Looking Back to Move Forward

Back in the 1980s, when Direct to Consumer advertising (DTC) was initially conceived, I was designing and executing marketing communications for prescription medications at a well-known promotional agency. During that same period, Howard Torman, MD was a medical correspondent for CBS Television and eventually the national medical correspondent and health editor for CBS News. Some years later our careers intersected when Dr. Torman left CBS and began consulting with me on media strategies.

Recently, Howard and I were chatting about the role of DTC over three plus decades and how it continues to evolve not only as an effective marketing tool, but also as an omnipresent source of consumer medical information. Dr. Torman suggests that perhaps it is now time for DTC to consciously embrace its role in patient education in a more meaningful way and extend beyond marketing objectives. DTC can potentially provide much needed context and perspective to enhance patient and consumer ability to participate in healthcare decision-making. Not only would this fill a void in current healthcare media, but it might also help to offset persistent criticism of DTC as well as yield goodwill in the present pharma-challenged environment. The following is a recap of Dr. Torman’s perspectives.

DTC’s Ups and Downs

“The regulatory opening to DTC happened with an inadvertent statement made by the FDA at a 1982 conference. DTC advertising started slowly, but a decade later underwent explosive growth, especially on television. In 1996, a prescription-only allergy drug began a DTC campaign with pervasive and catchy reminder style ads that was very successful and opened the DTC door wide. Several years later, another new and popular lifestyle drug blew the doors off with provocative, mischievous, and seductive ads. These spots pushed boundaries, and on occasion the FDA’s buttons as well, resulting in some not unexpected government pushback. However, overall, it’s now clear that DTC even within the confines of regulations, has real power and still unrealized potential. Besides delivering on marketing objectives, more generally, DTC also raises consumer disease awareness, awareness of therapeutic options, as well as arguably helping promote treatment compliance.

But it’s not all blue skies. Several studies looking at the influence of DTC on patient and physician behavior and interactions show adverse effects. Patients often ask doctors for DTC drugs by name or category, which some physicians are then happy to write, regardless of whether it’s strictly necessary or the best choice under the clinical or economic circumstances. Critics of DTC also worry that it promotes unnecessary diagnostic testing as well as over diagnosis. DTC ads are also criticized for promoting unrealistic patient expectations. Consumer expectations also take a hit due to a lack of perspective, especially when considering the risk part of the risk-benefit equation inherent in any treatment decision. Additionally, these same ads often prompt prospective consumers to respond to, “Ask your doctor if XYZ is right for you.” But even ignoring that, many physicians do not enthusiastically embrace that role. Patients increasingly want to at least get a start in making that determination themselves, but that can be challenging.

The Impact of Negative Attorney Ads

Ironically, the content easiest for consumers to access and absorb to help decide whether to pursue a DTC promoted treatment also shows up constantly on TV—competing DTC pitches from attorneys and law firms trolling for business. These aggressive ads use phrases such as “dangerous” or “bad drug” and other negative descriptions to convey a strong message that commonly advertised medications have extreme risk or are even lethal. Think that doesn’t make an impression?

Recently I conducted an informal study with 50 healthy, medically naïve young adults to look at the residual “take home” message after exposure to both pharma and law firm DTC ads.

First, participants were given the medical basics on the common diseases for which anti-coagulants (blood thinners) were usually indicated or prescribed. Then, they viewed several examples of high-reach DTC ads for the newest class of blood thinners (known as NOACs or DOACs). Their impression: If a close relative needing anticoagulant treatment came home with a prescription for one of these drugs they’d be very comfortable with them taking it, expect it to be beneficial, and conducive to a normal lifestyle.

However, after next watching several attorney TV ads that strongly suggested these same drugs are extremely dangerous or life threatening, their opinion changed significantly. Overall, they were no longer sure about the wisdom of taking these medications. Absent further discussion of perspective or a realistic sense of risk versus benefit, including impact on lifestyle, this isn’t surprising.

Moving Forward With DTC

The future sweet spot for DTC may reside in campaigns that place additional emphasis on providing context, perspective, and the clinical rationale for medications being promoted. Marketing objectives will still be met, maybe even enhanced, by helping to address some of the problems associated with current DTC efforts. It would also serve to give DTC an expanded utilitarian role in the accelerating healthcare trend towards more formalized shared decision-making.

This process, intended to include structured decision aids, aims to more actively integrate patients into health decisions and become an alternative to simply informed consent. But where do patients get the initial information needed to help make informed decisions and engage them in that process? Well, it will likely often continue to come from exposure to media where DTC ads dominate. Creatively designing future DTC to incorporate medical context and decision-making tools could not only address critics and adversaries, but also improve the pharma image while maintaining or even increasing marketing effectiveness. Over the past 30 years, DTC has evolved into a multifaceted tool for sales and promotion. Now, by integrating broader patient education content as part of the message, it could make an evolutionary leap—a leap that transcends pure marketing goals to better equip consumers for the shared decision-making challenges of contemporary healthcare.”

  • Ilyssa Levins

    Ilyssa Levins is President and Founder of Center for Communication Compliance (CCC). Ilyssa helps manufacturers and their promotional agencies save time, money and manage risk, when promoting drugs and devices. She combines her regulatory compliance, marketing communications, and change management expertise to help clients achieve their goals.

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