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Drug ads deliver a few side effects

Firms reap rewards, but so do their rivals, and patients take data to the doc, study finds

By Christopher Rowland, Globe Staff, 6/12/2003

rug companies tripled their advertising budgets in recent years to acquaint American consumers with things like acid reflux disease, depression, erectile dysfunction, and even toenail fungus, a marketing blitz that accounted for roughly 12 percent of the growth in national prescription drug spending in 2000, according to a Harvard University-MIT study released yesterday.

Overall, direct-to-consumer advertising spending by the drug industry rose to $2.7 billion in 2001 from $800 million in 1996. And as prescription drug ads became ubiquitous on the airwaves and in newspapers and magazines, the study said, drug companies received a good return on their investment: For every $1 spent on direct-to-consumer ads, they reaped $4.20 in sales.

But while the ads definitely boost consumer spending on drugs, it is not always in expected ways. The study found that direct-to-consumer ads aren't a primary reason for the significant increases in drug prices in recent years, for instance. And while the ads definitely boost sales of drugs, they boost sales for a whole class of drugs, including competing brands.

The study by a team of Harvard and Massachusetts Institute of Technology researchers was funded by the Henry J. Kaiser Family Foundation, an independent philanthropic organization focused on healthcare policy research. The foundation has been funding an ongoing review of direct-to-consumer advertising.

Pharmaceutical companies seized on the practice to push sales of prescription drugs in the 1990s after the Food and Drug Administration loosened advertising rules. Among the most surprising results, the study's authors said, was the finding that advertising individual brands helped entire classes of drugs.

Advertising for Claritin, for example, also spurred sales of other allergy medications. Richard G. Frank, a professor of healthcare policy at Harvard Medical School and the study's director, said patients may ask for a specific drug, but the doctor, who has the real purchasing power, may prescribe a cheaper, just-as-effective medication from another company.

''That is different from a Chevy, because when you see an ad for a Chevy, you go to a Chevy dealer,'' Frank said. ''The drug advertising gets the person in to the doctor, aware of symptoms and aware of a potential fix.'' But the decision on what to prescribe, he said, is not in the consumer's hands.

Drug advertising has become a focal point of debate on cost controls in the medical system, with critics charging that the practice is contributing to unnecessary prescription spending each year. The 12 percent share of prescription spending growth the advertising fueled in 2000 is significant, but it proves advertising is not the primary driver behind higher costs, the study said. Nonetheless, it has the potential to grow in importance.

''This isn't going away,'' Frank said. ''Consumerism is a growing force in healthcare, and this advertising sort of plays into that. It's asking patients to be more involved in their own care.''

The study compared consumer-oriented advertising to the more traditional approaches of marketing drugs: sending drug representatives to meet with doctors, handing out free samples, and advertising in medical journals. Drug companies are still putting most of their effort, about 81 percent, into those time-tested strategies, the study said. But with the direct consumer approach, doctors have begun to see a new, powerful market force: their own patients.

Public surveys cited by the study have shown that 85 percent of respondents reported seeing or hearing an ad for prescription drugs in 2002, up from 63 percent in 1997.

A spokesman for the drug industry trade group, the Pharmaceutical Research and Manufacturers of America, did not respond to a request for comment.

Although the effect of much of this advertising may be to help a company's competitors, Matt Giegerich, president and CEO of Commonhealth, a New Jersey-based healthcare marketing and communications company, said it still makes sense.

''In the most heavily advertised categories -- high cholesterol, allergies, depression -- there are frequently multiple brands available. It is not surprising that the effect is general, that there's an overall market growth. A rising tide lifts all boats,'' said Giegerich.

''It has the effect of at least driving a dialogue and discussion in the doctor's office, and with that increase in dialogue has got to come an increase in diagnosis, and that's a good thing, contrary to what the critics say.''

Much of the debate over prescription drug advertising is associated with costs, not medical questions. The American Medical Association and the Massachusetts Medical Society are not opposed to prescription drug advertising, although they have urged the FDA to ensure that safety and balanced presentations remain a high priority.

Dr. Thomas E. Sullivan, president of the Massachusetts Medical Society, said patients fall victim to advertising for ''me-too drugs,'' new, expensive treatments for an ailment that already has cheaper generic drugs available.

Massachusetts doctors said they worry that the ad spending is raising the cost of drugs. Dr. Svend W. Bruun, an internist in Fitchburg for 30 years, questioned whether more ad spending leads to higher drugs costs.

''If they are spending $17 billion on advertising, to get between us and the consumers, how much cheaper can that pill be if they backed off?'' he said. ''I've got a blue-collar community here, and a lot of people just can't afford their meds.''

In Framingham, Dr. Stephen Hoffmann, also an internist, said he sees benefits in having better-educated patients. But he said his relationship with patients has been dramatically altered by drug marketing because patients already have their own ideas about specific medicines based on a 60-second commercial.

''If they come in and say, `Gee, I have low testosterone,' that really preempts the visit,'' he said. ''It obliges us to take five, 10, 15 minutes to respond in a very busy environment. In some cases, we're almost put on the defensive.''

Christopher Rowland can be reached at crowland@globe.com.

This story ran on page E1 of the Boston Globe on 6/12/2003.
© Copyright 2003 Globe Newspaper Company.