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Dave Hosick
Kelley School of Business

George Vlahakis
University Communications

Last modified: Tuesday, February 2, 2010

IU Kelley School professors assert that benefits of direct-to-consumer drug ads outweigh criticisms

Physician-targeted marketing a greater public concern

Feb. 2, 2010

BLOOMINGTON, Ind. -- With their his-and-hers outdoor bathtubs (erectile dysfunction) and veiled references to a "growing, not going problem" (enlarged prostate), direct-to-consumer (DTC) pharmaceutical ads are roundly criticized by consumer advocates, health professionals and elected officials.

Yet two authorities on health-care marketing consider these ads more honest than most other forms of consumer advertising and the most forthcoming type of pharmaceutical promotion.

Anthony Cox and Dena Cox, professors at the Indiana University Kelley School of Business, assert that many charges against DTC pharmaceutical ads are overblown. They believe the public should be more concerned about physician-targeted marketing -- such as medical journal advertising, sales calls and distribution of drug samples.

"In contrast to physician-targeted marketing, DTC appears to be an admirably direct and straightforward way of communicating with consumers," said Anthony Cox.

Side effects disclosed, claims substantiated

The Coxes emphasize that DTC pharmaceutical ads are unlike other forms of consumer advertising because they're subject to the strict guidelines of the Food and Drug Administration (FDA). As such, they must disclose the products' most common and severe side effects -- requirements that do not apply to fast-food restaurants, which might otherwise have to state that beef is known to increase risk of heart disease and cancer.

What's more, DTC pharmaceutical ads must support all product benefits claimed or even implied with rigorous scientific evidence, unlike ads for nutritional supplements, which can highlight unsubstantiated benefits as long as they mention that the claims have not been evaluated by the FDA.

While the Coxes defend the openness of DTC pharmaceutical ads, they acknowledge that certain charges are, to an extent, warranted. These include:

  • Downplaying drug risks, often by presenting visual elements to distract consumers. For instance, a television commercial for an antihistamine featured a kinetic buzzing bee while the announcer read risk information. In this case, the FDA issued a complaint and the bee was grounded by the company.
  • Not discussing alternatives to the advertised product. For example, ads for cholesterol-reducing drugs may not mention that diet and exercise are the best remedies.

Such issues as these about DTC pharmaceutical ads, while legitimate, say the Coxes, are not so detrimental as to nullify the ads' positive aspects.

"Certainly, the principal purpose of DTC advertising is to help sell products -- and the pharmaceutical companies want ads that will be most effective. However, DTC ads also prompt recognition of undertreated conditions, increase awareness of drugs' potential risks and side effects and stimulate broader conversations between doctors and patients," said Dena Cox.

Physician-targeted marketing

While DTC represents the pharmaceutical industry's most visible effort to influence consumer behavior, it is not close to being the largest. This distinction belongs to physician-targeted marketing, which accounts for 86 percent of drug company promotional expenditures compared to the 14 percent reserved for DTC advertising.

Physician-targeted marketing makes a lot of sense from a business standpoint; physicians serve as gatekeepers for prescription drugs and are highly trusted by patients, who perceive them as independent sources of medical advice. Yet, this independence is sometimes more apparent than real, as many doctors are not financially independent of drug companies.

These corporations regularly provide doctors' offices with free food and drug samples, underwrite continuing medical education, and compensate doctors for consulting, lecturing and enrolling patients in clinical trials.

"Many of these activities seem harmless and some serve a legitimate medical purpose," said Anthony Cox. "That said, evidence indicates they also serve their intended promotional purpose -- influencing prescriptions and the advice that doctors give to their patients."

According to the Coxes, such tactics are effective for the same reason that they are most worrisome: they bypass the skepticism that consumers are able to muster when seeing an advertisement they recognize as paid promotion.

"Patients have innate defenses against DTC ads; there is no comparable protection against the indirect influences of physician-targeted marketing," said Dena Cox. "Further, doctors always have the final decision to prescribe or not. When independent of drug companies, they curb the power of even the most compelling ads."

Tony and Dena Cox's article, "A Defense of Direct-to-Consumer Prescription Drug Advertising" will appear in the March/April 2010 issue of Business Horizons, the bimonthly journal of IU's Kelley School of Business.