Study to Examine Direct-to-Consumer Drug Ads on TV
[Writer] This is research news from UIC – the University of Illinois at Chicago.
Today, Sherry Emery, as senior research scientist at the UIC Institute for Health Research and Policy, talks about her study examining whether or not televised drug commercials educate patients and improve health, or help to drive drug sales.
Here’s Professor Emery:
[Emery] I’m really excited about this study because it’s a little bit of a departure from what I’ve been working on in the last ten years, which has been looking at the role of tobacco-related advertising on population smoking – whether or not people smoke, whether or not they’re interested in quitting. And as a result of that work we had access to a lot of Nielsen Ratings Data for pharmaceutical advertising — all prescription drug advertising that’s happened in the United States since 1996 when the FDA started to allow advertising for prescription drugs on TV.
And that’s particularly interesting because the United States is the only country in the world currently that allows the pharmaceutical companies to advertise prescription drugs on TV. For a while New Zealand allowed it and then they stopped it. Currently South Korea is debating whether it would be useful, but the United States is the only place that allows it.
And it’s controversial because the amount of advertising has gone up astronomically in the last 15-20 years. You see ads for pharmaceutical products on TV all the time. I think it’s the fourth biggest category of advertising on TV. And the increase in the amount of advertising has coincided with huge increases in health care costs. And it doesn’t necessarily mean that the advertising has caused all of the rise in health care costs, but it’s controversial. And on the one hand the pharmaceutical industry itself claims that these advertisements provide a public service, that they educate consumers and give people information to take to their doctors that might improve their health and ultimately result in lower health care costs. But there’s a lot of economists who would suggest that you don’t advertise a product unless you expect to make money from it and they might be driving excess demand.
We were aware of that debate and we were sitting on a pile of Nielsen data that was just going unused that we had as a byproduct of our tobacco research. So I don’t have an extensive background in pharmacy policy or pharmacoeconomics, but I did recognize that we have a goldmine here and that we’re uniquely positioned to take a look at this like nobody else has.
There’s been some research on the role of pharmaceutical advertising and health care costs, but there’s no consensus in the literature. One of the things that, when we were looking into this to see if this was a feasible study for us, one of the things I noticed was that the previous work (that doesn’t give us a strong conclusion) has involved studies of single classes of drugs.
So, for example, there’s a group from Harvard that looked at the role of advertising for blood pressure medication and they showed that expenditures in that class of drugs increased, but there was no significant difference by specific brand; which you would expect that advertising for a brand would increase demand for that particular product.
There’s other people who’ve looked at depression medication or drugs for arthritis. They have found either no difference in prescription volume. Some have done patient interviews and shown that patients are more likely to ask their physician for a particular prescription if they’ve seen an ad. So there was a lack of consensus because they’re looking at different classes of drugs and they’re using different methodologies – they’re looking at different outcomes like expenditures versus prescription volume versus individual patient responses about what they said to their doctor — so there’s mixed methods and mixed outcomes.
So the exciting thing for us is even though we’re kind of new in this area we’re uniquely positioned with this great data set of ratings data for prescription advertising that spans the whole country – so it’s all the top 75 media markets in the country – over the past sixteen years. So we’ve got nice variation in time, nice variation across geography, and we capture all the major types of drugs that have been advertised.
I think that unlike most other groups who’ve looked at this, we’ll really be able to take a comprehensive look. And thinking about it some more – some of the research questions that came out of our initial look into this was it made sense to us that there is no consensus because people have been looking across single categories of drugs. And it seems reasonable that an advertisement for a medication like a blood pressure medication or a cholesterol medication that treats a condition that doesn’t have any immediate health care outcome, might be different than an advertisement for an asthma medication, where if you don’t adhere to that medication you may end up in the hospital or in the emergency department with a flare up of your asthma.
Or similarly, it stands to reason that an advertisement for a sleeping aid or depression medication or medications for erectile dysfunction might operate differently than an advertisement for something like an asthma medication or cholesterol.
So we went in to the proposal with the hypothesis that well maybe there’s no one single answer ‘does pharmaceutical advertising induce excess demand?’
It might have one effect across one type of drug category and an entirely different effect across a different type of drugs where using this drugs is more discretionary unless critical to maintaining your health.
So that was kind of the overarching question that we had. When we looked a little bit more closely at the data that we had access to, we’ve got the great advertising data, we partnered with a group at the University of Chicago that has access to great health care utilization data. So they have insured patients from all of the major employers in the United States; they’ve got millions of patients so we get doctors visits, we get new prescriptions, prescription refills – and we also have related hospitalizations so we can look across the spectrum of health care utilization and we can also control for patient characteristics like co-morbidities – so how much does it affect a person’s response to advertising if they are already taking a lot of other medications, or if they live in a part of the country where they have only one or two physicians in their community to go to as opposed to having a community with a number of physicians, where a physicians says ‘no I’m not going to give you that prescription’ they might be able to go shop around a little bit. So those are the types of things that we can control for that makes our approach unique and not really done before. The final thing that we’re going to be able to do, which I think is really interesting, is look at the content of the advertisements themselves, so not just across drug class. But there’s three different types of pharmaceutical ads and they’re subject to different levels of regulation by the FDA. So there’s the types of advertisements that tell you this drug is for this condition and here’s how it will help you but here’s all the side effects. You’re subject to death, dismemberment, spontaneous combustion, everything if you take this drug. There are others that are called reminder ads that say if you take this drug – but it doesn’t say for this condition – and they have to provide fewer disclosures. There’s help-seeking drugs that vaguely refer to a condition and flash the drug name, but really can give no other information. So it’s conceivable that the different types of advertising are used differently by drug class and that they might affect the way people respond to the advertisement in terms of their health seeking behavior and their demand for the medication.
So our study is really unique in three ways: one that we can look across drug classes, two that we can control for individual patient characteristics, and three that we’re going to look at the actual content of the advertising in terms of the different types of approaches that the drug companies can use.
[Writer] Sherry Emery is a senior research scientist at the UIC Institute for Health Research and Policy an a research assistant professor of economics.
For more information about this research, go to www.news.uic.edu, click on news releases and look for the release date September 14, 2011.
This has been research news from UIC – the University of Illinois at Chicago.