Prescription Drug Advertising Research Articles

Literally Experts: Expertise and the Processing of Analogical Metaphors in Pharmaceutical Advertising

This research examined differences between novices and experts in processing analogical metaphors appearing in prescription drug advertisements. In contrast to previous studies on knowledge transfer, no evidence of the superiority of experts in processing metaphors was found. The results from an experiment suggest that expert consumers were more likely to process a metaphor in an ad literally than novices. Our findings point to a condition in which the expertise effect with processing analogies is not the linear relationship assumed in previous studies.

The Ethics of Advertising for Health Care Services

Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly.

Direct-to-Consumer Advertising and Insurerss Spending Control Mechanisms for Prescription Drugs

Numerous studies have examined the effects of direct-to-consumer advertising (DTC) on patient and physician behaviors; however, none has focused on the relationship between DTC and insurance benefit design. In this study, we explored the impact of DTC advertising on the cost control behaviors of private firms supplying insurance in the Medicare Part D program. We used data from the IMS National Prescription Drug Promotions database and formulary information from Medicare Part D prescription drug plans from the Centers for Medicare and Medicaid Services (CMS) to study the relationship between DTC spending and formulary tier placement, using an instrumental variables estimator to control for the endogeneity of DTC spending. Our results suggest that direct-to-consumer advertising puts pressure on insurers for more favorable formulary placement. Television direct-to-consumer advertising and other measures of manufacturer market power had a significant and negative effect on the likelihood of a branded drug being classified as nonpreferred in formularies. Similarly, we found that when insurers had more market power, branded drugs were more likely to be placed in a nonpreferred formulary tier. We hypothesize that consumers play an important mediating role in the relationship between DTC advertising and insurance coverage for drugs.

Consumers' Optimism Bias and Responses to Risk Disclosures in Direct‐to‐Consumer (DTC) Prescription Drug Advertising: The Moderating Role of Subjective Health Literacy

Despite a substantial body of research in direct‐to‐consumer advertising (DTCA) for prescription drugs, what is missing from the existing discussion on the risk disclosure in DTCA is a focus on the roles of individual motivation and ability to process risk information. Guided by the Elaboration Likelihood Model (ELM) and the Motivation‐Ability‐Opportunity framework, the current study examines the roles of the consumer's optimism bias and subjective health literacy in responding to the risk disclosure in DTCA. By analyzing survey data (N = 404), the study reveals that: (1) consumers who show a tendency to believe that they are at less risk of experiencing adverse reactions to prescription drugs than their peers are less likely to pay attention to the risk disclosure or intend to seek further information about the health risks of drugs, (2) the relationship between optimism bias and information‐seeking intentions is stronger for consumers with high subjective health literacy than for those with low health literacy. Implications and recommendations are provided.

A compromise too far: a review of Canadian cases of direct-to-consumer advertising regulation.

Since the mid 1990's, Canada has introduced partial direct-to-consumer advertising (DTCA) of prescription drugs through administrative policy shifts. Little documentation exists on how regulation occurs in practice. To evaluate Health Canada's response to complaints about DTCA. We use case studies about DTCA spanning from 2000 to 2011 to examine the stringency of regulation by Health Canada. The aim was to identify key themes in Health Canada's approach to regulation from a public health perspective. All of the material related to the cases was independently read by each of the authors and any disagreements in interpretation were resolved through discussion. We identified six weaknesses in how Health Canada deals with DTCA: failure to act on concerns about promotion for unapproved "off-label" uses, possible financial inducements to use a product, advertisements perceived to stimulate unwarranted fear about disease risks, and advertising of products with serious safety concerns identified in Health Canada safety advisories; ineffective enforcement actions undertaken by Health Canada; and lack of transparency in Health Canada's decision-making. There is an astonishing degree of discordance between public health priorities and regulation of DTCA in Canada. The current approach to enforcement is notable both for its lack of teeth and lack of accountability and transparency.

