice when the debate is framed (narrowly) around educational value. More research is clearly needed to better define these risks. At the same time, it is important that the potential benefits and harms of DTC advertising be evaluated in context. The benefits are likely to be magnified when the advertised condition is serious and under-treated, and the treatment highly efficacious and safe relative to its alternatives. On the other hand, aggressive advertising of marginally effective therapies directed against relatively trivial conditions could represent a significant public health hazard. Readers will have to form their own judgements about which type of advertising dominates at present, but I for one have yet to see an ad urging patients with hypertension to take their thiazides.

Competing interests:   None declared

Dr. Frosch and colleagues’ research provides important counterevidence to the pharmaceutical industry’s claim that consumer advertising has educational value [1]. We would like to suggest an additional point which will strengthen their conclusions. Zoloft advertisements (one of the data points captured in their analysis) claim that various mental disorders are caused by a lack of serotonin and that this putative imbalance is remedied by Zoloft. However, these claims are contradicted by a large body of empirical evidence and we have argued that they are misleading and incongruent with FDA labeling (2). Providing metaphorical or theoretical explanations as factual will likely increase the sales of Zoloft, but it will not provide consumers with educational content.

Thus, future studies should address not only the type of appeal made to consumers, but also the veracity of the information provided.

References

1. Bonaccorso SN, Sturchio JL. For and against: Direct to consumer advertising is medicalising normal human experience: Against. BMJ. 2002 Apr 13;324(7342):910-1.Click here to read

2. Lacasse JR, Leo J. Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. PLoS Medicine Vol. 2, No. 12, e392 doi:10.1371/journal.pmed.0020392

Competing interests:   None declared

The skillful combination of quantitative and qualitative methods used by Frosch and his colleagues provides a fascinating view into the structure of pharmaceutical television advertising. From the data they present, it is clear that almost all of these ads function on two levels.

The overt message is rational and is intended to persuade based on providing information about indications, symptoms and side effects. As the authors point out, this information is incomplete at best, and intentionally misleading at worst, but nonetheless presents a rational and logical argument for using the product.

The other level is what the authors refer to as “emotional appeals.” I would argue that these messages function primarily at an unconscious level and are probably considerably more powerful than the overt messages. There is an extensive social science literature documenting how media images can be designed to create unconscious associations between a product and consumers' preexisting mental models (ways of framing and interpreting the world).[1-3] If, in fact, the ads have their primary effect through this unconscious pathway, it is unlikely that changing regulations for the informational content of the ads will be very useful.

That these advertising strategies are successful can be indirectly inferred from the fact that the authors' sample included seven of the ten top selling prescription drugs in 2004. In addition to the possible adverse effects on individual patients, the “soap selling” approach to marketing pharmaceuticals has substantial implications for the skyrocketing costs of U.S. health care. In reviewing the authors' sample from a clinician's point of view, I found that 17 of the 24 drugs in the sample have less expensive generic alternatives that are just as effective.

The data from this study make a strong case for advocating an outright ban on DTCA by pharmaceutical companies. This, coupled with the “just say no” approach to pharmaceutical marketing to physicians advocated by Howard Brody,[4] just might lead us in the direction of more rational prescribing.

1. Roskos-Ewoldsen D. Framing public life: Perspectives on media and our understanding of the social world. Journal of Communication. Dec 2003;53 (4):739-741.

2. Price V, Tewsksbury D. News values and public opinion: A theoretical account of media priming and framing. In: Barnett G, Boster FJ, eds. Progress in the communication sciences. Vol 13. Greenwich, CT: Ablex; 1997:173-212.

3. Domke D, Shah DV, Wackman DB. Media priming effects: Accessibility, association, and activation. International Journal of Public Opinion Research. Spr 1998;10(1):51-74.

4. Brody H. The company we keep: why physicians should refuse to see pharmaceutical representatives. Ann Fam Med. Jan-Feb 2005;3(1):82-85.

Competing interests:   None declared

The content analysis of television direct-to-consumer (DTC) prescription drug advertising presented by Frosch and colleagues yielded intriguing findings regarding the educational value of those advertisements. [1] Most critically, their analysis found that this advertising presented limited information about the causes of disease conditions or who might be at risk for those conditions.

These results are similar to findings from our previously published study of television DTC advertisements. [2] In that study, Kaphingst et al. found that a majority of the 23 advertisements in the sample did not describe the symptoms of the relevant medical condition or provide information that could help undiagnosed individuals discover that they might be at risk. Our study also examined how risk and benefit information was presented. We found that most advertisements gave consumers somewhat more time to absorb facts about benefits than about risks. Furthermore, almost all of the advertisements showed only positive or neutral visual images during the audio presentation of risk information – allowing the visual component to contradict the audio information. Our follow-up study with a small sample of adults with limited literacy found that fewer participants correctly answered risk-related questions than benefits-related questions. [3]

The results presented by Frosch et al. suggest several directions for future research. For example, some advertising depicts characters both before taking a medication (negative emotional appeal) and after (positive emotional appeal). What impact on consumers does this combination have, as opposed to a positive appeal alone? The authors’ inductive coding process also generated intriguing data on lifestyle and medical portrayals in DTC advertisements; the effects of these various portrayals on consumers warrants further investigation.

