Business Horizons (2010) 53, 221228

www.elsevier.com/locate/bushor

A defense of direct-to-consumer prescription

drug advertising
Anthony D. Cox *, Dena Cox
Kelley School of Business, Indiana University, 801 West Michigan Street, Indianapolis, IN 46202-5151,
U.S.A.

KEYWORDS
Direct-to-consumer
advertising;
Advertising regulation;
Drug costs;
Doctor-patient
relationship

Abstract Within the past 20 years, consumer advertising of prescription drugs has
grown from a rarity to one of the most pervasive forms of consumer advertising,
with ads for antidepressants and heart medications now as common as those for fast
food and automobiles. At the same time, direct-to-consumer (DTC) advertising has
attracted a growing chorus of criticism from consumer advocates, health professionals, and elected officials. This article explores the extent to which such
criticism has merit and the extent to which it lacks soundness. Specifically, the
article casts doubt on the charges that (1) DTC advertising is deceptive; (2) DTC
downplays product risks; (3) DTC focuses on trivial or imaginary maladies; (4) DTC
doesnt promote non-pharmaceutical solutions to health problems; (5) DTC harms
the doctor-patient relationship; and (6) DTC is responsible for the rapid rise in drug
costs.
# 2009 Kelley School of Business, Indiana University. All rights reserved.

1. How we got here: A brief history of

DTC drug advertising
Prescription drug marketing has always been a bit of
an anomaly. For most of the 20th century, drug makers
marketed their products solely to the physicians who
prescribed them rather than to the patients or
consumers who actually used them. In fact, the very
idea of direct-to-consumer (DTC) promotion of

* Corresponding author.
E-mail addresses: acox@iupui.edu (A.D. Cox),
dcox@iupui.edu (D. Cox).

prescription drugs was practically a taboo, carrying

the taint of unscrupulous 19th-century snake oil
salesmen. Thus, DTC advertising was strongly discouraged by the U.S. Food and Drug Administration
(FDA) and eschewed by ethical drug makers, in
favor of medical journal advertising and physician
sales calls (Palumbo & Mullins, 2002).
This began to change in 1985, when the FDA lifted
a previous moratorium on DTC promotion of prescription drugs and issued a statement that effectively encouraged pharmaceutical firms to consider
communicating directly with consumers (FDA,
1985; Palumbo & Mullins, 2002). Still, the green
light on DTC advertising came with a catch: The

0007-6813/$ see front matter # 2009 Kelley School of Business, Indiana University. All rights reserved.
doi:10.1016/j.bushor.2009.11.006

222
FDA required that all DTC advertisements include
the exhaustive statement of product risks and contraindications called the brief summary, a somewhat misleading term because the summary is
typically anything but brief (FDA, 2005; FDA,
2009). Under this requirement, magazine advertising of prescription drugs became feasible, though
expensive. Pharma advertisers typically had to purchase two magazine pages, one for the main body of
the advertisement and a second for the dense type
of the brief summary. However, television advertising remained impractical, because it was not feasible for advertisers to read or scroll through an
exhaustive list of product risks within the span of
a 30-second commercial (Bell, Kravitz, & Wilkes,
2000).
In 1997, the FDA modified these rules. Although
print advertisements were still required to include
the brief summary, broadcast advertisements could
now simply include a major statement of the
most common and most serious product risks, and
then refer consumers to print ads and web pages
containing more detailed risk information (FDA,
1997; GAO, 2002). With these changes, television
advertising became feasible and spending on DTC
advertising began to explode. Whereas the pharmaceutical industry had spent only $12 million on
consumer advertising in 1989, DTC spending reached
$1 billion in 1997. By 2003, this total had tripled to
$3 billion, and in 2007, DTC spending reached $4.8
billion (Calfee, 2002; U.S. DTC, 2009). Thus, in
the span of a relatively brief number of years,
consumer advertising of prescription drugs has
grown from a rarity to one of the most pervasive
forms of consumer advertising, with ads for antidepressants and heart medications becoming as
common as those for fast food restaurants and
automobiles.
The increasing pervasiveness of DTC advertising
has not translated into increasing public affection
for this form of marketing, though. There may be no
facet of marketing that currently attracts more
public disdain than direct-to-consumer advertising
of prescription drugs. For example, our students
who tend to view advertisements as a form
of entertainment rather than a commercial
enterprisecomplain that DTC ads are often
cryptic (Whats the story with the side-by-side
bathtubs?) and annoying (Who cares if your going
problem is really a growing problem?). More
seriously, DTC has attracted a barrage of substantive
criticism from medical professionals, consumer advocates, public health researchers, and members of
Congress. While some of these critics merely suggest
reforms to DTC (e.g., AAFP Supports, 2007),
other writers suggest that the ills wrought by DTC