Drug advertisements in two dermatology journals: A critical comparison of IJDVL and JAAD

Though drug promotion regulations exist worldwide, low quality of journal drug advertising is a global issue. Medical journals are regarded as a leading source of information for new drugs. They may also modulate prescribing behavior of physicians without their knowledge. A comparative analysis of advertisements from different countries may provide insights regarding strengths and weaknesses of different regulating systems. Prescription drug advertisements from the Indian Journal of Dermatology, Venereology, and Leprology (IJDVL) and Journal of American Academy of Dermatology (JAAD) were compared to check their compliance with criteria of World Health Organization (WHO) and International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). All the prescription drug advertisements of at least one page length appearing in all the issues of IJDVL and JAAD from January 2012 till December 2012 were included in this study. The contents of both advertisements were compared for compliance regarding different criteria of ethical codes for drug advertising of WHO and IFPMA. Statistical analysis was done using Fisher's exact test. Compared to IJDVL, more advertisements in JAAD complied with WHO and IFPMA codes. On the whole, advertisements in IJDVL had significantly less information regarding the approved usage, dosage, abbreviated prescribing information (API), summary of scientific information, safety information regarding the drug, and references to the scientific literature to support various claims. However, JAAD had more advertisements with multiple claims than IJDVL, and many advertisements interspersed between scientific articles while IJDVL had none. The complex issue of ethical drug advertising in dermatology journals requires constant review and discussion. Dermatologists should be cautious in assessing any advertisement or claim even if it seems evidence-based. The results from our study highlight the need for a global, proactive and effective regulatory system to ensure ethical medicinal drug advertising in medical journals.

Presenting efficacy information in direct-to-consumer prescription drug advertisements

ObjectiveWe evaluated whether presenting prescription drug efficacy information in direct-to-consumer (DTC) advertising helps individuals accurately report a drug's benefits and, if so, which numerical format is most helpful. MethodsWe conducted a randomized, controlled study of individuals diagnosed with high cholesterol (n=2807) who viewed fictitious prescription drug print or television ads containing either no drug efficacy information or efficacy information in one of five numerical formats. We measured drug efficacy recall, drug perceptions and attitudes, behavioral intentions, and drug risk recall. ResultsIndividuals who viewed absolute frequency and/or percentage information more accurately reported drug efficacy than participants who viewed no efficacy information. Participants who viewed relative frequency information generally reported drug efficacy less accurately than participants who viewed other numerical formats. ConclusionAdding efficacy information to DTC ads—both in print and on television—may potentially increase an individual's knowledge of a drug's efficacy, which may improve patient-provider communication and promote more informed decisions. Practice implicationsProviding quantitative efficacy information in a combination of formats (e.g., absolute frequency and percent) may help patients remember information and make decisions about prescription drugs.

Prescription drug advertisements and older adults: a case for implicit memory

Purpose – Prescription drug advertisements are commonly seen in magazines and on television. Many drug ads are targeted toward older adults, who tend to use more medications and suffer from more chronic conditions. Nonetheless, the effectiveness of such advertising remains uncertain. The aim of this paper is to compare implicit and explicit memory for drug ads in older and younger adults. Design/methodology/approach – Older adults typically perform more poorly than young adults on explicit memory tasks, but not on implicit memory tasks. The current study measured implicit memory with an incidental ratings exercise and an indirect test of preference; explicit memory was also measured with intentional studying and a direct test of recognition. The study was a 2 x 2 mixed experimental design with one between-participants variable and one within-participants variable. The between-participants variable was age group (older vs younger adults) and the within-participants variable was implicit and explicit memory. The memory test measures were the outcome variables of the study. Findings – The results showed no age difference for implicit memory for drug ads, but an age difference was found for explicit memory for the ads. The implicit memory manipulation succeeded in demonstrating that drug ads are persuasive, suggesting that a complete assessment of advertising effectiveness should include a test of implicit memory. Research limitations/implications – The fact that age differences were not found for implicit memory, but were found for explicit memory, is not surprising. Practical implications – The study is of theoretical significance because it contributes to cognitive aging research and examines memory within an everyday context. The study is of practical significance because pharmaceutical companies spend vast amounts of money on prescription drug advertisements that may or may not be effective with older adults. The component of this study that may be most important is that the results expanded everyday memory research to another applied context using an implicit memory measure, and the indirect test of memory demonstrated that the prescription drug advertising was effective. Originality/value – Although the findings were consistent with previous research, the study focuses on the real-world context of direct-to-consumer advertising for prescription drugs. Given that older adults have poorer explicit memory than younger adults, but not poorer implicit memory, it is particularly important for advertisers to use implicit memory measures when assessing advertisements aimed at older adult consumers. Marketers of pharmaceutical drug companies must remain aware that the memory abilities of their potential customers are extremely variable, and in some cases, limited.

