Original Research

Direct-to-Consumer Prescription Drug Advertising, 1989-1998: A Content Analysis of Conditions, Targets, Inducements, and Appeals

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BACKGROUND: We conducted a content analysis of consumer-targeted prescription drug advertisements to explore trends in prevalence, shifts in the medical conditions for which drugs are promoted, reliance on financial and nonmonetary inducements, and appeals used to attract public interest.

METHODS: We collected the drug advertisements appearing in 18 consumer magazines from 1989 through 1998. Two judges independently coded each advertisement and placed it in a category pertaining to the target audience, use of inducements, and product benefits (mean k=0.93). We employed descriptive statistics, cross-tabulations, and curve estimation procedures.

RESULTS: A total of 320 distinct advertisements were identified, representing 101 brands and 14 medical conditions. New advertisement and brand introductions increased dramatically during this decade. Advertisements for drugs used for dermatologic, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and obstetric/gynecologic conditions were most common. Almost all of the advertisements were aimed at the potential user of the drug, not third-party intermediaries such as parents and spouses. Although most advertisements were gender-neutral, women were more likely to be exclusively targeted. One eighth of the advertisements offered a monetary incentive (eg, a rebate or money-back guarantee), and one third made an offer of additional information in printed or audio/video form. The most common appeals used were effectiveness, symptom control, inno-vativeness, and convenience.

CONCLUSIONS: Consumer-directed prescription drug advertising has increased dramatically during the past decade. The pharmaceutical industry is turning to this type of advertising to generate interest in its products. Our data may be useful to physicians who want to stay abreast of the treatments that are being directly marketed to their patients.

Direct-to-consumer (DTC) advertising of prescription pharmaceuticals in the United States is a fast-growing, much-heralded, and important phenomenon. The purpose of this type of advertising is to induce consumers to request prescriptions from their physicians, usually from their primary care physician.1 The amount of money the pharmaceutical industry spends annually on DTC advertising is expected to quadruple current levels during the next few years and may approach $7.5 billion by 2005.2,3 Regulatory oversight of this form of advertising has been the responsibility of the US Food and Drug Administration (FDA) since 1962.4 Historically, the industry’s advertising has been placed in medical journals. However, in the early 1980s several companies began to promote their drugs directly to consumers. The FDA obtained a voluntary moratorium on this type of advertising in 1983, which was then lifted in 1985.5

Despite the FDA’s green light, the industry did not resume advertising to consumers in earnest until 1990. Regulations have dictated that a DTC advertisement must include a brief summary of indications, side effects, and contraindications.6 As a result, advertisements were initially placed primarily in magazines and newspapers, because it was difficult to fulfill the brief summary requirement in a broadcast advertisement.7 This requirement was relaxed in 1997, leading to the recent emergence of DTC advertisements on television.8

Members of the medical profession have editorialized on the promise9,10 and pitfalls11 of DTC advertising. Disputes have focused on issues such as whether this type of advertising simultaneously informs and influences consumers,12 enhances or worsens health outcomes,13,14 leads to the treatment of underserved patients or to an overmedicated society,15 improves or hurts the physician-patient relationship,16 and educates or confuses the consumer.17 We seek to improve the quality of this policy debate through a descriptive analysis of the content of prescription drug promotions that have appeared in popular US magazines from 1989 to 1998.

Our study addresses 4 sets of concerns. First, we examine trends in the breadth of DTC advertising to augment available data on advertising expenditures. We also profile the medical conditions for which advertising has been used, because viewpoints about the appropriateness of DTC promotion sometimes have as their premise assumptions about the seriousness of the conditions for which drugs are advertised.18 Second, we examine the intended target of these advertisements to better understand the promotional strategies of the drug industry. Third, we describe the inducements offered to readers to promote demand for drugs. Fourth, we document the advertising appeals used to enhance a patient’s interest in the drugs, including selling points pertaining to the promoted drug’s effectiveness, social-psychological benefits, safety, and ease of use. In all likelihood, these appeals provide patients with motivation to request prescriptions and with arguments to present to the family physician.


Sampling Procedure

Advertisements were collected from 18 diverse magazines. Based on the annual reports of the market research firm CMR, leading American consumer 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 at the commencement of our project). The magazines were then stratified according to the classifications reported in Magazines for Libraries.19 The highest-ranked publication within each of the following 13 categories was selected for inclusion in our sample: business (Business Week), fishing/hunting/guns (Field & Stream), food/wine (Gourmet), home (Better Homes and Gardens), men (GQ), music (Rolling Stone), news and opinion (Time), parenting (Parents), personal finance (Money Magazine), sports (Sports Illustrated), tabloid/general editorial (Reader’s Digest), women (Vogue), and medicine/health (Prevention). To these magazines we added 5 publications targeted to narrower segments of the population defined by ethnicity (Ebony and Hispanic), age (Modern Maturity and New Choices for Best Years), and sexual orientation (The Advocate). With the exception of promotions for HIV treatments, which usually appeared in The Advocate, most of the advertisements in these supplemental publications were also found in the primary sample of magazines.


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