December's PharmedOut Fodder:
Doctors Speak Out on DTC Advertising
In November, physicians at a meeting of the American Medical Association (AMA) voted in support of a ban of direct-to-consumer (DTC) drug advertising. AMA Board Chair-elect Patrice A. Harris said the vote "reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices ... direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate."
DTC drug advertising is only allowed in two countries: New Zealand, since 1981, and the United States, since 1997. Although some print ads appeared in U.S. publications before then, FDA's new guidelines in 1997 effectively allowed for broadcasted pharmaceutical ads by implementing an “adequate provision” standard for risk information.
According to market research firm Kantar Media, television ads make up the majority of drug advertising ($2.8 billion out of $4.5 billion spent in 2014). Expenditures had dipped since 2006's peak of $5.4 billion, but 2014 represents the highest spend since that year.
It is essential to note that while the AMA is taking issue with DTC advertising, targeting the public through television, radio, and mainstream publications, Pharma spends much more on marketing to physicians — $24 billion in 2012. This has been primarily done through detailing (drug rep visits and promotions), free samples to physicians, and educational and promotional meetings. A relatively smaller fraction of $90 million was spent on print ads in medical journals.
Still, DTC advertising reaches a vast population and leads to major ROI. Online advertising has been most lucrative, with data showing a 5:1 ROI in past years. And the average American television viewer is said to watch up to nine drug ads a day, totaling 16 hours per year. A 2015 survey by Treato, a pharma analytics firm, found that 21% of respondents said they talk to a doctor about a drug or treatment after watching a TV ad, and an additional 5.8% suggest the treatment to someone else.
What is the likely outcome from the AMA vote? Thus far, pharmaceutical companies have successfully deflected calls for restrictions on marketing by citing their right to free commercial speech. One of the arguments made by DTC advertising proponents is that the ads promote provider-patient dialogue and strengthen their relationship. But ads are often inaccurate and may encourage overprescribing.
A DTC advertising ban would require Congressional action. AMA certainly may have the clout needed to make a difference as the #2 lobbyist to Congress this year.
To avoid the Constitutionality argument of a full-out ban, more regulation may be a logical intermediate step. Rep. Jarrold Nadler (D-NY) introduced the Say No To Drug Ads Act, most recently in 2013, which would have amended the IRS Code to prevent drug companies from claiming tax deductions for the cost of DTC ads. Perhaps with the momentum of the AMA announcement and hopefully, their support, Rep. Nadler or another member of Congress will reintroduce this common-sense piece of legislation.