DTC drug advertising ethics: laboratory for medical marketing

Purpose – The aim of this paper is to call for an increased focus on the ethics of direct-to-consumer (DTC) prescription drug advertising. This is important, not only to improve DTC prescription drug advertising, but also to inform DTC advertising of future medical advances. Design/methodology/approach – This conceptual paper discusses two examples of medical advances – personal genetic testing services and surgically implanted medical devices – to explain how investigating the research of DTC prescription drug advertising can set the stage for more ethical advertising of future medical advances. Findings – Specific issues related to health literacy, at-risk populations impacted by health disparities, and medicalization of issues common to aging relate to the DTC advertising of prescription drugs and other medical advances. Creative approaches to investigating these issues in the context of prescription drug advertising can enrich the debate about drug advertising, but also prepare researchers, policymakers, and consumers for future advertising of new medical developments. Originality/value – The value of this paper is its call for increased focus on the ethics of DTC prescription drug advertising, to improve the current marketing environment but also lay the foundation for other healthcare marketing in the future.

Capsule Commentary on Faerber et al., Content Analysis of False and Misleading Claims in Television Advertising for Prescription and Nonprescription Drugs

The study by Faerber and Kreling1 adds to a growing literature about direct-to-consumer advertising (DTCA), a unique form of drug advertising prohibited in most of the world. They found that of television ads airing from 2008 to 2010, 33 % were objectively true, 57 % were potentially misleading and 10 % were just outright (“pants on fire”) false. There were more objectively true claims and fewer false claims for prescription than non-prescription ads. The authors used a well-defined protocol and the high inter-rater agreement between coders was reassuring. The differences between prescription and non-prescription drugs were of interest—one has to wonder whether differences in the regulatory environment of the Food and Drug Administration (FDA) and Federal Trade Commission (FTC) account for this. Although the authors only examined a subset of claims from a subset of ads from a subset of DTCA, there is no obvious reason that this would substantially bias their results. They acknowledge that their endpoint was a proximal one—some of the claims may not have misled consumers, and consumers may have been misled without consequential changes in their clinical care. Perhaps most vexing is that while many of the claims were misleading, they were not illegal per se. While this study may be welcome ammunition for those opposing DTCA, others will continue to argue that DTCA serves a valuable social good by leading to case-finding and by destigmatizing diseases such as depression. Interestingly, despite the volume of rhetoric, there is remarkably little evidence about DTCA’s true effects on prescription drug utilization and health outcomes, though most research suggests DTCA is associated with an increase in drug utilization, patient requests for specific drugs, and physicians’ confidence in prescribing.2 Although DTCA remains a lightning rod for controversy, it remains highly concentrated in a small number of products and accounts for only 15 % or so of prescription drug marketing.3 Tried and true methods of pharmaceutical marketing, detailing visits, and free office samples4 continue to account for the lion share of promotion; this is not surprising, given how effective these methods are at changing physician behavior.5

Content Analysis of False and Misleading Claims in Television Advertising for Prescription and Nonprescription Drugs

