Pharmaceutical direct-to-consumer advertising: past, present, and future

Pharmaceutical direct-to-consumer advertising: past, present, and future

Article Type: Editorial From: International Journal of Pharmaceutical and Healthcare Marketing, Volume 7, Issue 3

Introduction and theme

Pharmaceutical Direct-to-Consumer Advertising (DTCA) includes different types of promotional efforts employed by pharmaceutical companies to provide prescription drug information to the general public through consumer-oriented media. It is allowed currently only in the US and New Zealand. In the past decade, pharmaceutical companies have been involved in intense direct-to-consumer advertising and promotion of prescription drugs. Spending on DTCA of prescription drugs has been accelerating (Parker and Delene, 1999; Donohue et al., 2007). DTCA spending grew from $2.5 billion in 2000 to $3.3 billion in 2003, $4.2 billion in 2005, and $4.5 billion in 2009. There was a 330 percent increase in DTCA spending between 1996 and 2005. As a result, the average American television viewer spent about 16 hours annually watching prescription drug advertisements; that was far more time than they spent with their family physicians (Brownfield et al., 2004).

The environment in which the DTCA of prescription drugs operates is unique in two ways: while consumers are targeted by DTC advertisers, only physicians have the right to prescribe the advertised drug; and considering the risks associated with prescription drugs, regulatory bodies and consumer protection agencies are more involved in approving and monitoring all DTCA communications. Consumer segments based on a variety of characteristics, e.g. demographics and psychographics such as health beliefs and health orientations respond differently to various dimensions of DTCA communication, such as information, comprehension, trust and valence (Mukherjee, 2011).

While DTCA has been credited for improvements in pharmaceutical sales growth, patient education, and improved health outcomes, it has been criticized for its role in drug over-utilization, public health concerns, higher drug costs, and physician dissonance. These issues become more paramount in the wake of the high involvement nature of prescription drugs, the average consumers’ lack of scientific knowledge, and their propensity to self-diagnose and ask physicians for specific medications. DTCA is thus an extremely complex and yet a very important topic that deserves researchers’ sincere attention (Farris and Wilkie, 2005; Gellad and Lyles, 2007). It has been an issue of intense public policy attention and debate since the early years of its existence (Hoek et al., 2001; Royne and Myers, 2008; van de Pol and de Bakker, 2010). Unfortunately, it is one of the most understudied areas in pharmaceutical and healthcare marketing. Empirical research on the effect of DTCA is especially scarce. Much of the extant research on DTCA is exploratory in nature, mostly based on literature reviews and using content analysis as the methodology (Harker and Harker, 2007). Comprehensive and empirically validated models of consumer responses to DTCA are still rare in the literature (Limbu and Ivonne, 2009; Wilson and Till, 2007) and little is known about its effects on attitudes and behavior of concerned parties such as consumers, physicians, nurses, and other healthcare providers (Huh and Becker, 2005; Harker and Harker, 2007; Torres and Limbu, 2010).

Thus, the main goal of this IJPHM special issue is to address these research gaps. Papers published in this issue are empirical or conceptual papers that have substantial practical and/or theoretical implications on various aspects of DTCA.

Research issues and areas

Research on DTCA is broad and multifaceted. There are several research issues and questions that come to mind. Some of these are:

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  Stakeholders’ (e.g. consumers, physicians, nurses, sales force) responses/attitudes to DTCA.

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  Patient-physician interactions, communication, and relationship.

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  Effect of DTCA on physician prescription behavior.

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  Information search from sources other than physicians as a result of DTCA (e.g. online search).

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  Other behavioral intentions (e.g. prescription request, intent to recommend, WOM).

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  Content of DTC advertisements (e.g. textual, pictorial).

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  Effect of DTCA expenditure on financial performance (e.g. price/sales/market share/roi/shareholder’s value).

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  Trend analysis of DTCA expenditures by product category and consumer segments.

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  Role of internet and technology on DTCA (e.g. DTC websites, blogs, social media etc.).

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  Risk disclosure and perceived risk.

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  DTC claims or message credibility/source or media credibility/perceived believability.

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  Role of different types of message appeal, persuasion.

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  Situation and context effects.

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  Role of affect, cognition, and emotion.

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  Role of different types of involvement, motivation, and individual differences.

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  Role of consumer knowledge/expertise/familiarity.