A.D. Cox, D. Cox

advertising are so severe as to justify an outright ban
on the practice (e.g., Lexchin & Mintzes, 2002;
Strange, 2007).
In this article, we seek to address some of these
criticisms and, in certain instances, speak in defense
of DTC advertising. We undertake this task with a bit
of reluctance. For starters, DTC advertising is not
the most attractive defendant. The ads are often
cryptic, annoying, embarrassing (try explaining a
Viagra ad to an 8-year-old) and jarring (In some
cases, taking XYZ can lead to death. . . .). And,
some of the charges against DTC are not without
merit; for example, some DTC advertising may
contribute to increased drug spending, and certain
DTC ads do seem to downplay product risks and
limitations.
However, we also believe that many of the
charges against DTC are overblown or lack context,
and some simply do not stand up to the evidence.
More fundamentally, we believe that certain
criticisms of DTC reveal a lack of understanding of
how consumers respond to advertising and other
forms of promotion. Therefore, we will herein discuss the merits and demerits of some of the most
common criticisms of direct-to-consumer advertising of prescription drugs. We will address the following charges against DTC advertising:

 That it is deceptive.
 That it downplays product risks.
 That it focuses on trivial or imaginary maladies.
 That it doesnt promote non-pharmaceutical solutions to health problems.

 That it harms the doctor-patient relationship.

 That it is responsible for the rapid rise in drug
costs.

2. Is DTC advertising deceptive?

Perhaps the most common criticism of DTC advertising (e.g., Lexchin & Mintzes, 2002; Strange, 2007)
is that it is misleading and deceptive, overstating
product benefits and understating product risks.
Certainly, DTC advertisements are not public service
announcements. Like all ads, they are promotional
tools designed with a persuasive purpose: to sell a
product. Having said that, we would argue the
following:

 That DTC advertising of prescription drugs is the

most honest form of consumer advertising; and

A defense of direct-to-consumer prescription drug advertising

 That DTC advertising is the most honest form of

drug promotion.

223

advertising. Three key traits distinguish advertising

from other forms of promotion (Belch & Belch,
2009):

If these conclusions seem surprising, let us explain.

1. It is paid for (in contrast with free publicity);

2.1. Why prescription drug advertising is

the most honest form of consumer
advertising
DTC drug advertising is by far the most strictly
regulated form of consumer advertising. While most
advertising is regulatedat least in theoryby the
Federal Trade Commission (FTC), prescription drug
advertising is regulated by the FDA (FDA, 2005;
Palumbo & Mullins, 2002). This is significant for
several reasons.
First, the FDA has strict guidelines for DTC that do
not apply to most consumer advertising. All product
benefits claimed, or even implied, in DTC advertising must be backed up by rigorous scientific evidence that has been reviewed by the FDA during the
drug-approval process. In addition, all DTC ads must
state the most common and most severe side effects
in the body of the advertisement or commercial, in
addition to including a more detailed description of
these side effects in print ads (FDA, 2005; FDA,
2009). Such risk-disclosure requirements do not
apply to other forms of consumer advertising. For
example, McDonalds ads do not have to say recent
research shows that consumption of beef increases
the risk of heart disease and cancer, and Toyota
does not have to say automobile driving can lead to
serious injury or deatheven though both statements would be accurate references to risk. For that
matter, an advertisement for a non-prescription
drugsay, a pain relieverdoes not have to state
that in some cases, use of [the pain reliever] can
cause liver failure, even if there may be evidence
to that effect. Perhaps most egregious are dietary
supplement advertisements, which sometimes
make largely unsubstantiated benefit claims and
accompany them with a tiny these claims have
not been evaluated by the FDA disclaimer rather
than a disclosure of risks.
Second, drug companies have a strong incentive to
comply with FDA ad guidelines, in order to maintain
good relations with the agency that has the power to
acceptor denytheir new drug applications. In
contrast, advertisers of other consumer products have
no similar incentive to comply with FTC guidance.

