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

Target Audiences

Our second set of questions concerned the kinds of consumers to which these advertisements are directed. Approximately 98% of the advertisements were judged as directed at the potential user of the drug; the remaining advertisements were aimed at third-party intermediaries (ie, the parent, spouse, or adult child of the potential patient). With regard to the sex of the targeted reader, 23% of the advertisements (18% of the brands) were judged as directed exclusively at women; 9% of advertisements (10% of the brands) were targeted exclusively to men; and 68% of advertisements (72% of the brands) were directed at both sexes.

Inducements

Our third set of questions addressed the nature of the inducements extended to consumers to encourage demand for the advertised pharmaceuticals. We examined 3 types of: patient support, information, and financial inducements. Patient support services were extended in only 3% of advertisements and 4% of brands.

Readers were offered additional printed information, such as free brochures or booklets in 34% of the advertisements (39% of brands). Audiotaped or videotaped information was available in 3% of the advertisements (6% of brands). Aggregating across format, 35% of advertisements (39% of brands) offered information in print or audio/video form. Offers of additional information were typically made available to the reader through a toll-free number.

With regard to monetary incentives, 13% of advertisements (9% of brands) offered a rebate or discount coupon. Only 1% of the advertisements provided a money-back guarantee; such a guarantee was extended at least once in the advertising campaigns for 3% of the brands. A total of 3% of the advertisements (4% of brands) offered a free sample of the product for the patient’s trial use. Of course, these inducements were available to patients through prescription only. Aggregating across these 3 monetary incentives, we found that 17% of the advertisements (17% of brands) offered at least one incentive.

Table 3 shows the percentage of advertisements that included patient support offers, information offers (in any format), and financial incentives (of any type) for each of the 14 medical condition categories. Virtually all patient support offers were extended in advertisements for tobacco cessation products. Information offers were most likely to be found in advertisements for cancer and tobacco addiction but were also common in advertisements for treatments of allergies and conditions of a cardiovascular, dermatologic, obstetric/gynecologic, and urological nature. Monetary inducements were found primarily in advertisements for treatments of allergies, dermatologic problems, and respiratory conditions.

Advertising Appeals

Finally, we examined the nature of appeals used in DTC advertisements. We initially examined the frequency with which each appeal was used across the 320 advertisements. Beginning with the most common appeal, the frequencies were: “effective” (57% of advertisements), “controls symptoms” and “innovative” (41% each), “prevents” condition (16%), “powerful” (9%), “reduced mortality” (7%), “dependable” (4%), and “cures” (3%). The percentage of advertisements using each of the social-psychological benefits claims was: “psychological enhancement” (11%), “lifestyle enhancement” (6%), and “social enhancement” (3%). The ease of use appeals were: “convenience” (38%), “quick acting” (6%), “economical” (5%), and “easy on system” (3%). The safety-related appeals were: “nonmedicated” (14%), “safe” (11%), “natural” (7%), and “not addictive” (5%).

We expected that the use of particular appeals would vary across the medical conditions treated by the promoted drugs. Using brand as the unit of analysis, 19 separate cross-tabulations were conducted, one for each appeal listed in Table 2 (therapeutic effectiveness, social-psychological benefits, ease of use, and safety-related), to examine the significance of association between medical condition category and the use of the appeal. Significant associations (P <.05) between the medical condition classification and appeal use were found for 7 of the appeals, for which adjusted standardized residuals were used to identify sources of significance. We organized these results around the medical condition categories for which an appeal was found to be significantly overrepresented or underrepresented.

Brands for allergy treatments were more likely to claim symptom control (100% of brands vs 41% of the total sample) and treatment without feelings of being medicated (88% vs 9%). Cancer and cardiovascular drugs were more likely to claim prolonged life as a benefit (100% and 20% of brands, respectively) than the total sample (6% of brands). In addition, cardiovascular treatments were more likely to offer economic benefits (40% of brands vs 6% for the entire sample), an effect largely attributable to comparative advertisements focusing on price. Three fourths of brands claiming to offer a powerful treatment fell into the HIV/AIDS category; 55% of those brands made such a claim compared with only 8% for all brands. HIV/AIDS brands were significantly less likely to claim symptom control as a benefit (9% of brands compared with 41% of all brands). Prevention was much more likely to be advanced in promotions for obstetric/gynecologic brands (60%, primarily contraceptives) and respiratory brands (67%) than the sample as a whole (17% of all brands). Respiratory brands were also more likely to claim symptom control as a benefit (100% vs 41% of the sample). Finally, respiratory treatments were more likely to make lifestyle-enhancement claims (67% vs 10% of all brands).