The pharmaceutical industry spends billions of dollars in the USA each year on direct-to-consumer advertising. According to a new study, such advertising may have no effect at all on sales – at best the impact has been described as modest.
Stephen Soumerai, main investigator of the study, said that most of us think that direct-to-consumer drug advertising must be paying off – otherwise, why would pharma do it? However, he adds that the “decisions to market directly to consumers is based on scant data”.
You can read about this study in the British Medical Journal, September 2nd issue. The study was carried out at the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care.
Only two countries, the USA and New Zealand, allow direct-to-consumer advertising of prescription drugs. Most other countries only allow OTC (over the counter) medications to be marketed directly to consumers.
When the FDA (US Food and Drug Administration) lifted some advertising restrictions on the drug industry in 1997, spending on consumer advertising rose 330% over the next decade. The industry spends over $5 billion per year on direct-to-consumer advertising (DTCA) campaigns. Data appeared to imply that these ads raised prescription numbers. However, these studies simply correlated ads with sales, leading one to wonder – are drugs that sell more simply advertised more?
Carrying out an effective study is not easy. As most Americans are exposed to advertising, how can you compare one group that sees and hears ads to another that does not? The answer is the French-speaking part of Canada.
Direct-to-consumer advertising of prescription drugs is not allowed in Canada. Even so, the USA and Canada have a porous border and TV programs from the US are seen on the Canadian side, as well as radio programs and magazines. However, all these ads are in English, none are in French. 7.5 million Canadians are French-speaking. In Quebec, where French is the native language of 80% of the population, most of the people’s TV and radio programs are seen/heard in French. In other words, residents of Quebec are far less exposed to prescription drug advertising than English speaking Canadians.
In this study Quebec was the control group. The researchers wanted to compare prescription rates for advertised drugs in English-speaking Canadian provinces to those in Quebec.
Michael Law, first author on the paper, said “It’s not an absolutely perfect control group. There’s obviously a small percentage of Quebec residents who are exposed to English language media. But as control groups go for this sort of observational study, it’s about as good as you get.”
The study focused on the rheumatoid arthritis drug, Enbrel, the nasal allergy medication Nasonex, and the irritable bowel syndrome medicine, Zelnorm. They had all been on the market for over 12 months before the DTCA campaign started. None of these three drugs had been advertised in Canada through softer consumer ads.
The researchers wanted to find out whether exposure to advertising resulted in a faster increase of prescriptions of these three drugs in the English-speaking parts of Canada, compared to Quebec. By using information from IMS Health Canada, which receives data from approximately 2,700 Canadian pharmacies, the authors studied the prescription statistics for these three drugs for a period of five years.
DTCA had no effect at all on the sales of Enbrel and Nasonex, the authors reported. The number of prescriptions remains the same in both Quebec and the English-speaking provinces after the DTCA campaigns started.
However, Zelnorm did rise significantly in English-speaking Canada as soon as the advertising campaign started. This 40% increase in sales was only an initial jump. After a few years prescription patterns became identical again even though the campaign had continued.
The authors suggest that DTCA of drugs may not be as effective as other types of consumer advertising. Soumerai explains that with a typical consumer product the individual sees the ad and can there and then decide to go out and get it. With a prescription drug he/she needs to get the product by going to his/her doctor. This involves making an appointment, explaining things to another person (the doctor), convincing this person, getting a prescription, and then going down to the pharmacy. “This is a chain of events that can break at any point,” explains Soumerai.
“Effect of illicit direct-to-consumer advertising on use of etanercept, mometasone, and tegaserod in Canada: controlled longitudinal study”
Michael R Law, Sumit R Majumdar, and Stephen B Soumerai
http://www.bmj.com
Written by – Christian Nordqvist