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  Consumer recall and memory.

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  DTCA exposure, attention, and interpretation.

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  Consumer learning, awareness, and literacy.

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  Impact on drug and therapy compliance, noncompliance, and adherence.

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  Effectiveness of different DTCA information sources (e.g. print, TV, online, radio, outdoor, direct mail).

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  Role of demographics on DTCA perceptions.

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  Historical evolution and growth of DTCA.

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  Ethical issues relating DTCA.

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  Government policy, laws, and regulations.

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  Pharmaceutical industry’s perspectives on impact of DTCA.

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  Attitudes toward and likely adoption of DTCA in countries other than US and NZ.

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  Macro impact of DTCA (e.g. impact on economy, healthcare sector, healthy living, patient care).

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  Future of DTCA.

Research on DTCA can adopt a plethora of research methodologies, such as quantitative and qualitative studies, including marketing and consumer behavior models, experiments, correlational studies, causal studies, comparative studies, descriptive studies, literature reviews, meta-analysis, case studies, viewpoint articles, pedagogical innovations, and book reviews. Papers can adopt a historical, current or future perspective.

The call for papers generated an overwhelming response. We received a large number of submissions which were then filtered through a multi-stage double blind review process to yield enough papers for two back-to-back special issues on DTCA. This is the first of the two special issues.

Summary of papers in this special issue

This special issue starts with a review article by Yam B. Limbu, Avinandan Mukherjee and Isaac Wanasika on research on DTCA of prescription drugs. Titled “A review of research on direct-to-consumer advertising of prescription drugs: directions for future research”, this article covers empirical research on DTCA of prescription drugs published in selected journals over the period 1997-2012. Based on a careful review of 130 empirical studies in the extant literature, seven key research themes were identified. The seven themes are: consumers’ attitudes toward DTCA, physician-patient interaction, contents of DTCA, awareness, literacy and memory, consumer information source and search, effects of DTCA expenditures on financial performance, and physicians’ attitudes toward DTCA.

The article concludes with avenues for future research.

The second article of this special issue is a research paper by Jennifer Gerard Ball and Michael Mackert titled “Pharmaceutical advertising practitioners’ approach to trust and emotion.” Studies on direct-to-consumer pharmaceutical advertising (DTCA) have examined the views of consumers and healthcare providers but the perspective of pharmaceutical advertisers has been largely ignored. This study seeks to fill that gap by exploring the perspectives of advertising professionals working on pharmaceutical brands. Interviews were conducted among 22 advertising professionals regarding the use of emotion in DTCA and considerations about consumer distrust and ad credibility. Results suggest emotion is used to gain attention, increase involvement, and enhance information processing. Consumer trust of pharmaceutical companies is recognized as an issue, and various thoughts are provided on trust-building strategies. However, several respondents expressed doubt that negative opinions of the industry translated into negative evaluations of the specific ads or brands with which consumers were familiar. Based on participants’ assertions, this paper poses a number of specific avenues for future research regarding the effects of emotion on response to DTCA and consumers’ conflicting sense of trust within the pharmaceutical category. Concerns are raised regarding the clarity and efficacy of current regulations. Although pharmaceutical advertising professionals expressed a desire to balance ad content, they indicated uncertainty regarding the acceptable boundaries of persuasive message tactics and acknowledged in some cases a lack of support from drug manufacturers to emphasize drug side effects or include unnecessary educational information. While scholars examining the design and effects of DTCA have inferred the motivations of pharmaceutical advertisers, this study provides insight on these practitioners’ actual intentions behind the messages created for DTCA.

The third article titled “The influence of the number of presented symptoms in product-claim direct-to-consumer advertising on behavioral intentions” is a research paper authored by Sooyeon Nikki Lee-Wingate and Ying Xie. In order to improve the effectiveness of product-claim Direct-to-Consumer Advertising (DTCA), this research study examines the effect of a presentational element – the number of treatable symptoms for the advertised medical condition featured in the ad – on consumers’ intentions to seek treatment. In this study, the authors recruited ninety-five participants at a mall in the northeastern US who provided data on behavioral and attitudinal intentions regarding a product-claim print DTCA for an antidepressant. The study results show that featuring a high (vs low) number of symptoms improve the effectiveness of the product-claim DTCA. Seeing more symptoms lead to heightened perceptions of informativeness, lower persuasive intent, and higher intentions to discuss the advertised ailment and the advertised drug with the doctor. Perceptions of disease prevalence mediate this influence. The perceived impact of each symptom featured in the DTCA was controlled across experimental conditions. This research contributes to the healthcare marketing literature by demonstrating how managing a presentational element in DTCA influences consumers’ metacognitive processing of the health information and consequently their intentions to engage in health-related behaviors. Within the regulatory boundaries, pharmaceutical marketers may wish to increase the number of treatable symptoms to feature in their product-claim DTCA in order to improve the effectiveness. This research builds on the extant literature of examining consumer perceptions of DTCA, and suggests a practical and metacognitive means to improve consumer perceptions to ultimately enhance DTCA effectiveness.

