Public Opinion About Health Care - Marketing Prescription Drugs To Consumers

Although health care consumers continue to receive much of their information from physicians, nurses, other health professionals, and the Internet, many also learn about health care services and products from reports in the news media and from advertising. Media advertising—promotion of hospitals, health insurance, managed care plans, medical groups, and related health services and products—has been a mainstay of health care marketing efforts since the 1970s. During the early 1990s pharmaceutical companies made their first forays into advertising of prescription drugs directly to consumers. Prior to the 1990s pharmaceutical companies' promotion efforts had focused almost exclusively on physicians, the health professionals who prescribe their products.

Since the mid-1990s, spending on prescription drugs has escalated and has become the fastest-growing segment of U.S. health care expenditures. In 1997 the Food and Drug Administration (FDA) released guidelines governing direct-to-consumer advertising and seemingly opened a floodgate of print, radio, and television advertisements promoting prescription drugs. Industry observers wondered if this upsurge of direct-to-consumer advertising had resulted in more, and possibly inappropriate, prescribing and higher costs.

Researchers from the Harvard School of Public Health and the Sloan School of Management at the Massachusetts Institute of Technology (MIT) examined the relationship between spending for promotional purposes and prescription drug sales and published their findings in the New England Journal of Medicine (vol. 346, no. 7, February 14, 2002). The researchers observed that pharmaceutical companies' budgets for promotion increased from $266 million in 1994 to almost $2.5 billion in 2000, and that television advertising, which accounted for 13% of direct-to-consumer promotions in 1994 and 64% in 2000, contributed to this growth. They found that direct-to-consumer advertising was generally used to promote long-term-use drugs prescribed for chronic conditions such as allergies, elevated blood cholesterol, and ulcers.

Is Direct-to-Consumer Advertising Effective?

It stands to reason that pharmaceutical companies must be receiving significant returns on their direct-to-consumer advertising investments in order to justify increasing budgets for consumer advertising, but it is difficult to measure the precise impact of consumer advertising

TABLE 9.7

Public opinion on where people look for health information online, 2004
"THE LAST TIME YOU LOOKED FOR INFORMATION ONLINE ABOUT A HEALTH TOPIC WHERE DID YOU FIRST GO TO GET THE INFORMATION YOU WERE INTERESTED IN? DID YOU FIRST GO TO A …?"
Base: All "cyberchondriacs"
	2001	2002	2003	2004
	%	%	%	%
Note: Numbers may not add up due to rounding.
SOURCE: "Table 4. Where People Go to Look for Health Topics Online," in Health Care News: No Significant Change in the Number of 'Cyberchondriacs'—Those Who Go Online for Health Care Information, vol. 4, no. 7, Harris Interactive, April 12, 2004, http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2004Vol4_Iss07.pdf (accessed September 13, 2004). © 2004, Harris Interactive Inc. All rights reserved. Reproduced with permission in 2004.
Site that focuses only on health-related topics	24	26	20	23
OR
A site that focuses on many subjects that may have a section devoted to health issues,	16	12	17	14
OR
A portal or search engine which will allow you to search for health information across many different sites	52	53	54	51
Not sure/refused	7	8	8	12

on drug sales. The Harvard and MIT researchers observed that consumer awareness of prescription drug ads, in terms of adults surveyed who reported having seen drug ads, has more than doubled from nearly 40% in 1993 to more than 90% of consumers surveyed in 2000.

Mollyann Brodie evaluated consumers' reactions to drug ads by showing research participants actual prescription drug ads and recording their responses. In Understanding the Effects of Direct-to-Consumer Prescription Drug Advertising (Washington, DC: Henry J. Kaiser Family Foundation, November 2001), Brodie reported that one in three adults said they talked with their doctor after seeing an ad for a prescription drug and nearly half of those who spoke with their physicians about the drug (44%) received a prescription for that drug. Brodie also found that two-thirds of consumers who viewed prescription drug ads trusted the information they received in the ads, and 84% said the ads did an excellent or good job informing them about the condition that the advertised drug was intended to treat. Despite the ad viewers' perception that they were well informed, Brodie found that recall about potential drug side effects, and viewer knowledge about where they could find more information about the advertised medication, varied widely. In view of the speed with which some television drug ads announce potential side effects and adverse reactions, it was not surprising that as many as 75% of viewers could not accurately identify many of the advertised drug's side effects.

