There are three types of DTC advertisements:
Advertisements for specific prescription drugs
are subject to strict regulations in the United
States. They must contain a summary of risks
and benefits, as well as detailing how customers
can access more information about the drug.
They must be fair and balanced, with no false
or misleading information, and must not omit
material facts.
Disease awareness advertisements, which do not
mention a specific drug, are not regulated by the
FDA.
Reminder advertisements, which just give the
name of the product but not its uses, do not
have to include risk information (Rados, 2004).
DTC advertising expenditure has been increasing
sharply in the United States, with almost $2.5
billion spent in 2000, three times the level spent
in 1996. However, this accounted for only 15% of
all drug promotion (Rosenthalet al., 2002). Of this,
60% was spent on television, 37% on print and 3%
on billboards and other media advertisements. Use
of DTC advertising varies from one pharmaceuti-
cal company to another. In the first quarter of 2000,
both Merck and the former GlaxoWellcome spent
more on DTC than on professional advertising,
while Eli Lilly and Novartis both spent less than
one-tenth as much on DTC as professional promo-
tion (Matthews, 2001).
DTC advertising is very effective. A study of the
effects of DTC advertising in the United States
concluded that a 10% increase in DTC spending
would be expected to yield a 1% increase in sales of
drugs in thatclass. The figures for 1999–2000show
that an estimated 12% of the growth in total pre-
scription drug spending at that time was attributa-
ble to DTC advertising, a yield of an additional
$4.20 in sales for every dollar spent on DTC adver-
tising. This makes DTC an important, but not the
major, driver of recent growth in drug sales (Kaiser
Family Foundation, 2003). Proponents of DTC
advertising claim that, although it can encourage
more drug consumption, this can lead to overall
cost cutting if it means that other, more expensive
treatments are not needed later (Matthews, 2001).
In contrast, most physicians in the United States
have negative feelings about DTC advertising,
especially feeling that they do not provide enough
information on cost, alternative treatment options
or side effects. More than half thought DTC adver-
tisements increased consultation length and
encouraged patients to ask for specific medication,
and only 29% thought they could be a positive
trend in healthcare (Robinsonet al., 2004).
Within the EU, member states are prohibited
from allowing the advertising to the general public
of medicinal products that are available on pre-
scription only, and may prohibit such advertising
where the product is eligible for reimbursement.
However, OTC products may be advertised gener-
ally (European Commission, 2000). Despite this, it
is possible to get a marketing message across to the
public in other ways. The majority of people in the
United Kingdom come into contact with 19 health
stories each week,viathe media, internet, mobile
phones, celebrity gossip and in public places, as
well as from advertising for other products such as
foods. In addition, patients in the United Kingdom
can be targeted legitimately by public relations
activities, disease area advertising and patient sup-
port programs (Pharmaceutical Marketing Live,
http://www.pmlive.com). The Medicines and Healthcare
Products Regulatory Agency (MHRA) lifted some
regulations in August 2003 to permit promotion of
medicines such as cardiovascular disease preven-
tion products such as statins (Pharmaceutical
Marketing Live, http://www.pmlive.com).51.13 Disease awareness
campaigns (DACs)While DTC advertisements are not permitted in
most countries, DACs are legal on the basis that
they advance public health. In the United
Kingdom, MCA guidelines state that DACs must
be aimed at increasing awareness of a disease and
to provide health education information on the
disease and its management. It must not be used
to promote or stimulate public demand for the use
of a particular product or to encourage patients to660 CH51 ADVERTISING AND MARKETING