DTC: the new philosopher’s stone?
pharmafile | October 15, 2003 | Feature | Medical Communications |Â Â EU, advertising, direct to consumer, dtcÂ
Marketers in the pharma industry have always been hampered by the limited number of ways they can use to get their message across to prescribers. In the 1970s there were just three channels – sales representatives, advertising in professional media and direct mail. Over the years, attempts have been made to widen the bridgehead, for example, by engaging in various PR activities. These have tended to work better in the US than in Europe, where the relationship between the medical profession and the industry is more arms length. On the other hand, prescription-to-OTC switching has been successful on both sides of the Atlantic and has widened the customer base for a number of products, but the necessary quantum leap in promotional costs has left some companies less than euphoric about the bottom line.
The advent of DTC
Enter direct to consumer advertising, seen by some as the pharma equivalent of the philosophers stone, which can be used to create gold. The thinking is that, having informed the doctor about your new product (with the usual high-grade support from trial results in peer-reviewed journals, and the rest), you then make its virtues known to patients so that they apply grass-roots pressure for prescriptions. The doctor is targeted not only by the usual expert endorsement supporting the product, but also, and most potently, by consumers creating a demand for it. The problem is that, until recently, it has been illegal to advertise prescription-only products to the public; indeed, it still is in Europe. But in the US, a legislative change in 1997 opened the way for DTC advertising in broadcast media, and we can now begin to see the effect this has had on pharmaceutical sales in the world's biggest marketplace.
The event that opened the door for DTC advertising was a change of heart at the Division of Drug Marketing, Advertising and Communications of the FDA. New guidance relaxed the regulations for the broadcast advertising of prescription products, and allowed for brand name and indication to appear in the same broadcast advertisement without the brief summary of prescribing information, as long as there was "adequate provision" for disseminating package labelling information. Although the scope of the change in DTC was narrow – covering TV and radio advertising – it has had enormous impact.
Effect of DTC in US
Delegates at the 1999 annual meeting of the American Association of Pharmaceutical Scientists heard a presentation about a telephone survey of doctors supported by funding from the RW Johnson Research Institute (an arm of Johnson & Johnson) about the effects of DTC advertising. About one-third of 199 primary care doctors were influenced by patient pressure to prescribe drugs they had seen advertised in the media, even when the drug in question may not have been the doctor's unprompted first choice. Doctors taking part in the survey reported that, on average, five patients asked them to prescribe a specific product each week. TV advertisements were the most frequent source of patients' information (77%).
There is evidence that this heightened level of demand for specific prescription products has translated into increased sales. According to the IMS publication 'Pharma Prognosis International', which covers the period 2000-4, growth in the international pharma market is driven mainly by the US, the largest and fastest-growing market. The US market is buoyed by increased DTC advertising and wider access to prescription drugs. A higher proportion of US pharmaceutical companies' promotional expenditure is being allocated to DTC advertising, which rose 38% in 1999 to account for 13% of the total $13.9 billion industry promotional spend.
The IMS report predicted that increasing investment in DTC advertising would drive an increase in volume in the US, which saw 9% more prescriptions dispensed in 1999. Fig 1 shows the predicted CAGR for national markets to 2004; the mean rate for all countries included is 7.4%, and the US growth, at 11%, is significantly higher than that. In fact, the US market has outstripped even this buoyant prediction; in the twelve months to May 2002, US sales (again according to IMS) were up 16% to $139.8 billion.
Effect on doctors' attitudes: the FDA survey
Although increased sales of prescription brands is gratifying in the short-term for pharma shareholders, there is a potential downside to the DTC strategy: the risk of damaging the relationship between the industry and the medical profession, and between doctors and their patients. In January 2003, the FDA published the results of a survey into the effect of DTC advertising on physician-patient relationships. The survey involved 250 general practitioners and 250 specialists and its findings offer rich pickings for both opponents and supporters of DTC advertising. For example, 62% of doctors say that patients often ask about prescription drugs, and 71% state that the frequency of these questions has increased over the last five years. This can be taken to suggest a welcome increase in patient awareness. However, when patients enquire about prescription drugs that they have seen advertised, 59% of doctors felt that their interaction with the patient was not benefited by the advertisement, although only 18% felt that problems had arisen because the patient saw the advertisement.
The survey offered a revealing sidelight on the way in which patient pressure does, or does not, translate into altered prescribing practice. In 86% of cases, patients asked about a specific drug, by brand name. However, only 59% of patients asked the doctor to prescribe a specific brand; and just 57% of doctors did prescribe the brand specified by the patient.
When asked to what extent DTC advertising makes patients think that drugs work better than they do, 32% of doctors ticked 'a great deal', and 43% specified 'somewhat'. Only 24% thought that advertising had little or no negative effect in this respect. However, when asked if advertising made patients more involved in their healthcare, the responses were a 'great deal' in 11% of cases and somewhat for 47%.
DTC in Europe
The key questions for European marketers are: will it happen here? To what extent? And when? The answers may be probably, moderately, and not that soon.
Back in mid-2002 the European Commission proposed a very limited relaxation in the blanket prohibition previously preventing companies from advertising their prescription products direct to the consumer. In fact, the proposal did not involve advertising at all, but rather the provision of information. It is relevant to distinguish between DTC advertising and the wider field of DTC communications, which includes communication via the Internet, patient education, word of mouth, and use of editorial space or air time in print and broadcast media.
The EC proposed a three-year trial period during which the pharma industry would be permitted to provide monitored information to patients with diabetes, HIV/AIDS and asthma. For some critics this was the thin end of the DTC wedge; others criticised the proposal roundly for not going far enough. The proposal was decisively rejected in a first round vote by the European Parliament in October 2002. The proposed scheme was strongly opposed by MEPs. Perhaps surprisingly, the ABPI and its European counterpart the EFPIA have opposed the plan, believing it to be more restrictive than existing regulations. Dr Trevor Jones, Director General of the ABPI, is quoted as saying: "I am delighted that these restrictive proposals have been turned down by the European Parliament."
The issue is now under review by the Council of Ministers, who have the power to make the MEPs consider the plans again. Any measures are unlikely to be implemented before 2004.
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