Impacts of Direct-to-Consumer Pharmaceutical Advertising on Quality of Care

Advertisements for drugs have long inundated television and other media platforms. They all follow roughly the same formula: miraculous claims, moving images of families, the music swells, and then a long, incomprehensible list of possible side effects written in fine print and recited so quickly that the dangerous ones almost go unnoticed. This style of direct-to-consumer advertising and the rhetoric it employs has massively grown the pharmaceutical industry but at the expense of quality patient care.

University of British Columbia researcher Barbara Mintzes wrote an article almost two decades ago discussing the validity of direct-to-consumer advertising, which the World Health Organization then published. Direct-to-consumer (DTC) advertising rose to popularity in the early 1980s, and since then, pharmaceutical sales and the cost of drugs have risen consistently and exponentially. According to a 2019 article by Senior Faculty Editor of Harvard Health Publishing, Dr. Robert H. Shmerling, “drug sales rise by $4 for every dollar spent on advertising.” 

The core idea behind DTC advertising is that pharmaceutical companies, rather than having to convince trained medical professionals of the merits of their drugs, can simply recommend their products directly to patients. Because most consumers are less knowledgeable than the average physician or pharmacist, pharmaceutical companies can take advantage of a more emotionally driven population that is less likely to be skeptical of skewed statistics and exaggerated claims.

Researchers and agencies studying pharmaceutical advertising have contested the merits of this advertising approach over the last few decades. Most countries restrict DTC advertising to some extent, if not prohibit it altogether. In fact, DTC advertising is only fully legal in the United States and New Zealand. DTC advertising takes advantage of the sick and vulnerable and drives up health care costs for the consumer to sell products that “even when used properly, [can] cause serious harm.”

That said, DTC advertising can, with a little due diligence, be a useful tool. In 2004, the Food & Drug Administration (FDA) conducted a survey of five hundred healthcare providers, in which many providers felt that DTC advertisements prompted their patients to ask more informed questions about their treatment. In the current healthcare environment, which pressures healthcare providers to rush through patient visits as quickly as possible to fit more appointments into the day, patient advocacy is more important than ever. Anything that empowers patients to participate more actively in their care, challenge their providers when they feel their care is inadequate, and better understand the healthcare system is a boon worth acknowledging.

However, while DTC pharmaceutical ads may effectively make patients more aware of available treatments, they still create a skewed impression of the marketed products. According to Mintzes, “advertisements commonly contain misleading and inaccurate information, and the public rarely receives corrections.” For example, in 2013, a study conducted by teams at Dartmouth College and the University of Wisconsin-Madison labeled 60 percent of ads for prescription drugs and 80 percent of ads for over-the-counter medication as “misleading or false.” One of the offenders cited was an antifungal cream whose ad included some negative side effects of the product but failed to warn users of possible local adverse reactions at the application site.

In the aforementioned survey conducted by the FDA, while doctors acknowledged some of the benefits of pharmaceutical ads targeting consumers, they also reported that these ads failed to weigh risks versus benefits accurately, giving patients unrealistic expectations of the drugs’s efficacies. Furthermore, the survey indicated that DTC advertising not only impacted patient behavior but also affected decisions made by healthcare providers, as many providers responded that they felt increasingly pressured to prescribe brand name drugs that patients had seen in an ad over alternatives. If a patient feels set on a certain course of treatment after seeing an ad for it and their doctor makes an opposing recommendation, this can cause a disconnect between providers and patients that can negatively impact the quality of care.

Not only has DTC advertising interfered with healthcare providers’ ability to administer the best care, but the burden has also been placed back onto these providers to try to curtail misleading advertising. The FDA’s Bad Ad Program encourages healthcare providers to learn to recognize and report falsehoods in DTC advertising. While programs like this are not categorically bad solutions to the problem, they are only reactive rather than proactive and rely unduly on healthcare providers to monitor content for which regulatory agencies like the FDA should be responsible.

These types of advertisements also make brand-name drugs seem more desirable than generic alternatives, largely due only to increased exposure, and regardless of the fact that generic drugs are most often less expensive and equally efficient. For these reasons, while direct-to-consumer advertisements may serve to engage patients in the process of their healthcare, they can also present roadblocks that prevent patients from fully collaborating with their healthcare providers to get the best quality of care available. 

Pharmaceutical advertisements are specifically designed to present drugs in the most optimal light possible. Dr. Ameet Sarpatwari, a researcher of pharmaceutical marketing at Harvard Medical School, described the goal of these ads as informing the audience of the purpose of a drug and its benefits, but not specifying who qualifies for its use. In these ads, pharmaceutical companies get as close as they can to promising a miracle cure without becoming liable to be sued for fraud or false advertising. This often paints an inaccurate, sometimes even dangerous, picture. Rather than taking pharmaceutical advertisements at face value, it is extremely important for patients and other consumers to investigate any possible treatment options and all of their side effects thoroughly and to always consult a physician for more information than what an advertisement provides.

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