US direct-to-consumer advertising ambiguous in communication of drug benefits

October 04, 2001

US consumers are given incomplete prescription-drug information in advertising campaigns directed to them, report Dartmouth Medical School/Veterans Affairs physicians.

Pharmaceutical companies spent $1.8 billion on direct-to-consumer advertisements for prescription drugs in 1999. Drs. Steven Woloshin, Lisa Schwartz, both assistant professors and H. Gilbert Welch, professor of medicine and of community and family medicine, from Dartmouth Medical School and the Veterans Affairs Medical Center (White River Junction, VT) investigated what messages these advertisements communicated to the public. Their study, published in the October 6 issue of The Lancet (p 1141) highlights how consumers can be ill informed.

Reaction to direct-to-consumer advertising for prescription drugs is mixed; proponents argue that it provides consumers with information about treatment options, and might help to increase public awareness and treatment of serious diseases such as diabetes, high blood pressure, or depression. Opponents express concern that such advertisements might inappropriately increase patient demand for specific (and often costly) agents, which might have a negative effect on medical practice and on the physician-patient relationship.

The investigators assessed prescription-drug advertising in 10 leading magazines. They included four women's magazines (Family Circle, Ladies Home Journal, Better Homes & Gardens, Good Housekeeping), three men's magazines (Sports Illustrated, Men's Health, Gentleman's Quarterly) and three general population magazines (Time, Newsweek, People).

Woloshin comments: "We selected 10 popular magazines with large circulations and varied readership to study. Consumers are increasingly exposed to direct-to-consumer advertisements for prescription products. In turn, physicians are increasingly confronted with patients who ask questions, or who make suggestions, on the basis of these advertisements. We hope that our study has provided clinicians with some sense of the content of direct-to-consumer advertisements.

"Our findings indicate that these advertisements rarely quantify a medication's expected benefit, and instead make an emotional appeal. This strategy probably leaves many readers with the perception that the drug's benefit is large and that everyone who uses the drug will enjoy the benefit. The provision of complete information about benefit would serve the interests of physicians and the public."

The researchers examined seven issues of each title published between July 1998, and July 1999. They documented 67 advertisements that appeared a total of 211 times during the study, and were more often placed in magazines predominantly read by women. Of these, 133 (63%) were for drugs to alleviate symptoms, 54 (26%) to treat disease, and 23 (11%) to prevent illness.

In the 67 different advertisements, promotional techniques used included emotional appeals (45, 67%) and encouragement of consumers to consider medical causes for their experiences (26, 39%). Nearly 90% of advertisements described the benefit of medication in vague, qualitative terms RATHER than with data; however, half the advertisements used data to describe infrequent side-effects. No advertisements mentioned cost.
For further information, contact: Dr. Steven Woloshin, VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, Dartmouth Medical School, White River Junction, VT 05009, 802-296-5178; or 802-296 6325; or email:

The Geisel School of Medicine at Dartmouth

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