Direct talks: How do derms view DTC advertising?

Key Points

National report - According to a recently released study, the $5 billion a year that pharmaceutical companies spend on direct-to-consumer (DTC) advertising may not always be such a good investment. And to some dermatologists, DTC drug advertising may not always be such a good idea from a medical standpoint.

The study, conducted by a team of Harvard researchers and published online in September by the British Medical Journal, assessed the impact of DTC advertising on three drugs: Enbrel (etanercept, Amgen/Wyeth), Nasonex (mometasone, Schering) and tegaserod (Zelnorm, Novartis).

The results show that DTC television advertising had no impact on prescription sales for the first two drugs, while tegaserod enjoyed a significant, albeit brief, spike in sales when its ads first aired in 2003.

Researchers, seeking a large control group that had not been exposed to such ads, measured differences in the number of filled prescriptions for English- and French-speaking Canadian provinces before and after the start of the DTC campaigns in the United States.

Talks: How do derms view DTC advertising?

While DTC ads are illegal in Canada, they can be seen there on U.S. networks. They are seldom viewed, however, by French-speaking Canadians.

Researchers found no increase in prescriptions for etanercept and mometasone associated with the ad campaigns in English-speaking provinces. Prescriptions for Zelnorm increased 42 percent in English-speaking provinces immediately after its DTC ads first started airing, but that increase dwindled over time.

The study concludes that the impact of DTC advertising on prescribing rates and prescription-drug use is highly variable and probably depends on the advertised drug's characteristics and the level of consumer exposure to the ads.

"I agree with the study," says David J. Goldberg, M.D., director, Skin Laser & Surgery Specialists of New York/New Jersey, and clinical professor of dermatology at New York's Mount Sinai School of Medicine.

"Patients are always telling us that the ads are so confusing and the disclaimers so worrisome. Because of both of these issues, patients - although initially enthused - become anxious," he says.

Peter Bye, senior medical technologies analyst for New York investment firm Jefferies & Co., says he's skeptical about the study.

"I don't necessarily agree with the results, mainly because they only looked at those three drugs," Mr. Bye tells Dermatology Times.

"I remember that when Allergan went to DTC ads for Restasis, a drug for dry eye, sales shot up - but when they took their foot off the DTC-spend accelerator, sales slowed down. From what we've seen, the growth of drug-prescription rates in the U.S. has gone right along with DTC ads being allowed on TV in 1997," he says.

Mr. Bye adds, however, that DTC ads work much better for drugs than for medical devices; still, even for drugs, DTC advertising eventually has less of an impact on sales.

"DTC advertising is good for creating awareness among consumers," Bye says, "but you can get to a point of diminishing returns because you can't create new patients."

Impact on derms

What about the impact of DTC advertising on dermatologists' prescribing decisions? Doctors' opinions vary.

Florence, Ky., dermatologist Susan Bushelman, M.D., says she thinks DTC drug ads may do patients a service.

"There are a large number of patients with medical conditions for which they are not being treated," Dr. Bushelman says.

"Perhaps they saw a physician many years ago and were dissatisfied with their treatment options. When they see an ad, they are optimistic that new treatment options are available, and they re-enter the healthcare system.