Direct-to-Consumer Advertising of Prescription Drugs

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Summary and Comment

Direct-to-Consumer Advertising of Prescription Drugs

In the past decade, drug companies have quadrupled expenditures on ads aimed at consumers.

Direct-to-consumer (DTC) advertising of prescription drugs is perhaps the most controversial form of pharmaceutical marketing in the U.S. Researchers from Pittsburgh gathered information on DTC advertising during the past decade.

Key findings were as follows:

Total spending on DTC advertising in the U.S. increased from about $1 billion in 1996 to $4 billion in 2005; DTC advertising represented about 14% of drug company promotional expenditures in 2005.
DTC advertising consumed about one third of the total marketing budgets for proton-pump inhibitors, statins, and erythropoietin in 2005. The five single drugs with the highest expenditures for DTC advertising were Nexium, Lunesta, Vytorin, Crestor, and Advair.
From 2002 to 2006, DTC advertising was the target of one third to one half of letters sent by the FDA to drug companies regarding violations in regulations on drug promotion. Most citations were for DTC advertising that minimized risks or exaggerated effectiveness.
The authors suggest that the level of FDA staffing dedicated to review of DTC advertising has not kept pace with the recent increase in DTC advertising.

Comment: Drug companies maintain that DTC advertising benefits patients because it increases awareness of drugs that might otherwise be underprescribed. In contrast, many clinicians believe that harmful effects (e.g., stimulating patient demand for unnecessary medications) outweigh any putative benefits. In my view, the big problem — both in DTC advertising and in drug promotion to physicians — is the manipulation of information in ways that subtly overstate the drug’s benefits, indications, and target populations.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 15, 2007