The Academy's stand against direct-to-consumer advertising
Alex Hutchinson, PharmD, is a 2021 graduate of The University of Cincinnati James L. Winkle College of Pharmacy and served on the 2020–21 APhA–ASP Policy Standing Committee.
Picture this. You sit down on your couch, turn on your TV to watch your favorite show, and see an image of a beautiful park. A couple is laughing, kids are playing, the sun is shining. A voice-over quickly begins talking over the scene, discussing a new treatment option for a particular disease.
No, this is not the latest episode of your favorite show—it’s direct-to-consumer (DTC) advertising for a newly approved medication. We have all seen them. In fact, they are hard to ignore, appearing on almost every channel, magazine, and web page in our everyday lives.
History of DTC advertising
DTC advertising enables pharmaceutical companies and manufacturers to market their newly approved medications to patients directly, bypassing the health care team entirely. Their origin can be traced to print advertisements in the 1980s. The original ads required a “fair balance” of information, mandating full adverse effect profiles for each claim made, thus making them expensive and inefficient marketing tools.
In 1997, FDA released a guidance statement saying that fair balance could be achieved by indicating a full adverse effect profile in an accompanying print advertisement or toll-free number. This change brought about the DTC ads we are familiar with today, which list fewer risks and adverse effects.
Since then, spending on advertisements skyrocketed from less than $1 billion in 1997 to $6 billion and rising in 2019. This spending has paid off for the manufacturers, with studies showing that for every dollar spent on advertising, there was a $4 dollar increase in sales of the advertised medication.
Beneficial or misleading?
Proponents of DTC advertising state that they empower patients, and national surveys have shown that physicians believe DTCAs educate patients and allow them to take a more active role in their care. These commercials can even help reduce stigma about the advertised disease state and may encourage patients to seek care for conditions they otherwise would have been uncomfortable discussing with their provider. However, they are at the center of ongoing medical controversies about the patient–provider relationship and who truly benefits from the ads.
Since these advertisements no longer require complete listings of the medications’ risks and adverse effects, patients and consumers receive incomplete information about the medications and their place in treatment. While the ads encourage patients to visit their physician to discuss their health and treatment plan, the medications featured may not be appropriate treatment for them because of unadvertised adverse effects or contraindications. This may lead to patient frustration and potential mistrust of their health care team if the medication is not prescribed.
Student pharmacists' role
The United States is one of only two countries that allow DTC ads. While legislation has been introduced to regulate or limit them, so far, no law exists. During the 2020 APhA–ASP Virtual House of Delegates, the following resolution statement was passed: “2020.9–Direct to Consumer Advertising: APhA–ASP opposes direct-to-consumer (DTC) advertising of prescription drugs to the general public to reduce unnecessary treatments and strain on the patient–provider relationship.”
We as student pharmacists can advocate for our patients by contacting our legislators and asking them to introduce or support any legislation that would regulate this practice. Our education allows us to continually inform and fully educate our patients about their medications. True empowerment of patients can only come from a complete and unbiased presentation of information that DTC ads are not currently providing.