Direct-to-consumer advertising may not be giving big pharma such a big bang for its buck, after all. Despite the billions spent on bringing drug marketing campaigns straight into patients’ living rooms, such strategies have a modest effect at best—and in some cases, no effect at all.
“People tend to think that if direct-to-consumer advertising wasn’t effective, pharma wouldn’t be doing it,” said HMS professor of ambulatory care and prevention Stephen Soumerai, principal investigator on the study. “But as it turns out, decisions to market directly to consumers are based on scant data.”
The research was based in the Department of Ambulatory Care and Prevention of HMS and Harvard Pilgrim Health Care and appeared online Sept. 2 in BMJ. It is the first-ever controlled study of direct-to-consumer advertising (DTCA) of pharmaceuticals.
Currently, the United States and New Zealand are the only countries that allow drug companies to advertise directly to patients, and, as of 2005, pharma was spending about $5 billion annually in the United States on such campaigns.
The researchers took advantage of the proximity of the U.S. to Canada to conduct their study. DTCA is illegal across the border. Not surprisingly, however, national borders are leaky and American media regularly crosses over. As a result, Canadians, like Americans, are swamped with these ads—with one key exception.
All American advertisements are in English. Yet Canada has a significant French-speaking population. As a result, residents of Quebec, on the whole, are far less exposed to DTCA than other Canadians. The researchers compared prescription rates for advertised drugs in English-speaking Canadian provinces with rates in Quebec, where residents were purportedly less exposed to those same ads.
“It’s not an absolutely perfect control group,” said Michael Law, first author on the paper. “But as control groups go for this sort of observational study, it’s about as good as you get.”
Using information from IMS Health Canada, a health information company that receives data from a panel of about 2,700 Canadian pharmacies, the researchers analyzed prescription statistics over five years for each of three drugs: Enbrel (rheumatoid arthritis), Nasonex (nasal allergies), and Zelnorm (irritable bowel syndrome).
They found that for two of the drugs, Enbrel and Nasonex, DTCA had no effect whatsoever. Sales for Zelnorm, however, did spike noticeably in English-speaking Canada as soon as the ad campaign began. While prescriptions for the drug increased by over 40 percent, this jump was relatively short-lived, and after a few years, prescription rates in both groups resumed identical patterns.
The researchers hypothesize that DTCA may not be as effective as other types of consumer advertising because consumers cannot simply go out and buy prescription drugs.
Conflict Disclosure: The authors declare no conflicts of interest.
Funding Sources: HMS, Harvard Pilgrim Health Care, The Social Sciences and Humanities Research Council of Canada, The Alberta Heritage Foundation for Medical Research, and the Agency for Healthcare Research and Quality