Clearly, additional research on how characteristics of television DTC advertisements affect consumers is essential. If public health efforts are to counter the effects of the advertising industry, research on the relationships between components of advertisements (e.g., visuals, appeals) and consumer feelings, beliefs, and behaviors is sorely needed. [4] Only then can we more fully understand how DTC advertisements are affecting the U.S. health care system and the public’s health.

1. Frosch DL, Krueger PM, Hornik RC, Cronholm PF, Barg FK. Creating demand for prescription drugs: A content analysis of television direct-to- consumer advertising. Annals of Family Medicine 2007; 5: 6-13.

2. Kaphingst KA, DeJong W, Rudd RE, Daltroy LH. A content analysis of direct-to-consumer television prescription drug advertisements. Journal of Health Communication 2004; 9:515-528.

3. Kaphingst KA, Rudd RE, DeJong W, Daltroy LH. Comprehension of information in three direct-to-consumer television prescription drug advertisements among adults with limited literacy. Journal of Health Communication 2005; 10: 609-619.

4. Kaphingst KA, DeJong W. The educational potential of direct-to- consumer prescription drug advertising. Health Affairs 2004; 23: 143-150.

Competing interests:   None declared

It is no surprise that Frosch and colleagues found emotional appeals ubiquitous in their survey of direct-to-consumer pharmaceutical ads. As an advertising executive explained, “We want to identify the emotions we can tap into to get the customer to take the desired course of action. If you can’t find that basic insight, you might as well forget everything else.” 1 What would be surprising, by contrast, is if physicians actually believed the self-serving rhetoric of the pharmaceutical industry, that these ads are somehow “education.” If the industry believed its own rhetoric, it would seek the assistance of public health educators, not advertising agencies, in designing these ads.

Physicians are unlikely to be taken in by the industry’s rationalizations because the majority of us are either skeptical or frankly hostile to DTCA. By contrast, when the industry feeds us rationalizations about our own behavior, we eagerly lap it up. We nod our heads when industry mouthpieces explain that drug reps provide us with “education” and “information,” and that because we are hard-headed scientists, we would never be swayed in our prescribing practices by gifts or blandishments.2

Before we start to feel too superior to our patients, it is worth going down the list of ad characteristics compiled by Frosch and colleagues, to ask how many of those same buttons are pushed when we interact with detail people or expose ourselves to advertising aimed at physicians. Surveys of the contents of medical journal ads and of reps’ presentations similarly show that they are long on promises of “taking control” over the disease, and short on statements of side effects and alternatives. Detail people are also adept at using our own social- approval needs, cheerfully telling us how many other physicians in town are prescribing their drug, and stoking our fears that others will see us as behind the times if we don’t join the crowd.2

Perhaps the most useful new information from Frosch and colleagues’ analysis is the way ads undermine or discourage lifestyle change. This strongly supports the complaints about DTCA from Abramson, a family physician who found his own relationships with his patients being subtly changed for the worse as a result of this advertising—that what had begun as a mutually respectful inquiry into all possible modes of controlling disease and reducing risk was turned into a consumerist encounter whose success depended, in the patient’s mind, on whether or not he walked out with the desired prescription.3

1. Ross W. Why Rubin-Ehrenthal sticks exclusively to DTC accounts. Med Marketing Media 1999; 34(Sept.):136 ff.

2. Brody H. Hooked: ethics, the medical profession, and the pharmaceutical industry. Lanham, MD: Rowman and Littlefield, 2007.

3. Abramson J. Overdosed America: the broken promise of American medicine. New York: HarperCollins, 2004:156-57.

Competing interests:   None declared

In my former life as a media effects researcher I spent a lot of time with media content. Part of the fun of watching was speculating how others might be affected by what I saw. This study provides an important first step to revealing the impact of these pervasive ads. I stress the first step, because content analysis is just that. We cannot jump to conclusions about the ads’ effect on patients or practice until we actually study those outcomes directly. Although there are several theories of media effects that could shed light on the next step, this systematic description of message content is necessary for understanding what can be learned from DTCA.

Traditional advertising has long played a role in health concerns, particularly in terms of smoking and drinking habits. Several studies show that adolescents are more likely to smoke/drink if they see, like, and learn about specific brands. Especially effective are “lifestyle” ads that show attractive people doing fun or exciting things (think those old Newport bill boards). We have similar themes in our current study, a “product that enables healthy or recreational activities”, control, and social approval. Advertising’s primary function is to form an intention, and offering identification and a desirable outcome is standard.

The authors call for better representation of risk factors, prevalence, and high risk subgroups. My question is, do we really want advertisers doing this? When cigarette ads started including risk information, viewers skipped over that material. Physicians have a vested interest in their patients’ health knowledge and behaviors. What a perfect opportunity to have a conversation with your patient, to increase literacy, or clarify a condition. I would be interested to know the prevalence of patients not at risk for a condition who request a medication for it. I think this problem needs to be clarified before we call for legislation.

The final paragraph of this paper suggests that we reconsider the distinction between selling soap and selling prescription drugs, primarily because of the risk of health consequences. This process clearly isn’t the same. When is it ever good practice to prescribe a drug because a patient wants it? Again, I contend that patient requests made on the basis of a viewed ad are an opportunity to educate and counsel. There is a long history of prosocial effects to viewing health information. Until we know more about the problem and the process, it would be efficacious to see how patient’s health literacy can be bolstered.

Competing interests:   None declared