2.2. Why DTC drug advertising is the most

honest form of pharmaceutical promotion
Why is DTC drug advertising the most honest form of
pharmaceutical promotion? Simply put, because it is

2. It is impersonal (in contrast with personal selling); and

3. It is openly sponsored.
In other words, an advertisement, by definition, is
clearly identified as a promotional message from a
company trying to sell you a product.
This last element is crucial. When consumers see
an advertisement, they know it is an ad and are thus
able to mount multiple defenses to its influence. For
starters, they can choose to avoid the ad altogether,
which they often doby flipping the page, changing
the channel, zapping it using TiVo, or getting
off the couch and going to the kitchen or bathroom.
(In the late 1940s, the Detroit water department
noticed mysterious drops in water pressure during
certain weekday evening hours. Eventually, the
water department figured out that these drops
in pressure coincided with the commercial break
following the popular Milton Berle television show.)
In addition, because consumers know they are
viewing an ad, they know to be skeptical of its
content. Research shows that audiences are much
more resistant to persuasion if they know someone is
trying to persuade them, and has something to gain
in persuading them (Petty & Cacioppo, 1979).
For all these reasons, persuading consumers
through advertising tends to be much more difficult
than advertising critics often imply. Years ago, department store magnate John Wanamaker famously
said, I know half my advertising is wasted, I just
dont know which half. Since then, consumers
ability to resist advertising has only grown, as they
have become increasingly busy, increasingly able to
avoid exposure via remote controls and DVRs, and
increasingly distrustful of businesses in general and
advertisers in particular (Gallup, 2008). All this does
not mean that advertising has no effect on consumers attitudes and behavior, but it does mean that
since consumers know it is advertising, they are
better able to evaluate it critically.
The same cannot be said, however, for all forms
of pharmaceutical promotion. While DTC represents
the pharmaceutical industrys most visible effort to
influence consumer behavior, it is not the largest or
necessarily the most effective. A much larger but
less conspicuous facet of pharmaceutical promotion
is designed to influence consumer behavior indirectly, by helping to shape the advice that consumers

