Industry on DTC Advertising Study: An Informed Patient Enables Better Care

Dec. 3, 2012 – Several industry advertising experts have weighed in regarding what message drug companies should take from a recent study published in Cancer regarding the impact of direct-to-consumer (DTC) advertising for aromatase inhibitors (AIs). The study, released in November, found that DTC advertising (DTCA) for AIs “was associated with increases in appropriate prescriptions with no significant effect on inappropriate prescriptions,” and noted that DTCA “may actually be beneficial.”

“This study demonstrates that DTC advertising helps get patients the right drugs to treat their conditions,” said Matt Giegerich, Chairman & CEO, Ogilvy CommonHealth Worldwide and Chair-elect of the Coalition for Healthcare Communication (CHC). “Let’s hope that public policy makers read and understand that this peer-reviewed research demonstrates that marketing often leads to more effective patient care.”

Jim Davidson, Executive Director, The Advertising Coalition, told the CHC that the study “seems to recognize what we’ve been saying for years: That DTC advertising is very important to the dialogue between doctors and patients.”

Davidson explained that this study, among others, helps to support the First Amendment argument that making more information – instead of less – available to the public is beneficial. “Any time we try to take information off the table and keep it away from consumers we do them a disservice,” he said. “We all perform better when we are armed with information.”

John Kamp, Executive Director of the CHC, noted that because

the report summarizes peer-reviewed research and is not initiated or supported by industry, “it is strong evidence supporting the value of marketing in

the delivery of appropriate care, blowing away much of the unsupported criticism that marketing leads to inappropriate prescribing. Though critics may well continue their refrain, this study proves it’s out of tune with solid evidence.”

The Cancer study authors state that although “the literature largely demonstrates that DTCA increases demand … it is unclear whether this increase is ultimately beneficial or harmful to patients.” They attribute this ambiguity to the difficulty in defining “appropriate and inappropriate use in an easily measurable way for most medications advertised in this manner.”

The researchers chose to study the effects of DTCA for AIs, a class of oral breast cancer therapies that reduce the risk of cancer recurrence in postmenopausal women – an appropriate use – because the drug also has a corresponding inappropriate use in the premenopausal population. As such, patient age could be used as “strong proxy for menopausal status” and as a “surrogate marker of appropriateness.”

The hypothesis for the study, which tracked prescription data from October 2005 to September 2007, was that there would be a significant increase in AI use associated with DTCA in all age groups, “both for older women, for whom this treatment is appropriate, as well as for younger, presumably premenopausal women for whom such treatment is inappropriate.”

However, the researchers found “that increases in DTCA for the AIs prompted prescriptions only in the patient population for whom they were appropriate,” which they state is due either to “perfectly successful targeted marketing” or, more likely, to physicians selectively blocking “the effect of advertising-induced interest in these agents among patients for whom they would be medically inappropriate.”

If the latter is the case, DTCA might be having a negative effect on the time management of physicians who have to spend time with patients explaining why a specific medication is not right for them, the authors state. However, Davidson suggested that for both patients and doctors, “the single most valuable resource is time, and it takes a lot less time to explain a condition and treatment options when a patient is knowledgeable.”

He added that the study also underscores the role of a doctor as a learned intermediary. “Doctors clearly are fulfilling this role as it was anticipated,” he said. “And most doctors would rather have an educated patient, even if they have to explain a condition further and redirect a patient” to a medicine that better suits his or her condition.

The study authors do speak to these benefits, stating that “DTCA may also have positive effects in addition to the increased demand for appropriate medication use that we found, such as increases in high-priority diagnoses, fostering medication compliance and encouraging patients to communicate with their physicians.” However, these benefits “are not well-characterized and merit further study,” they note.

The researchers conclude that their data suggest “that this controversial form of medical communication may not be harmful for certain classes of drugs such as cancer medicines.”