Covert Marketing to Physicians Using Direct to Consumer Pharmaceutical Advertising

UK consumers recently rejected the type of direct-to-consumer-pharmaceutical-advertising (DTCPA) that we see in the United States.  BMJ 2002;324:1416.4   Advocates who support a pharmaceutical company's right to advertise prescription drugs directly to patients correctly argue that some patients (and even some physicians) may become aware of treatments they were not previously knowledgeable about. And because the FDA requires these advertisements to carry the same kinds of warnings that a drug's package insert might contain, they believe that these ads are balanced. The presumption is that when a consumer-patient sees the ad, he or she will ask the doctor to prescribe it, and published research seems to support this presumption.
     But the negatives associated with this kind of advertising may not be as apparent. The content of the ad may seem balanced, but the drug's long list of side effects often contains medical jargon that a consumer will not understand, and while the 50 word a minute voice-over cheerfully warns that this medicine may cause heart attacks, stroke, dementia, or psychosis, the visual picture shows a happy patient playing with her grandchildren. I doubt we will ever see the picture of the stroke patient being carted off to the hospital in an ambulance. These ads also don't tell either the doctor or the consumer when a less expensive medicine with a better track record might be a better choice - and because this medicine is "newer" and "Seen on TV" many assume this newer medicine is somehow "better."
     Like any consumer, a physician is susceptible to name recognition, so if she sees this medicine advertised the night before a patient's visit, she might be more likely to prescribe it the following day. More worrisome is that physicians frequently watch these advertisements with the mindset of a consumer rather than a professional. When I read an advertisement for a pharmaceutical in a medical publication, I am much more likely to pay attention to the negatives than I am when I watch the same content during my favorite TV show. Even though I am aware of this problem, it takes great effort for me to maintain focus because I am watching this show as an escape from my work mentality.
     The most covert and dangerous effect of patient advertising on physician behavior is that doctors may be more likely to prescribe medicines for conditions they would not have treated previously. The prototypic example is prescribing Viagra for "Erectile Dysfunction". Before a massive advertising effort, if a patient approached his physician with a complaint of sexual dysfunction, the doctor would have checked the patient for depression, anxiety, cardiovascular disease, diabetes, and other potentially serious conditions. After ruling these out, the patient would usually have been referred to a urologist to rule out anatomic problems and to discuss a variety of treatments. But, because the advertisements for "ED" appeared with the same frequency as those for laundry detergents, it created the impression that this is an everyday non-medical problem that can be adequately treated by any doctor willing to phone in a prescription for blue pills. No examination or history-taking is necessary. Luckily, most patients with ED do not have serious underlying illness, but physicians should remember the Viagra story as a cautionary tale. Advertising to patients may have more impact on physician behavior than has been previously recognized.