FIGURE 9.10

A nationwide survey of adults conducted by Harris Interactive between July 2001 and January 2002 reconfirmed the marketing impact of direct-to-consumer advertising. The overwhelming majority of survey respondents (86%) recalled seeing or hearing the direct-to-consumer advertising of prescription drugs, and more than one-third (35%) discussed an advertised drug with a physician (Humphrey Taylor and Robert Leitman, "The Impact of Direct-to-Consumer Advertising of Prescription Drugs on Consumer Behavior, Diagnosis and Treatment," Health Care News, Harris Interactive, vol. 3, issue 11, June 23, 2003). Further, the survey aimed to determine the specific conditions that were diagnosed as a result of physician visits prompted by direct-toconsumer advertising, the actions taken during such visits, and the outcomes that resulted from taking prescription medication prescribed during these visits.

The researchers found that at one-quarter of the physician visits prompted by advertising, the physician diagnosed new conditions—identifying previously undiagnosed conditions. The most common new diagnoses were allergies, GERD (gastroesophageal reflux disease), high cholesterol, arthritis, hypertension, diabetes, depression, anxiety, heartburn, heart disease, and the effects of menopause. (See Figure 9.10.) Nearly three-quarters of physician visits prompted by advertising resulted in a prescription being

TABLE 9.8

Actions taken by physicians on behalf of patients having recent office visits prompted by "direct-to-consumer advertising" (DCTA) of prescription drugs, 2001–02
"AS A RESULT OF THE VISIT AND ANY FOLLOW-UP VISITS YOU HAD WITH YOUR DOCTOR, DID YOUR DOCTOR DO ANY OF THE FOLLOWING?"
Base: The 35% of adults who were promoted by DTCA to have a discussion with a doctor.
	Patient reports %
SOURCE: "Table 3. Actions Taken by Physicians on Behalf of Patients Having Recent DCTA Visits," in Health Care News: The Impact of Direct-to-Consumer Advertising of Prescription Drugs on Consumer Behavior, Diagnosis and Treatment, vol. 3, no. 11, Harris Interactive, June 23, 2003, http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2003Vol3_Iss11.pdf (accessed September 13, 2004). © 2004, Harris Interactive Inc. All rights reserved. Reproduced with permission in 2004.
Prescribed DTCA drug	43
Prescribed a drug for you	72
Prescribed any drug (and patient was not receiving treatment for condition priority to visit)	23
Referred you to a specialist	32
Suggest a change in your diet or how much you should exercise	52
Recommended OTC drug	19
Order a laboratory or diagnostic test	57
Suggest that you quit smoking or drinking	33

TABLE 9.9

Overall health and results of lab tests following office visits prompted by "direct-to-consumer advertising" (DCTA) of prescription drugs, 2001–02
Base: The 21% of the adults taking prescription drugs following a DTCA visit
	Type of drug			Switched drugs
	All	DTCA	Other	To DTCA	To other
SOURCE: "Table 4. Overall Health and Results of Lab Tests," in Health Care News: The Impact of Direct-to-Consumer Advertising of Prescription Drugs on Consumer Behavior, Diagnosis and Treatment, vol. 3, no. 11, Harris Interactive, June 23, 2003, http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2003Vol3_Iss11.pdf (accessed September 13, 2004). © 2004, Harris Interactive Inc. All rights reserved. Reproduced with permission in 2004.
Overall health
Much/some better	81	81	81	86	78
About the same	13	11	15	10	18
Some/much worse	5	6	4	4	3
Lab tests (where done before and after) showed:
Change for better	84	86	82	94	87
No change/not sure	3	4	2	6	3
Change for worse	13	10	16	0	10

written, and in 43% of visits the prescription was for the drug the patient had seen advertised. (See Table 9.8.)

The majority (81%) of patients who received prescriptions at their advertising-induced physician visits reported overall improvement in their health. Interestingly, patients who were prescribed the advertised drug were more likely to report favorable health outcomes than those who received prescriptions for drugs other than the advertised drug. (See Table 9.9.)