224
receive from seemingly independent sources such as
their family physician, the news media, and their
friends and neighbors.
The largest component of this indirect influence
effort is targeted at prescribing physicians. DTC is
only the visible tip of the iceberg of pharmaceutical
promotion, accounting for just 14% of total drugcompany promotional expenditures. Most of
the remaining 86%, roughly $25 billion in 2005
(Donohue, Cavasco, & Rosenthal, 2007), is
aimed at influencing the prescribing behavior of
physicians through medical journal advertising,
physician-targeted sales calls, distribution of drug
samples, pizza for medical office staff, and other
promotional activities. From a business standpoint,
these efforts make a lot of sense. Physicians not only
serve as the gatekeepers for prescription drugs
they hold the prescription padbut they are highly
trusted by patients (Gallup, 2008), in large part
because they are perceived to be independent sources of medical advice.
However, research suggests that this independence is sometimes more apparent than real. For
starters, many physicians are not financially independent of drug companies. According to a recent
national physician survey published in the New
England Journal of Medicine, 83% of physicians
reported receiving free food from pharmaceutical
reps; 78% received free drug samples; 35% received
reimbursement for the costs of attending a professional meeting; and 28% received drug-company
payments for consulting, giving lectures, or enrolling patients in clinical trials (Campbell et al., 2007).
Although many of these activities seem harmless,
and some may serve a legitimate medical purpose,
the evidence indicates that they also serve their
intended promotional purpose; that is, they influence the prescriptions and the advice that these
doctors give to their patients. In summarizing the
research findings on this topic, Goodman (2001,
p. 232) concludes that many physicians say pharma
promotion, be it pen or penne, has no effect on their
prescribing behavior. But the medical literature
abounds with studies suggesting that promotion
does affect behavior. There have been some efforts at self-regulation, as both the AMA and the
pharma industry have issued guidelines to limit the
size and scope of gifts that doctors receive. Nonetheless, research on the reciprocity principle
(Cialdini, 2009) suggests that sometimes even small
gifts can induce large changes in behavior, often in
ways that the gift recipient does not recognize.
Concern over undue drug-company influence has
caused some hospitals and health systems to limit or
even prohibit contact between physicians and sales
reps, and has spurred the emergence of physician

A.D. Cox, D. Cox

self-help groups aimed at assisting doctors wean
themselves from drug company largesse. One such
group, called No Free Lunch, even gives doctors a
checklist of warning signs of drug-company dependence. Consider, for example, this question: Are
you currently drinking coffee from a mug that says
Lipitor?
To many doctors, pharmaceutical representatives
seem ever-present. To patients, however, their influence is largely invisible. Therein lies the problem.
When a drug company runs a direct-to-consumer
advertisement, the company openly adopts the role
of salesperson, giving the consumer fair warning to
be skeptical or to change the channel. But when the
same company influences that consumers physician, it operates behind the scenes, shaping the
apparently independent advice the patient receives
from her or his trusted medical advisor.
Beyond physician-targeted promotion, there are
other ways in which drug companies try to influence
consumers trusted sources of medical information.
For example, drug companies often hire public relations firms to try to generate favorable news
coverage for their brands, or to generate positive
word of mouth among consumers. Sometimes these
efforts are limited to traditional PR tools such as
press releases and news conferences. At other
times, though, they move into the more controversial realm of stealth marketing. Consider the
following:

 Some drug companies have hired celebrities to

talk candidly about their experiences with
specific prescription drugs on television news
programs and talk shows. Sometimes the celebrities reveal their financial ties to the drug maker,
and sometimes they do not. For example, football
player Ricky Williams appeared on numerous
news and talk shows, telling heart-rending stories
of his struggles with Social Anxiety Disorder, and
the role that the drug Paxil1 played in helping
him overcome it. It was occasionally mentioned
that he was a paid spokesperson of GlaxoSmithKline (Paxils maker), but not always (Moynihan,
2003).

 Some drug companies, or their PR firms, have

hired ghostwriters to pen editorials touting the
benefits of their products, and have then paid
noted physicians to take authorship credit when
the editorials are published in prestigious medical
journals (Rampton & Stauber, 2002).

 One company actually created its own journal,

entitled the Australasian Journal of Bone and
Joint Medicine. The publication appeared to be

A defense of direct-to-consumer prescription drug advertising

a real medical journal, with no obvious sign of
company sponsorship, but it consisted largely of
articles favorable to the companys drugs (Grant,
2009).

 A recent article in Pharmaceutical Executive

notes the influence that friends and neighbors
have on patient decision making, and then suggests ways in which pharmaceutical companies
can shape that influence to their advantage. The
article emphasizes that word of mouth. . .
comes with the power of a recommendation from
a trusted sourcea friend, a family member, a
business colleaguewith an element of authenticity a traditional advertisement can never
match (Levitt, 2008, p. 118). The article goes
on to provide instructions on how pharma company personnel can recruit and train friends and
family members to be brand ambassadors.
What all of these methods have in common is hidden
sponsorship: an effort to bypass the natural defenses (e.g., inattention, skepticism) that consumers are able to muster when they know they are
seeing an advertisement. In contrast with these
methods, DTC advertising appears to be an admirably direct and straightforward way of communicating with consumers.

