The Educational Value of Consumer-Targeted Prescription Drug Print Advertising

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Original Research

The Educational Value of Consumer-Targeted Prescription Drug Print Advertising

J Fam Pract. 2000 December;49(12):1092-1098

References

1. Holmer AF. Direct-to-consumer prescription drug advertising builds bridges between patients and physicians. JAMA 1999;281:380-82.

2. Hollon MF. Direct-to-consumer marketing of prescription drugs: creating consumer demand. JAMA 1999;281:382-84.

3. Barrett A. Are drug ads a cure-all? Business Week March 30, 1998;59-60.

4. Growth seen in ads for direct-to-consumer drugs. AMA News April 27, 1998;16.-

5. Maguire P. How direct-to-consumer advertising is putting the squeeze on physicians. ACP-ASIM Observer 1999;19:1, 24-25.

6. Pierpaoli PG. ASHP’s position on direct-to-consumer advertising of prescription drug products. Am J Hosp Pharm 1986;43:1763-65.

7. Cohen EP. Direct-to-the-public advertisement of prescription drugs. N Engl J Med 1988;318:373.-

8. Committee on Drugs. Prescription drug advertising direct to the consumer. Pediatrics 1991;88:174-75.

9. Bradley LR, Zito JM. Direct-to-consumer prescription drug advertising. Med Care 1997;35:86-92.

10. T’hoen E. Direct-to-consumer advertising: For better profits or for better health? Am J Health-Syst Pharm 1998;55:594-97.

11. Wall Street Journal August 22, 1997; 168:B5. Schering-Plough is told to halt Claritin TV ads.

12. Wilkes MS, Doblin BH, Shapiro MF. Pharmaceutical advertisements in leading medical journals: experts’ assessments. Ann Intern Med 1992;116:912-19.

13. Stryer D, Bero LA. Characteristics of materials distributed by drug companies: an evaluation of appropriateness. JGIM 1996;11:575-83.

14. Avorn J, Chen M, Hartley R. Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med 1982;73:4-8.

15. Schommer JC, Doucette WR, Mehta BH. Rote learning after exposure to a direct-to-consumer television advertisement for a prescription drug. Clin Ther 1998;20:617-32.

16. Ingram RA. Some comments on direct-to-consumer advertising. J Pharm Marketing Manage 1992;7:67-74.

17. Wind Y. Pharmaceutical advertising: a business school perspective. Arch Fam Med 1994;3:321-23.

18. Rubin PH. What the FDA doesn’t want you to know. Am Enterprise 1991;2:18-20.

19. Lipsky MS, Taylor CA. The opinions and experiences of family physicians regarding direct-to-consumer advertising. J Fam Pract 1997;45:495-99.

20. Peyrot M, Alperstein NM, Van Doren D, Poli LG. Direct-to-consumer ads can influence behavior: advertising increases consumer knowledge and prescription drug requests. Marketing Health Services 1998;18:26-32.

21. Bell RA, Kravitz RL, Wilkes MS. Direct-to-consumer prescription drug advertising, 1989-1998: a content analysis of conditions, targets, inducements and appeals. J Fam Pract 2000;49:329-35.

22. Keith A. The benefits of pharmaceutical promotion: an economic and health perspective. J Pharm Marketing Manage 1992;7:121-33.

23. Whyte J. Direct consumer advertising of prescription drugs. JAMA 1993;268:146,150.-

24. Reynolds WJ. Trends in advertising pharmaceuticals: a publisher’s perspective. J Pharm Marketing Manage 1992;7:5-22.

25. Masson A, Rubin PH. Matching prescription drugs and consumers. N Engl J Med 1985;313:513-15.

26. Katz WA. Magazines for libraries. New Providence, NJ: R.R. Bowker; 1997.

27. Cohen J. A coefficient of agreement for nominal scales: educational and psychological measurement 1960;20:37-46.

28. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.

29. Hays WL. Statistics. New York, NY: Holt, Rinehart, and Winson, 1981.

30. Everitt BS. The analysis of contingency tables. London, England: Chapman and Hall; 1980.

31. Petty RE, Cacioppo JT. Communication and persuasion. New York, NY: Springer-Verlag; 1986.

32. National Institute for Health Care Management, Research and Education Foundation. Factors affecting the growth of prescription drug expenditures. July 9, 1999. Available at www.nihcm.org.

33. Bell RA, Kravitz RL, Wilkes M. Direct-to-consumer prescription drug advertising and the public. JGIM 1999;13:651-57.

34. Bell RA, Wilkes MS, Kravitz RL. Advertising-induced prescription drug requests: patients’ anticipated reactions to a physician who refuses. J Fam Pract 1999;48:446-52.

