Robert Erlich, chief executive officer of Rx Insight Inc. and publisher of DTC Perspectives Magazine, told PT that it is not surprising that consumer-oriented advertising requires a larger budget than journal advertising. "Just look at the cost of the media. You pay $60,000 for some pages in People. A minute on ER can cost $500,000 to $600,000. You pay $2 million a minute for the Super Bowl. That's more than your whole journal budget for a year."
Pages in People or spot ads during the Super Bowl have also raised the visibility of DTC advertising, leading some critics to call for its regulation or elimination. Rep. Henry Waxman (D-Calif.), the ranking minority member of the House Governmental Reform Committee, told a hearing, "Whatever your view of whether these ads should be allowed (and frankly I don't believe they should), most of us would agree that we should have a system that ensures that direct-to-consumer drug ads are accurate and fair. We do not have such a system."
Sidney M. Wolfe, M.D., director of the Public Citizen Health Research Group, in a letter to the New England Journal of Medicine, said, "The education of patients -- or physicians -- is too important to be left to the pharmaceutical industry." Wolfe called on the National Institutes of Health and the U.S. Food and Drug Administration to "replace tainted drug company 'education' with scientifically based, useful information that will stimulate better conversations between doctors and patients and lead to true empowerment."
The American Medical Association, while refusing to petition the government to ban DTC advertising, has called for a regulation requiring ads to feature the sentence, "Your physician may recommend other appropriate treatments." In addition, the AMA plans to collaborate with the National Council for Patient Information and Education to create and distribute materials that will educate consumers and physicians about the risks, benefits and potentially misleading information in drug ads.
Critics of consumer-oriented promotion of prescription drugs say that ads are changing the physician-patient relationship and that physicians will feel pressured to prescribe drugs that patients ask about based on advertising. One study in Health Affairs concluded, "Clinical quality of care is harmed by DTC advertising." However, while definitive studies of the effect of advertising are only beginning, the preliminary findings do not seem to support the critics' worst-case fears.
Researchers led by Meredith Rosenthal, Ph.D., of the Harvard School of Public Health wrote in the New England Journal of Medicine, "The relatively moderate emphasis on direct-to-consumer advertising by the pharmaceutical industry contrasts with the apparent degree of concern about it among physicians and policy makers."
One survey Rosenthal cited "found that 71 percent of family physicians believe that direct-to-consumer advertising pressures physicians into prescribing drugs that they would not ordinarily prescribe."
Rosenthal's team found "relatively few people surveyed (less than 6 percent), however, actually received a prescription for the advertised drug after being prompted by direct-to-consumer advertising to ask their doctor about the drug."