3. Do DTC ads downplay risks?

We believe that there is some truth to the claim that
DTC ads downplay product risks. Although all prescription drug ads are required to report product
risks, our analysis of DTC magazine advertisements
has found that risk information tends to be presented less prominently than product benefit information. For example, risk information tends to
appear in smaller type and to be written in more
difficult-to-comprehend language. Regarding TV
ads, research by Ruth Day at Duke University suggests that DTC television advertisements sometimes
present distracting visual elementsfor instance,
the notoriously kinetic buzzing bee in a certain
antihistamine adat the same time that risk information is being read by the announcer. Such
criticisms, while legitimate, should be viewed in
context:

 Both DTC advertisers and the FDA are well aware

of the criticisms about DTC risk presentation, and
have taken steps to address them. For example,
the FDA issued a complaint about the buzzing-bee
distraction mentioned above, and the bee was
quickly grounded by the advertiser. Similarly,
in recent years there has been a noticeable

225

improvement in the presentation clarity of the

brief summary page in DTC magazine ads, so that
these risk disclosures are increasingly written in
larger font and more consumer-friendly language,
and employ cleaner layout and graphics. Currently, there are other proposals being considered,
such as having all DTC print ads summarize drug
efficacy and risk information in a standardized
tabular format, similar to nutritional labeling on
food products (see, e.g., Schwartz, Woloshin, &
Welch, 2007).

 Prior to the advent of DTC advertising, consumers main source of prescription drug information
was physicians. In theory, doctors should discuss a
drugs risks and side effects with the patient
before prescribing it. However, research shows
that this rarely happens; that doctors seldom tell
patients about the risks of the drugs they are
prescribing (Calfee, 2002). So, for all of the criticism of inadequate risk disclosures in DTC ads,
patients almost certainly learn more about product risks from DTC advertising than they do from
their doctors.

 As noted earlier, product risk information is presented much more prominently in DTC drug ads
than in ads for other consumer products that are
at least as risky. Alcoholic beverage ads sometimes contain a brief drink responsibly tagline,
but arent required to itemize the multitude of
risks associated with alcohol use. Even tobacco
marketerswhose products kill nearly half a million Americans each year and, unlike prescription
drugs, have no offsetting health benefitsare not
required to mention product risks in the main
copy of their advertisements, but can instead
relegate them to a small warning box. So, singling
out DTC ads for this criticism seems a little odd.

 While it is possible for DTC ads to understate

product risks, it is also possible for them to
overstate them. In our research, we have found
that consumers often greatly overestimate the
actual likelihood of side effects described as
rare or very rare in DTC ads (Cox & Cox,
2007; see also Berry, 2004). And, since prescription drugs often have important health benefits,
such overestimation of risk can itself endanger
consumers health, by deterring use of potentially
beneficial products. For example, Wosinska
(2005) presents evidence that the risk warnings
in Lipitor ads caused some heart patients to stop
taking the medication, despite the fact that the
described risk was quite rare. Similarly, some
research suggests that FDA black box warnings

226
about suicidal thoughts associated with antidepressant use may have actually increased teen
suicides, by dramatically decreasing antidepressant use among depressed adolescents who really needed to be taking the medications
(Gibbons et al., 2007). Thus, while the push is
toward more and more prominent presentation
of product risk information in DTC ads, there
is a point beyond which this trend may be
counterproductive.

