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As the Food and Drug Administration (FDA) prepares to conduct a new physician study on the perceived effectiveness of direct-to-consumer pharmaceutical advertising, another recent study indicates that a majority of doctors already believe the advertising practice should be scaled back.
Legally permitted in two countries, the United States and New Zealand, direct-to-consumer pharmaceutical advertising (DTCPA) is defined as, “The use of mass media—e.g., TV, magazines, newspapers, the internet —to publicly promote drugs, medical devices or other products which, by law, require a prescription, which targets consumers, with the intent of having a patient request the product by name.”
The most recent study, conducted in April 2013 by CMI/Compas, found that of the 140 physicians surveyed, approximately 71 percent believe the practice should be scaled back or eliminated. Sixty-three percent surveyed agree that DTCPA misinforms patients and 74 percent agree that the advertising practice overemphasizes drug benefits.
An overwhelming majority of physicians surveyed in the study also agree that DTCPA encourages drug over-utilization, is not rigorously regulated, and ultimately increases the cost of health care.
On the lighter side, 52 percent of physicians agree -- 9 percent strongly; 43 percent somewhat -- that DTCPA removes stigma associated with certain diseases while 48 percent agree -- 5 percent strongly; 43 percent somewhat -- that DTCPA informs, educates, and empowers patients.
The upcoming FDA nationwide study will survey 2000 health care workers who have prescribing privileges, including general practitioners, specialists, nurse practitioners, and physician assistants. The study will be completed by 2015.
With DTCPA now the most prominent type of health communication that the public encounters, the Nielsen Company estimates that there are “an average of 80 drug ads every hour of every day on American television.” Additionally, NPR reported that between 1992 and 2008, the average number of prescriptions administered in the United States increased 71 percent.
DTCPA has grown exponentially since the FDA eased advertising requirements in 1997, making it easier for companies to launch mass media ad campaigns. The new regulations allowed drug companies to begin advertising products that “did not devote an equal amount of time to promotion and risks,” as long as sources for more information were included in the advertisement.
Drug companies are now required to include only the “major risks” along with a source to find more information. Prior to this regulation, drug companies were required to include a comprehensive list of every possible side effect, which often made running effective advertisements unfeasible.
Supporters assert that DTCPA educates patients on treatment options and allows for increased discussion with their doctors. According to Pharmaceutical Research and Manufacturers of America (PhRMA), “these advertisements can increase the likelihood that patients will contact their physicians to discuss and receive appropriate care for conditions that are often under-diagnosed and under-treated.”
DTCPA is also protected under the First Amendment and has been ruled as such by the courts in a series of cases.
Opponents claim that DTCPA is little more than a sales pitch which places pressure on doctors to prescribe unnecessary medications. Another objection often raised is the belief that DTCPA harms public health by encouraging drug use as the primary remedy to problems that can often be solved through diet, exercise, or stress reduction.
The Government Accountability Office has previously criticized the FDA for its “inability to ensure all ads are reviewed adequately.”
The Chief Nursing Officer at Duke Raleigh Hospital, Rosemary Brown, noted the interesting correlation between the rise in DTCPA and a few other statistics:
“The United States, at 5 percent of the world's population, accounts for 42 percent of the world's spending on prescription drugs. The U.S. ranks 40th in terms of life expectancy, 13th in quality of life, and – despite anti-depressants being one of the most prescribed and advertised drugs – ranks as the 105th happiest country.”
Perhaps the most astounding fact mentioned by Brown is a New York Times report from 2004 claiming that 50 percent of the FDA budget comes from the pharmaceutical industry.
As for why DTCFA is banned in every country except the United States and New Zealand, perhaps the following quote from Health Action International of Europe will provide some insight:
“Unless there is clear evidence of lack of harm and of health benefits, the prohibition against direct-to-consumer advertising of prescription drugs should be maintained. The European Union is committed to the precautionary principle. This principle is as relevant to advertising policies with health consequences as to direct chemical exposures.”