False and misleading advertising for drugs can harm consumers and the healthcare system, and previous research has demonstrated that physician-targeted drug advertisements may be misleading. However, there is a dearth of research comparing consumer-targeted drug advertising to evidence to evaluate whether misleading or false information is being presented in these ads. To compare claims in consumer-targeted television drug advertising to evidence, in order to evaluate the frequency of false or misleading television drug advertising targeted to consumers. A content analysis of a cross-section of television advertisements for prescription and nonprescription drugs aired from 2008 through 2010. We analyzed commercial segments containing prescription and nonprescription drug advertisements randomly selected from the Vanderbilt Television News Archive, a census of national news broadcasts. For each advertisement, the most-emphasized claim in each ad was identified based on claim iteration, mode of communication, duration and placement. This claim was then compared to evidence by trained coders, and categorized as being objectively true, potentially misleading, or false. Potentially misleading claims omitted important information, exaggerated information, made lifestyle associations, or expressed opinions. False claims were factually false or unsubstantiated. Of the most emphasized claims in prescription (n = 84) and nonprescription (n = 84) drug advertisements, 33% were objectively true, 57% were potentially misleading and 10% were false. In prescription drug ads, there were more objectively true claims (43%) and fewer false claims (2%) than in nonprescription drug ads (23% objectively true, 7% false). There were similar numbers of potentially misleading claims in prescription (55%) and nonprescription (61%) drug ads. Potentially misleading claims are prevalent throughout consumer-targeted prescription and nonprescription drug advertising on television. These results are in conflict with proponents who argue the social value of drug advertising is found in informing consumers about drugs.

A review of research on direct‐to‐consumer advertising of prescription drugs

PurposeThe purpose of this paper is to review empirical research on direct‐to‐consumer advertising (DTCA) of prescription drugs published in journals over the period from 1997 to 2012.Design/methodology/approachA structured review of 130 published studies on direct‐to‐consumer advertising of prescription drugs was conducted.FindingsBased on the structured review, the authors identified seven key research themes in DTCA. These are: consumers' attitudes toward direct‐to‐consumer advertising, physician‐patient interaction, content of DTC advertisements, awareness, literacy and memory, consumer information source and search, effect of DTCA expenditures on financial performance, and physicians' attitudes toward DTCA.Research limitations/implicationsAvenues for future research are proposed. Future research needs to focus on more empirical studies, television DTCA, online and emerging media DTCA, new and improved measures, ethical issues and regulations, diverse countries, and nurse and pharmacist attitudes towards DTCA.Originality/valueThe primary contribution of this paper is a thorough understanding of the state‐of‐the‐art in research on DTCA and future research directions.

When Numbers Count: Framing, Subjective Numeracy, and the Effects of Message Quantification in Direct-to-Consumer Prescription Drug Advertisements

In this study, two experiments were designed to examine the persuasive effects of message quantification. Experiment 1 showed that subjects with a low level of numeracy responded more favorably to a direct-to-customer (DTC) ad presenting a quantified description of the benefits and risks of a drug than to an ad using broad language. Experiment 2 revealed that when a DTC ad emphasized the positive consequences of taking the medicine, a quantified message was more effective than using broad statements. In contrast, when an ad focused on the negative consequences of not taking the medicine, the effects of message quantification were minimal.

Health literacy and its outcomes: Application and extension of elaboration likelihood model

Approximately 90 million adults in the USA have difficulty understanding and using health information. In 2010, the U.S. Department of Health and Human Services included improved consumer health literacy as one of the top priorities and identified health literacy as an important component of health communication. According to the American Medical Association, poor health literacy is a stronger predictor of a person's health than age, income, employment status, education level and race. It also has been found to be associated with limited knowledge of healthcare issues which may contribute to poor personal healthcare management. Public policy and advocacy organizations have expressed concern as well as studies examining the concept of health literacy with instruments to measure individual level of health literacy. In this study, we review current development of health literacy, its measures and effects on information processing of direct-to-consumer prescription drug advertising. Applying Elaboration Likelihood Model, we further develop a conceptual framework and postulate health outcomes depending on the routes of information processing.

American physician perceptions of direct-to-consumer advertising: A qualitative study

Although scientific evidence concerning harms and benefits of direct-to-consumer advertising (DTCA) is constantly growing, there is a paucity of published research focusing on gaining a better understanding of the perceptions and experiences of involved parties. This gap in the literature becomes even more salient when it comes to the indirect target audiences of DTCA, such as healthcare providers. This study explores American physician perceptions of prescription drug advertising, while elucidating the perceived impact of DTCA in a US context. Our results suggest that 15 years after the introduction of DTCA, physician concerns about its impact on the doctor–patient relationship persist. Negative effects of DTCA include patient acquiring a false sense of autonomy; requests for unnecessary or more expensive drugs; exaggerated perception of advertised drugs’ side effects; as well as additional workload and time commitment. Nevertheless, DTCA is also viewed as a stimulus for ‘opening communication opportunities’ with the patient. Results of this study can be used to inform the dialogue not only in the United States, but also in other countries where efforts are being made to reduce restrictions on DTCA.