4. Do DTC ads cause consumers to take

drugs they dont need?
DTC critics often complain that such ads cause patientsand, ultimately, doctorsto focus on trivial
and even imaginary ailments (e.g., Moynihan, Heath,
& Henry 2002), rather than serious illnesses. Certainly, many DTC ads focus on non-life-threatening
ailments such as insomnia, incontinence, and erectile
dysfunction. However, many DTC ads also focus on
drugs for serious illnesses such as heart disease,
clinical depression, asthma, and Alzheimers disease.
Furthermore, it is easy to be dismissive of insomnia, incontinence, or erectile dysfunction if you
dont suffer from them. These ailments, while not
lethal, seriously diminish the quality of life of the
people who suffer from them. The reason that DTC
often focuses on these types of illnesses is that they
are usually not on the doctors radar screen, and
therefore are likely to be discussed only if the
patient first brings them up. For example, doctorpatient discussions of erectile dysfunction are often
brought up in what is called the doorknob momentwhen the doctor has her hand on the doorknob to exit the exam room and the patient says,
Oh yeah, one more thing I wanted to mention. . .
The ensuing conversation would never have been
initiated by the doctor, and the patients initiation
of it was very likely facilitated by having seen an ad
for Viagra or Cialis. But that doesnt mean that the
underlying problem is imaginary or trivial.

5. Do DTC ads promote

non-pharmaceutical solutions?
DTC prescription drug ads are sometimes criticized
for not discussing alternatives to the advertised
product, including non-pharmaceutical solutions;
consider, for instance, diet and exercise as alternatives to statins for reducing serum cholesterol. It
is true that even though DTC ads sometimes mention
non-drug alternatives, often they do not. Similarly,
automobile ads seldom mention the benefits of

A.D. Cox, D. Cox

bicycling and public transportation, and restaurant
ads seldom mention the pleasures of home cooking.
Is it important that consumers understand the
usefulness of non-pharmaceutical solutions to their
health problems? Absolutely. Should the role of
educating consumers on these solutions be shouldered primarily by prescription drug advertisements
as opposed to family doctors, public health officials,
or the companies that market such alternative remedies? Maybe not.

6. Does DTC advertising harm the

doctor-patient relationship?
Some critics of DTC advertising argue that it disrupts
the doctor-patient relationship, because physicians
waste valuable time debunking misinformation from
DTC ads and because patients frequently pressure
their doctors to prescribe advertised drugs. However, empirical evidence suggests that these concerns
are exaggerated. For example, a physician survey
conducted by Parnes et al. (2009) found that patients mentioned specific drug brands in only 3.5% of
doctor-patient encounters, and in only 10% of these
casesor 0.35% of all encountersdid doctors feel
that patient requests had a negative impact on the
visit. In fact, doctors were twice as likely (24%) to
say the patient request had a positive impact on the
doctor-patient interaction; for example, by stimulating a discussion of the patients ailment and
alternative treatments. The idea that large numbers
of patients are going to insist their doctor prescribe
a specific drug brand, simply because they saw an
ad, not only is contradicted by research evidence
but also defies common sense. As noted earlier,
patients are much more likely to trust their doctor
than an advertiser (Gallup, 2008), so if they bring up
an ad, it may be just to hear what their doctor has to
say.

7. Is DTC to blame for skyrocketing

drug costs?
As noted earlier, spending on DTC drug advertising
has grown greatly over the last dozen years. And,
during the same period, there has also been a rapid
increase in overall prescription drug spending
(Kaiser Family Foundation, 2008). So, is the growth
in drug spending caused by the growth in DTC, as
some commentators suggest? A comprehensive discussion of the causes of drug-spending growth
is beyond the scope of this article. For various
reasons, however, it seems highly questionable to

A defense of direct-to-consumer prescription drug advertising

assert that DTC advertising is the primary driver of
drug spending growth:

 Critics point out that during the decade of most

rapid DTC growth, from 1997-2006, total prescription drug spending in the U.S. grew by 12%
a year. What they often do not mention is that
drug spending had been growing at a similar rate
before the advent of DTC advertising. For example, in the decade of the 1980s, before the emergence of DTC advertising, prescription drug
expenditures in the United States grew by 13%
a yearfaster than they grew during the period of
most rapid DTC growth. One of the fundamental
criteria for proving cause and effect is that causes
(DTC) should precede effects (growth in drug
spending). That doesnt appear to hold in this case.

