Content Analysis of Psoriasis and Eczema Direct-to-Consumer Advertisements

Comment

In our study of televised DTC advertisements for psoriasis and eczema in the United States, we identified underrepresentation of racial/ethnic minorities and specific age groups (older adults for psoriasis and all adults for eczema) across all advertisements. Although psoriasis is suggested to be less prevalent among minority patients (1.3%–1.9% among Black patients and 1.6% among Hispanic patients) compared to White patients (2%–4%),^16,17 minority vs White representation in psoriasis DTC advertisements was disproportionately lower than population-based prevalence estimates. Direct-to-consumer advertisements for eczema included more minority characters than psoriasis advertisements; however, minority representation remained inadequate considering that childhood eczema is more prevalent among Black vs White children,¹⁸ and adult eczema is at least as prevalent among minority patients compared to White patients.¹⁹ Not only was minority representation in all advertisements poor, but advertisement placement also was suboptimal, particularly for reaching Black viewers. FOX network was home to 2 of the top 3 primetime broadcast programs among Black viewers around the study period,¹³ yet no DTC advertisements were aired on FOX. Together, our findings suggest inadequate patient reach of psoriasis and eczema DTC advertisements that, particularly in the case of psoriasis, mirror and may reinforce existing age and racial disparities in treatment^5-7 and poor familiarity with biologics.¹⁰ A similar impact of eczema DTC advertisements on emerging eczema treatment patterns and potential treatment disparities also might be anticipated and is of concern.

The current literature regarding minority representation in DTC advertisements is mixed. Some studies report underrepresentation of Black and other minority patients across a variety of diseases.²⁰ Other studies suggest that representation of Black patients, in particular, generally is adequate, except among select serious health conditions, and that advertisements depict tokenism or stereotypical roles for minorities.²¹ Our study provides new and specific insight about the state of racial/ethnic and age diversity, or lack thereof, in DTC advertisements for the skin conditions that currently are most commonly targeted—psoriasis and eczema. Although it remains unclear whether DTC advertisements are good or bad, existing data suggest that potential benefits of DTC advertisements include strengthening of patient-provider relationships, reduction of underdiagnosis and undertreatment of disease, and reduction of disease stigma.²² However, in our analyses, we found disease-specific factual content among all DTC advertisements to be sparse and obvious depictions of skin disease and symptoms to be uncommon, especially for psoriasis. As such, it seems unlikely that existing DTC advertisements for psoriasis and eczema can be expected to contribute to meaningful disease education, reduce underdiagnosis, and reduce the stigmatizing attitudes that have been documented for both skin diseases.^23-25

Furthermore, it is important to consider our findings in light of the role that social identity theory plays in marketing. Social identity theory supports the idea that a person’s social identity (eg, age, gender, race/ethnicity) influences his/her behavior, perceptions, and performance.²⁶ The principle of homophily—the tendency for individuals to have positive ties to those who are similar to themselves—is a critical concept in social identity theory and suggests that consumers are more likely to pay attention to and be influenced by sources perceived as similar to themselves.²⁰ Thus, even if the potential benefits of DTC advertisements were to be realized for psoriasis and eczema, the lack of adequate minority and older adult representation raises concerns about whether these benefits would reach a diverse population and if the advertisements might further potentiate existing knowledge and treatment disparities.

Limitations
Our study is not without limitations. The sampling period was short and might not reflect advertisement content over a longer time course. We did not evaluate other potential sources of information, such as the Internet and social media. Nevertheless, televised DTC advertisements remain a major source of medical and drug information for the general public. We did not directly evaluate viewers’ reactions to the DTC advertisements of interest; however, other literature lends support to the significance of social identity theory and its impact on consumer behavior.²⁶

Conclusion

Our study highlights a lost opportunity among psoriasis and eczema DTC advertisements for patient reach and disease education that may encourage existing and emerging knowledge and treatment disparities for both conditions. Our findings should serve as a call to action to pharmaceutical companies and other organizations involved in creating and supporting DTC advertisements for psoriasis and eczema to increase the educational content, diversify the depicted characters, and optimize advertisement placement.