FEBRUARY 01, 2006
Jamie Swedberg

Recent troubles with cyclooxygenase (COX)-2 inhibitors may have contributed to a change in attitudes toward direct-to-consumer (DTC) drug advertising, as suggested by an annual survey released in March of last year.

The 2005 National Survey on Consumer Reaction to DTC Advertising of Prescription Medicines was a nationwide telephone survey of 1504 adults conducted by Princeton Survey Research Associates (PSRA) International for Rodale Inc's Prevention and Men's Health magazines. The survey has been conducted annually for the past 8 years with only minor changes in subject matter. Last year's questionnaire, however, was administered between December 28, 2004, and January 12, 2005, in the wake of Merck's withdrawal of rofecoxib (Vioxx) and Pfizer's decision to stop advertising of celecoxib (Celebrex). New studies have shown that these arthritis medications increased the risk of heart attack and/or stroke in certain patients.

"The timing this year was really unusual," says Larry Hugick, chairman of PSRA. "We had just seen the publicity [about the COX-2 inhibitors], and I have to believe that a lot of consumers had conversations with their doctors about side effects. It may have been about medicines they were already taking. I think that made it more likely that their recent conversation didn't involve asking for a medicine."

The survey, which has a margin of error of 3 points, shows a 5% decrease in patients asking a doctor specifically for drugs they had seen in advertisements. Among those who asked for DTC-advertised drugs, 18% fewer patients received the medication than in the previous year.

The drop occurred despite a 121% increase in drug company spending on DTC advertising in the past year. According to estimates by TNS Media Intelligence, pharmaceutical firms spent nearly $4.2 billion in 2004 to market drugs to patients.

Although patients are requesting specific drugs less often, the survey suggests they are relying on DTC advertising as an informational resource. After reading or viewing advertisements, many go on to ask their doctors for more information.

"There's sort of a standard percentage of Americans—about a third—who say that they've talked to their doctor [about a drug] after seeing one of these ads,"Hugick says. "That percentage does not change much from year to year."

He suggests that, ideally, advertisements should inspire discussion between patients and doctors, not necessarily make a patient ask for a particular prescription.

"Many within the industry see [the drop in specific drug requests] as a negative, but I think it's a fairly complicated issue,"he says. "We do know that consumers were more interested in risk information this year than they were in the previous year. And those who noticed the risk information rated it more useful than the benefit information. They seem to be pleased with what they found."

Hugick said that the Rodale survey from 2005 differed significantly in one respect from previous years' surveys: It asked about Internet use. About 20% of respondents said they had gone on-line to look for information on prescription medicines, compared to approximately half who said they had consulted DTC ads.

"There is still quite a gap there,"Hugick says. "[The Internet] is not used nearly as much yet as these other sources."

He adds that the recent arthritis drug troubles affected Internet use in much the same way that they affected patients' use of advertisements. Patients tend to look for information about drugs they have already taken, rather than research new drugs before asking a doctor for a prescription.

Hugick urges caution in drawing conclusions from the survey results. "One of the problems in interpreting these results, though, is that there is so much more competition," he says. "If doctors have more choices about what to prescribe, that alone should mean that they are less likely to give these respondents the medicines that they might ask for."

Hugick says the survey has consistently shown that good risk information is good business for pharmaceutical companies. "It may be hard for some in the industry to accept that, but that's what we found,"he says. "So now I think that we have to wait and see what the survey shows next year."

Ms. Swedberg is a freelance medical writer based in Woodville, Ga.

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