35. Wilkes MS, Bell RA, Kravitz RL. Consumer-directed prescription drug advertising: trends, impact, and implications. Health Aff 2000;19:110-28.

Methods

Sampling Procedure

Major popular magazines were ranked in terms of the average number of advertising pages sold from 1989 through 1996 (the last year for which data were available) and then grouped into an established set of categories.²⁶ The highest-ranked publication within each of 13 categories was selected for inclusion in our sample. To these magazines we added 5 publications with audiences composed of narrower segments of our population defined by ethnicity, age, and sexual orientation. Thus, we garnered our sample of advertisements from 18 diverse publications Table 1. All the advertisements promoting a specific, named prescription drug that appeared in these magazines from January 1989 through December 1998 were photocopied. Advertisements for the same brand often differed in nonsubstantive ways and were thus coded as a single case based on detailed rules that are available from the authors. After aggregating essentially identical advertisements, 320 remained for analysis covering 101 distinct brands.

Medical Conditions Classification

Each advertisement was grouped in one of 14 medical condition categories based on the indication of the marketed drug. The numbers of advertisements and brands within each of these categories were as follows: allergies (46 advertisements, 8 brands); cancer (2, 2); cardiovascular disease (36, 10); dermatologic conditions (37, 12); diabetes (9, 4); gastrointestinal/nutritional disorders (17, 7); human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS; 33, 11); infections, non-HIV (16, 6); musculoskeletal disorders (17, 7); obstetric/gynecologic conditions (45, 10); psychiatric/neurologic disorders (17, 7); respiratory disorders (3, 3); tobacco addiction (23, 6); and urologic conditions (19, 8).

Advertisement Coding

Two coders independently analyzed each advertisement. Our goal for this classification effort was to determine whether each advertisement contained 5 kinds of information pertaining to the focal medical condition and 6 types of drug treatment information Table 2.

Statistical Analyses

We examined each of the 11 education codes listed in Table 2 and computed 3 more general measures. We created a condition information index by summing the number of medical condition codes present within each advertisement (theoretical range=0-5). Likewise, a treatment information index was computed by summing the number of treatment codes present within each advertisement (theoretical range=0-6). A combined education index was created by adding the condition and treatment information variables (theoretical range=0-11).

The reliability of coding was assessed with the k statistic, a measure of inter-rater agreement with a range of 0 to 1.0.²⁷ The mean k value for the variables reported was 0.91 (range=0.88-1.0). Landis and Koch²⁸ suggest that k values in this range can be considered “almost perfect.”

We employed 2 units of analyses. For our descriptive analyses, the advertisement served as the unit of analysis (N=320). We relied on the brand (N=101) as the unit of analysis when computing cross-tabulations and one-way analyses of variance. Using the advertisement as the unit for inferential statistical analyses would have violated the assumption of independence of observations,²⁹ because most advertisements for a particular brand represent alterations of earlier promotions for that brand. The advertisements for each brand were aggregated into a single case by weighting; each advertisement was assigned a weight of 1/n, with n representing the number of advertisements for that brand. When a significant chi-square value was obtained for a cross-tabulation, the source of significance within the table was determined by examining the cell-adjusted standardized residuals using a P <.05 criterion.³⁰

Results

The Figure shows the percentage of advertisements for which the 5 medical condition information codes and 6 treatment information codes were present. These results have been ordered in the Figure on the basis of frequency of occurrence.

Information About Medical Conditions

The medical condition name was provided in virtually all of the advertisements (95%). This information was excluded in 1 “teaser ad” that simply showed a bottle of tablets for a forthcoming treatment, in 7 advertisements alerting patients of a new formulation of a drug already prescribed for them, and in 9 advertisements notifying patients of an alternative delivery system for an established treatment. Sixty percent of the advertisements described at least one symptom of the condition treated by the promoted drug or explicitly stated that the condition could be a “silent disease”. Among those advertisements that omitted symptom information, 54% were targeted to individuals who had already been diagnosed with the condition and were presumably aware of its symptoms. The remaining advertisements tended to be for conditions with well-known symptoms (eg, pregnancy, impotence, and tobacco addiction). Information about a precursor to the condition such as a cause or risk factor was provided in 27% of the advertisements. A total of 6% of advertisements provided precursor information by means of a set of diagnostic questions, such as a quiz that readers could use to assess their risk of being or becoming affected by the condition (data not diagramed). Information about condition prevalence (12% of advertisements) and clarifications about a condition-related misconception (9%) was rarely provided.