Direct-to-Consumer Antidepressant Advertising and Consumers’ Optimistic Bias about the Future Risk of Depression: The Moderating Role of Advertising Skepticism

Although exposure to direct-to-consumer prescription drug advertising (DTCA) is reported to influence the public’s beliefs about diseases, no research has investigated how DTCA may affect the extent of consumers’ optimistic bias about the future risk of diseases. Based on a survey with members of an online consumer panel (n = 699), the current study revealed that: (a) Consumers exhibited a tendency to believe they were at less risk of developing clinical depression in the future than their peers, demonstrating an optimistic bias. (b) Exposure to antidepressant DTCA acted to reduce the extent of such bias, especially when consumers were less skeptical of prescription drug advertising. When consumers were highly skeptical, DTCA exposure did not significantly relate to the extent of optimistic bias. (c) Once formed, the extent of optimistic bias negatively related to consumers’ intention to seek information about depression. Implications of the research for the theory and practice of DTCA were discussed.

FDA and the Rise of the Empowered Consumer

This Article traces the still-evolving view of consumers of FDA-regulated products as capable, rational, and rights-bearing decision makers. It also examines the corresponding diminution of FDA’s role as a paternalistic gatekeeper collaborating with medical and scientific experts to prevent products and manufacturer-provided information from reaching the public. Compared with their 1960s counterparts, today’s consumers of food and drugs have far greater freedom to make unmediated choices among a wider variety of products, guided by a relative deluge of labeling and advertising information. Moreover, food and drug regulation, once the exclusive domain of bureaucrats and experts, has become a focus of successful social movement activism.The Article explores these phenomena against a background of three societal and cultural trends during the past five decades: Americans’ declining trust in major institutions, the “rights revolution,” and the dramatic expansion of health care information accessible to consumers. It then analyzes a variety of specific regulatory developments during this period of change. In its discussion of food, the paper considers the evolution of standards of identity and nutrition labeling, the rise of health claims as facilitated by the First Amendment, and various popular movements for freedom of choice with respect to food ingredients and dietary supplements. The Article then turns to drug regulation, examining the rise of patient labeling and direct-to-consumer advertising of prescription drugs, the tidal wave of “switches” from prescription to over-the-counter status, and the development of social movements intended to shape FDA drug approval policy. The Article concludes by speculating on whether this new model of consumer is a permanent one and by considering the implications of this question for FDA regulation in the future.

Objects Closer Than They Appear: Regulating Health-Based Advertising of Food

Until I moved to the United States more than a decade ago, my only exposure to prescription drug advertising was the weekly copy of the British Medical Journal that my father, a physician, left in ...

Direct-to-Consumer Television Advertising: Time to Turn Off the Tube?

Direct-to-Consumer Television Advertising: Time to Turn Off the Tube?

The Politics and Strategy of Industry Self-Regulation: The Pharmaceutical Industry's Principles for Ethical Direct-to-Consumer Advertising as a Deceptive Blocking Strategy

As the pharmaceutical industry lobbies European regulators to permit direct-to-consumer advertising (DTCA) of prescription drugs in the European Union, we found that five leading companies violated industry-developed and -promulgated standards for ethical advertising in the United States. Utilizing multiple data sources and methods, we demonstrate a consistent failure by companies that market erectile dysfunction drugs to comply with the industry's guiding principles for ethical DTCA over a four-year period despite pledges of compliance by company leaders. Noncompliance resulted in children being exposed to sexually themed promotional messages more than 100 billion times. We argue that the guidelines are a coordinated effort by the industry to prevent unwanted federal regulation, and we introduce the concept of a blocking strategy to explain company behavior and to advance theoretical understanding of firms' public affairs strategies. We recommend policy responses to prevent deceptive practices, protect children from adult content, and promote genuine health care education.