Tuesday, March 4, 2008

Drug Advertising that Doesn't Work--Is It Possible?

No less a guru than Dr. Peter Mansfield, the main guy at Australia's Healthy Skepticism website, says so.

Two articles in the Medical Journal of Australia (http://www.mja.com.au/, free access, but you have to register) tell the story. It seems that a few years back, when Australian GPs were (unlike most of their U.S. counterparts) eagerly embracing the electronic health record with computerized prescription writing and other features, they were offered two software packages-- a more expensive one that was advertising-free, and a less expensive system that was supported in part by advertising, primarily pharmaceutical. The ads run in two sizes and are typically changed each month. They are programmed so as to pop up when the physician performs certain tasks--for example, when a doc clicks on an area of the medical chart that records cardiac risk factors, a Lipitor ad might then be triggered.

Joan Henderson and colleagues from Sydney took advantage of an ongoing survey of GP practice patterns to compare the prescribing behavior of GPs who used the ad-containing software with those using the ad-free software. They looked at a number of variables and data adjustments but were unable to find any difference.

Mansfield, in his commentary on their research, agreed that they had rigorously controlled for as many variables as possible, so that their findings were probably reliable. If so, then the drug companies seem to have broken new ground--finding a method of spending their advertising dollars that does not actually change physicians' behavior. Mansfield speculates that the annoyance factor may have actually have swamped out the usual value of ads. He offers the possibility that the ads may prove more effective in future years when the docs have become more habituated to them and so the annoyance variable fades.

I am no advertising expert (thank heaven) but would offer a slightly different hypothesis, or maybe the same hypothesis worded differently. How does pharmaceutical advertising work? Many docs (like me for instance) are quite sure that they completely skip over the drug ads in medical journals, for example, yet most company studies show that the return-on-investment for journal ad dollars is pretty good. I think the secret of a successful ad campaign is that there is no one element working in isolation. The physician hears a consistent message simultaneously from several sources (drug reps, journal ads, patients coming in reporting TV ads in the U.S., and now these software ads Down Under), each reinforcing the other. It's human nature to imagine that what you hear from one place might be false, but what you hear over and over from numerous sources must be true.

Henderson et al. assume quite reasonably that the companies must have gathered data of their own on the apparent effectiveness of their advertising expenditures; and she invited them to make these data public so that her group's results could be compared. Companies making public their proprietary marketing data? As the Russians used to like to remark, when pigs fly.

Henderson J, Miller G, Pan Y, Britt H. The effect of advertising in clinical software on general practitioners' prescribing behaviour. Med J Aust 188:15-20, 7 January 2008.

Mansfield PR. Do advertisements in clinical software influence prescribing? Med J Aust 188:13-14, 7 January 2008.


Anonymous said...

I would be interested to know your opinion on the "unbranded educational campaign" by AZ to raise awareness of atherosclerosis.


Call me cynical, but I think they are just trying to raise awareness of atherosclerosis so they can sell more Crestor.


Anonymous said...

Published on www.brainblogger.com

Your Television as you doctor?

Often, usually on television, one viewing will often at times see an advertisement for some type of medication- usually one involved in a large market disease state and the commercial is sponsored usually by a big pharmaceutical company for a particular network. This is called direct to consumer advertising, and doctors would prefer they did not exist.
Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry spends around 5 billion annually on this media source now. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns. And involves money spent that could be applied to greater uses, according t many, but we are dealing with a corporation here.
The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective, which is to increase sales and grow their market and, in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads, in relation to their accuracy and clarity, as well as their effect on the health care system.
DTC advertising is also a catalyst for and similar to disease mongering.
Disease mongering is the creation of what some believe to be medical flaws, and illustrated by the creators through exaggeration and embellishments through media sources as an avenue for suc propaganda, as is often seen with DTC advertising. Yet the flaws may not be medical, but corporate creations of these questionable human ailments that do not require treatment, possibly, and may be an attempt to develop a particular medical condition to acquire profit. One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. And it is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.
Also, DTC ads discuss only one treatment option normally, so it seems, when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the doctor, as they assess your health, not your television or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of our country and New Zealand.
Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome for the doctor chosen for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads require a prescription.
Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some over-prescribing, which will benefit everyone in the long term. And the Health Care System can regain control of their purpose, which is far from financial prosperity.

“Do every act of your life as if it were your last.” ---- Marcus Aurelius

Dan Abshear

Lily said...

First someone invented new holidays so we would send more greeting cards and now they are inventing new diseases that require new drugs. I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new, when something old or generic would do the job for cheaper.