227

effort was focused on getting previously untreated men with ED to realize that there was now a
pharmaceutical solution to their problem. However, as the ED market has matured and additional
brands have entered the market, ED advertising
increasingly focuses on getting existing ED-drug
users to use one brand or another. For example,
advertisements for Cialis appear largely aimed at
persuading existing Viagra users to switch brands,
with the appeal that Cialis 36-hour effectiveness
window causes couples to feel less time pressure,
allowing them to wait until the moment is
right. It seems likely that as many pharmaceutical product categories mature, DTC advertising
will follow the example of beer advertising and
increasingly focus on shifting brand market share.
In doing so, DTC advertising will have less and less
impact on increasing overall drug spending.

 A common explanation of the claimed link between DTC and drug costs is that drug companies
pass on the high costs of DTC advertising in the
form of higher drug prices, and that this practice
drives up overall drug spending. One problem with
this argument is that the costs of DTC advertising
are much too small to account for the enormous
growth in drug costs. For example, from 19902006, total prescription drug spending in the
U.S. increased from $40.3 billion to $216.7
billionan increase of $176.4 billion, or 438%
(Kaiser Family Foundation, 2005, 2008). During
the same period, DTC spending increased by about
$4 billion. Even if we assume that all DTC costs are
passed on to consumers, DTC spending would only
account for 2.3% of the total increase in aggregate
drug expenditures. Put another way, if we
eliminated the $4 billion in DTC-spending costs
from the equation, total U.S. drug expenditures
would have increased by 428% instead of 438%.

 It may seem obvious that high levels of advertising

in a product category (e.g., prescription drugs)
inevitably lead to rapid growth in productcategory sales. However, this is often not the
case. For example, enormous amounts of money
are spent each year on beer advertising, yet
aggregate beer consumption has remained flat
for years. Most advertising is intended to take
market share away from competitors rather than
to increase total product category sales. It is true
that when an entire product category is new and
growing, one role of advertising may be to attract
new users to the product category. However, as
markets mature and category growth slows, most
advertising is focused on influencing the brand
selection of existing users. For example, when
Viagra was introduced, much of its marketing

8. The verdict
It is perfectly legitimate to criticize the marketing
practices of pharmaceutical firms, as we have ourselves at several points in this article. However, we
believe that direct-to-consumer advertising should
not be the main target of that criticism. DTC is
imperfect, and it can certainly be annoying. Yet it
is vastly more open, honest, and forthcoming than
most other forms of prescription drug promotion and,
for that matter, most other consumer advertising.
Of course, no consumer should rely solely on DTC
advertising for information on medical conditions
and treatments. Fortunately, there is a wealth of
independent health information readily available to
consumers in books and magazines, and especially
on the Internet. Most importantly, there is the consumers physician. It should never be forgotten that
no matter how persuasive a consumer might find a
DTC ad to be, the final decision to prescribeor not
prescribelies with the consumers physician. As
noted earlier, consumers trust the medical information provided by their physician much more than
any advertisement. That is why it is so important
that physicians remain truly independent sources of
medical advice, and why we believe that physiciantargeted drug-company promotion should be a
greater source of public concern than direct-toconsumer promotion.
Finally, while the principal purpose of DTC is to
help pharmaceutical companies sell their products, the practice does appear to produce some
positive side benefits: by prompting recognition
of undertreated diseases; by increasing awareness
of drugs potential risks and side effects; and
by stimulating broader conversations between

228
doctors and patients about medical conditions and
alternative treatments.
So, the next time you suffer through images of
amorous senior citizens, side-by-side bathtubs, or
going problems that might be growing problems,
feel free to change the channel, leave the room,
or throw something at your television. But lets not
ban DTC advertising.

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