The fourth article of this issue is titled “An experimental examination of consumer attitudes, behavioral intentions, and information search behavior after viewing a predictive genetic test direct-to-consumer advertisement.” Authored by Brent L. Rollins, Shravanan Ramakrishnan, and Matthew Perri, the study focuses on the consumer attitudes, behavioral intentions, and information search behavior related to predictive genetic tests. Predictive genetic tests (PGTs) have greatly increased their presence in the market, and, much like their pharmaceutical peers, companies offering PGTs have increasingly used direct-to-consumer advertising as part of their promotional strategy. Given many PGTs are available without a prescription or physician order and the lack of empirical research examining the effects of PGT-DTC, this research examines consumer attitudes, intentions, and behavior in response to a PGT-DTC ad with and without a prescription requirement. A single factor, between subjects online survey design with the presence or absence of a prescription requirement as the experimental variable was used to evaluate consumers’ attitudes, intentions, and behavior in response to a predictive genetic test DTC advertisement. A minimum sample size of 198 was determined a priori and 206 surveys were completed within five hours of deployment to 600 randomly selected general consumer participants for a response rate of 34.3 percent, with 106 in the prescription requirement group and 100 in the non-prescription group. Descriptive statistics, T-tests, and chi-square techniques were used to examine the various dependent variables (consumer attitudes, behavioral intentions, and the pre-defined behavior measure) and their differences. The results show that overall, consumers hold favorable attitudes to PGT-DTC ads, but they do not intend to engage in physician discussion, take the test, or perform information search behavior. The effect of a prescription requirement is not significant, as no differences are seen with the dependent variables of attitude and behavioral intention. The article concludes that at this relatively new phase in the PGT cycle, consumers still seem to be skeptical about the value of predictive genetic tests and their associated DTC advertisements.

The final article of this special issue is a research paper by Nilesh S. Bhutada, Aparna D. Deshpande, Ajit M. Menon, and Matthew Perri with the title “Consumers’ evaluation of brief summary formats of print direct-to-consumer advertisements.” In this article, the authors measure the effect of various brief summary formats on consumers’ drug-related knowledge, evaluations of ad information, ad believability, attitudes towards the ad and brand, perceived product risk and intention to use ad information in making healthcare decisions. Using mall-intercept surveys, 307 US women, aged 18-50 years, were randomly assigned to one of the six different versions of brief summary formats for a birth control medicine. The six brief summary formats used are: no brief summary, traditional (continuous prose) brief summary, risk information window, bulleted list, nutrition facts panel, and question-answer format. The participants completed a closed-ended questionnaire after reviewing the print ad. MANOVA indicated presence of a multivariate main effect. However, univariate ANOVAs, performed to evaluate the effect of individual formats, revealed that the eight outcome variables did not vary significantly across the six brief summary formats. Nevertheless, respondents exhibited more positive evaluation of the newer brief summary formats compared to the traditional brief summary format, albeit there was no statistically significant difference among the newer formats. One of the practical implications of the study is that the consumers clearly prefer newer brief summary formats to the traditional brief summary format. Additionally, this research provides insights about risk communication in direct-to-consumer ads and may assist the FDA in the development of a standardized regulatory structure for the future. Providing brief summary in a clearer, understandable, and consumer-friendly manner can help consumers in deciding whether the drug is appropriate for their condition.

We hope you will find the articles in this issue informative, refreshing and thought-provoking. The next issue will be a continuation of this theme and will offer more insights into this intriguing DTCA phenomenon.

Avinandan Mukherjee, Yam B. LimbuMontclair State University, New Jersey, USA