BMJ: Direct-to-consumer drug ads are a waste of money

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Despite the billions spent on bringing drug marketing campaigns straight into patients' living rooms, direct-to-consumer advertising (DTCA) may not be giving big pharma a bang for their buck after all, according to a study published early online Sept. 2 in the British Medical Journal.

Currently, the U.S. and New Zealand are the only countries that allow drug companies to advertise directly to patients. When the FDA eased advertising restrictions on the pharmaceutical industry in 1997, consumer advertising jumped 330 percent over the next 10 years. As of 2005, the pharmaceutical companies were spending about $5 billion annually on such campaigns.

“People tend to think that if direct-to-consumer advertising wasn't effective, pharma wouldn't be doing it," said the study’s principal investigator Stephen Soumerai, PhD, an associate professor at Harvard Medical School in Boston. “But as it turns out, the decision to market directly to consumers is based on scant data.”

The researchers said that the study is the first-ever controlled study of DTCA of pharmaceuticals.

The investigators looked to Canada to find a control group, where DTCA is illegal and U.S. ads are prevalent, except for the French-speaking residents of the Quebec province. The researchers compared prescription rates for advertised drugs in English-speaking Canadian provinces with rates in Quebec.

Study author Michael Law, research fellow at the department of ambulatory care and prevention at Harvard, acknowledged that the control group was not “perfect.”

Despite the limitations, Law and Soumerai studied three specific drugs: Enbrel (rheumatoid arthritis), Nasonex (nasal allergies) and Zelnorm (irritable bowel sydrome). All three drugs were on the market for at least one year before the DTCA campaign began, and none were advertised in Canada through “softer” consumer ads that may mention the drug by name, without identifying the relevant conditions.

Using information from IMS Health Canada, which receives data from approximately 2,700 Canadian pharmacies, the researchers analyzed prescription statistics for each of the three drugs for a five-year period to determine the effectiveness of DTCA.

The researchers found that only a modest effect on drug sales. In some cases, DTCA had no effect at all. They found that for two of the drugs, Enbrel and Nasonex, DTCA had no effect whatsoever. Prescription patterns in English-speaking Canada and in Quebec remained identical both before and after DTCA campaigns began.

Sales for Zelnorm, however, did spike noticeably in English-speaking Canada as soon as the ad campaign began. While prescriptions for the drug increased by more than 40 percent, the jump was relatively short-lived, and after a few years, prescription rates in both groups resumed identical patterns. A similar analysis of U.S. Medicaid prescriptions found a slightly higher, but similarly brief, jump in sales.
The researchers hypothesized that DTCA may not be as effective as other types of consumer advertising due to the unique complexity of the marketing and sales trajectory.

“A person needs to see an ad, get motivated by that ad, contact their doctor for an appointment, show up at the appointment, communicate both the condition and the drug to the doctor, convince the doctor that this drug is preferable to other alternatives, then actually go out and fill the prescription. This is a chain of events that can break at any point,” Soumerai said.

This may explain the disparate effects of DTCA on the three drugs. For Enbrel and Nasonex, there are a number of over-the-counter and prescription alternatives that doctors would likely recommend as first-line treatments. Zelnorm, however, was the only drug on the market in both the U.S. and Canada for constipation-predominant irritable bowel syndrome. The researchers said that Zelnorm would have sold very well without the consumer advertising.