Even though drugmakers spent an estimated $3 billion in 2005 on those DTC ads in the US, the effort apparently failed to result in more prescriptions, according to researchers at Harvard University and the University of Alberta.
"People tend to think that if direct-to-consumer advertising wasn't effective, pharma wouldn't be doing it," Harvard Medical School's Stephen Soumerai says in a statement. "But as it turns out, decisions to market directly to consumers are based on scant data."
The researchers used French-speaking Quebec residents as their control group. Although DTC ads are illegal in Canada, English-dominant Canadians see a great deal of US advertising, but French-speaking Quebecois see far less and get most of their news from French-language media. As a result, they are less likely to be influenced, the researchers reported in the British Medical Journal.
Using information from IMS Health Canada, the researchers analyzed prescription statistics for each of these three drugs for a five-year period. They found that for two of the drugs, Amgen's Enbrel and Schering-Plough's Nasonex, DTC ads had no effect. Prescription patterns in English-speaking Canada and in Quebec remained identical both before and after DTC campaigns began.
Sales for Novartis' Zelnorm, however, did spike in English-speaking Canada as soon as ads appeared. While scrips increased by over 40 percent, this jump was relatively short-lived, and after a few years, prescription rates in both groups resumed identical patterns, they reported. A similar analysis of US Medicaid scrips found a slightly higher, but similarly brief, jump in sales.
"A person needs to see an ad, get motivated by that ad, contact their doctor for an appointment, show up at the appointment, communicate both the condition and the drug to the doctor, convince the doctor that this drug is preferable to other alternatives, then actually go out and fill the prescription," Soumerai tells Reuters. "This is a chain of events that can break at any point."
In April, a Kaiser Family Foundation report found 91 percent of adults surveyed had seen or heard DTC ads, but just one-third spoke to a doctor about a drug they saw advertised, and 54 percent got a scrip for a different drug. Among doctors, 76 percent said they sometimes recommend a different drug to a patient who mentions an ad and 5 percent said they frequently gave patients the drug.
9 Comments
I really wish the world would make up its mind. Are DTC ads the bane of all mankind as the Marcia Angells of the world contend or are they harmless since they don't work as "proven" in this study?
I won't comment on the Marcia Angells of the world since that ground has been covered many times. This particular study, though, is worthless in the US. It was based on a Canadian population that is very different culturally from the US and operates in a radically different healthcare system, with differing structures, incentives, expectations, etc.
Good point, atlex, I was thinking the same thing.
Ed -- I think the Reuters story missed a good chunk of the actual data -- consider the NEJM data we both blogged on, back on April 19, 2008:
http://shearlingsplowed.blogspot.com/2008/09/mixed-messages-do-those-expensive-tv.html
At least in the US -- and at least as to heavily advertised (with vignettes, actors playing doctors, etc.) -- I think the case can be made that the DTC Ads "helpd drive and create" accelerating demand for a product.
Hi Folks,
Good points, all. Yes, it should be noted that pharma has its own data on the utility and return on DTC ads - otherwise, why would they bother? And DTC ads aren't permitted in Canada, so the experience is likely to be different that in the US itself.
But I posted simply because the study appeared a bit provocative, given what we know about ad constraints in Canada and the proximity of some of its population to the US and subsequent exposure to TV ads.
I'm not endorsing the findings. I simply found them interesting and thought the study may engender some discussion for the reasons cited.
Cheers ed
It's an interesting and as Ed stated, provocative start.
The lore is that the DTC ads work, and this study is a beginning to actually look at data.
I cannot access the NEJM article proper, but I looked at the table, and if they worked as expected (in the case of the statins), then wouldn't there be an increase in statin market share? Maybe I am missing something here.
Clearly there is information out there stating that the DTC stuff works. Of course, it could also be someone justifying their jobs, salary and bonuses.
atlex makes an excellent point. As is often the case, the truth is more complicated as this issue is highly polarized given the increasing cost of health care.
What might happen is that the ads get people into their doctors and then they then get a treatment that fits them.
There is no one single best treatment for people, and consumers need to be informed and question!
Of course they work! They're the best thing since sliced bread. It's all about name recognition. Use a cutesy commercial to get the public interested and they'll flock to their doctors asking for the meds. Just look at the "two sources - food and family" campaign that merck and Schering-plough used for Vytorin. It took sales through the roof! DTC is investing for success.
The jury is definitely still out on this one.There is some evidence to spuuort both schools of thought. The main problem however, is evaluating the results of a DTC campaign (branded or unbranded)in isolation. Many of the big DTC promotions are run alongside an intensive rep promotion to doctors. No conclusive work separates the marketing effects of either. Sales increase but which campaign is really driving it.Research I have done does shows that DTC can drive patients to doctors but the evidence suggests that doctors push back against prescribing the promoted product. My feeling is that the effects of DTC advertising are limited and the huge amounts of money spent do not justify the results. Merck spent more on Vioxx advertising than was spent on advertising for Budweiser. Sales quadrupled that year, but was it the DTC or the rep promotion. I doubt whether they know....
From a Canadian perspective there may be some flaws with the assumptions made in the study methodology.
First is the assumption that US ads are seen in Canada. Some are, but most are not. That is because Canadian broadcast law mandates that cable companies delete ads on all TV shows that are appearing on Canadian channels at the same time as they appear in the US.
Here's what this means. While US residents are seeing DTC ads while watching episodes of "Lost", Canadians are watching the same episode on either a US or Canadian channel and the ads are replaced by the cable company with Canadian non-drug ads. This happens even if the viewer is tuned to a US station. So it would be interesting to know exactly what the exposure rate was for these ads to determine if they were above or below threshhold.
Second, Enbrel is subject to strict usage controls in Canada. So I as a patient could demand Enbrel until I was blue in the face and my doctor could agree that Enbrel was right for me. But if I don't meet the usage criteria set by the government drug plans, too bad. Therefore the assumption that Enbrel DTC advertising could affect prescribing in Canada should be questioned.
Regarding Zelnorm, one explanation could be that they had a very successful launch. Novartis has a strong presence in Canada. Perhaps then they moved their priorities into other areas.
Now, from a purely statistical point, and not to be boring, what was the null hypothesis being tested? Was it that DTC ads are effective or not effective? Then one could look at the methods and potential confounding factors and determine if the study was designed appropriately to reject the hypothesis.
Rule #1 for understanding the business world: "Never assume that large, complex, successful organization is guided by morons, just because you can't understand that organization's behaviour."
I blogged about this story, here: http://www.businessethics.ca/blog/2008/09/are-pharma-companies-idiots-unlikely.html