Study Casts Doubt on Value of DTC Ads

Prescription Sales Found to Be Barely Affected in the Long Run

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NEW YORK ( -- The $5 billion-plus that pharmaceutical advertisers spend advertising to consumers may have less of an impact than believed, according to a joint U.S. and Canadian study released this week.
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The research was conducted by Harvard Medical School and Harvard Pilgrim Health Care in conjunction with the Alberta Heritage Foundation for Medical Research. The controlled study of direct-to-consumer advertising of pharmaceuticals concluded that all the TV spots and multipage magazine spreads for Big Pharma's miracle drugs have a minor to negligible effect on consumer behavior.

Spending surges
Currently, the U.S. and New Zealand are the only countries that allow drug companies to advertise directly to consumers. Since the U.S. Food and Drug Administration eased advertising restrictions on the industry a decade ago, ad outlays by drug makers rose some 330%, the researchers said. Some $5 billion was spent by drug companies on such campaigns in 2006.

"People tend to think that if direct-to-consumer advertising wasn't effective, pharma wouldn't be doing it," Stephen Soumerai, an author of the study at Harvard Medical School, said in a statement. "But as it turns out, decisions to market directly to consumers are based on scant data."

Researchers at Harvard and the University of Alberta set up an experiment using French-speaking Quebec residents as their "control" group, based on the idea that French-speaking Quebecois are less exposed to U.S. advertising than English-speaking Canadians and are less likely to be influenced.

"It's not an absolutely perfect control group," said Michael Law, the first author on the paper. "There's obviously a small percentage of Quebec residents who are exposed to English-language media. But as control groups go for this sort of observational study, it's about as good as you get."

Focus on three drugs
Messrs. Law and Soumerai chose to look at three specific drugs: Enbrel, sold by Wyeth and Amgen to treat rheumatoid arthritis; Novartis' now-withdrawn irritable-bowel drug Zelnorm; and the Nasonex allergy treatment produced by Schering-Plough Corp.

All three drugs were on the market for at least one year before the DTC campaigns began, and none were advertised in Canada through "softer" consumer ads; that is, ads that may mention the drug by name without identifying the relevant conditions.

Using information from IMS Health Canada, a health information company that receives data from a panel of about 2,700 Canadian pharmacies, the researchers analyzed prescription statistics for each of these three drugs for a five-year period, with the aim of answering a simple question: Did sales of the drugs increase with American DTC campaigns?

They found that for Enbrel and Nasonex, direct advertising had zero effect; prescription patterns in English-speaking Canada and in Quebec remained identical both before and after campaigns began.

Sales for Zelnorm, however, experienced a 40% increase in English-speaking Canada as soon as the ad campaign began. The jump was relatively short-lived, though, as prescription rates in both groups resumed identical patterns within several years. A similar analysis of U.S. Medicaid prescriptions found a slightly higher, but similarly brief, sales spike.

Many steps to completion
The simplest explanation for the lack of efficacy in pricey drug ads may be the unorthodox nature of the pharmaceutical product, because it must be prescribed by a physician.

Mr. Soumerai points to the fragile chain required of prescriptions that translate advertising into purchasing -- a tenuous string consisting of a prospective buyer not only pursuing medical consultation on an advertised drug, but also having their doctor prescribe the same product.

An April report from the nonprofit Kaiser Family Foundation drew similar conclusions: 91% of adults surveyed had seen or heard ads for prescription drugs but only one-third spoke to a doctor about a drug they saw advertised. Some 54% actually filled a prescription.

The Kaiser study suggests the bridge is further strained when potential consumers reach their doctors; 76% of medical professionals polled in the Kaiser report said they recommend a different prescription drug to a patient who mentions a drug ad.

Marketers believe ads work
Schering-Plough, marketer of Nasonex, was adamant about its marketing strategy. "We look at direct-to-consumer-advertising as an effective way to provide health and treatment information to consumers," said Julie Lux, a representative. "As always, it's up to the patient's doctor to prescribe the ultimate treatment."

Pharmaceutical Research and Manufacturers of America (PhRMA) Senior VP Ken Johnson echoed Schering-Plough's defense of the industry's marketing efforts, stressing that while specific ads might not lead to sales of corresponding products, the relevance of direct advertising lies more with advocacy.

"Surveys show that DTC advertising brings patients into their doctors' offices and helps start important doctor-patient conversations about conditions that might otherwise go undiagnosed or untreated," he said. "In fact, a national survey by Prevention Magazine found that 29 million patients talked to their doctor for the first time about a health condition after seeing a DTC ad.

"We are also not surprised by the study's findings, considering the fact that more than 67% of medicines prescribed in the U.S. are generic," he added. "In fact, according to IMS Health, nine out of the top 10 drugs prescribed in America are generic."
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