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PowerPoint Presentation - Direct to Consumer Advertising

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					Direct to Consumer Advertising




Myth: DTCA is good education for
 patients that doesn’t influence
 providers’ prescribing practices
 Project funded by a grant from the Attorneys
 General Division of Consumer Fraud
Internal Medicine   Business

• Linda Pinsky      • Mary Anne Odegaard

• Rick Deyo         Dean’s Office

Pharmacy            • Marge Weinrich

• Tom Hazlet        • Harry Kimball

Mursing & Ethics    Filmmaker

• Sara Shannon      • Michelle Mansfield




                                                2
Objectives

Define Direct to Consumer Advertising
(DTCA) & its impact on clinical practice
Learn approaches that use DTCA as an
opportunity for better clinical practice
Have patient education tools that help
patients be more informed consumers
of pharmaceutical marketing




                                           3
How do you feel about direct to consumer
advertising?
• My patients rarely mention DTC
• I think it is great
• I think it is okay
• I have mixed feelings
• I don’t like it
• I hate it

                                   Ask your doctor


                                                     4
Equip for Requip®

Making Direct to Consumer Advertising work for you




                                                     5
Your next patient is waiting in room 4




                                         6
7
Requip®




          8
9
Direct to consumer advertising

Tricked or taught?
• Review of DTCA’s history, goals, impact
Transform
• Techniques to use DTCA for better patient care
Translate
• Tools to educate your patients on DTCA
Transcend
• Make personal and policy changes to lessen the influence of
  marketing on your clinical practice


                                                                10
What is Direct-to-Consumer Marketing?

Promotional advertising of pharmaceutical products directly to
consumers via
•Magazine & newspaper ads
•Television & radio ads
•Product placement
•Web sites & other internet sites




                                                                 11
Types of DTCA

• Informational ad
• Ad-no product mentioned
• Reminder ad-no purpose mentioned
• Product promoting ad
• Product placement
• Product integration
• Free samples
• Pseudo-news stories

                                     12
Top 10 TV drug Ads
in terms of consumer recognition
• Viagra
• Fonase
• Procrit
• Vioxx
• Lipitor
• Zyrtec
• Celebrex
• Nexium
• Paxil


                                   13
History of DTCA
                                                                 $700
1981: 1st DTC ad by Boots
      Pharma                                                     $600
                                                                                             $595


1982: FDA requests ads                                           $500

      moratorium
                                                                 $400

1985: Moratorium lifted                                                               $313
                                                                 $300

1997: Draft guidance on DTC                                                    $224
      broadcast ads                                              $200


                                                                        $104
                                                                 $100



Sources: Completive Media Reporting and Publishing Information     $0

                                                                        1993   1994   1995   1996


                                                                                               14
DTCA outcomes

53 billion patients asked their doctor for a DTCA medication
80% of patients who requested a drug got it


                                           (Perri, Clin Ther, 1999)




                                                                 15
DTCA outcomes

If requested denied:
46% of patients disappointed
25% try to change provider’s mind
24% try to get drug from another provider




                                            16
DTCA outcomes

Request denied:
15% of patients transfer to another provider




                                               17
DTCA Does it help or harm?
Potential Benefits & Potential Harm

Educate or confuse consumers?
Educate or improperly influence physicians?
Improve or worsen health outcomes?
Treat underserved patients or promote an overmedicated
society?
Improve or worsen provider-patient relationship?




                                                         18
DTCA

Is it good thing or bad?
Studies to date give DTCA mixed reviews.
So do providers.




                                           19
Do you think your patients are influenced by
DTCA?
The pharmaceutical industry thinks they are.




                                               20
Pharmaceutical industry spending 2005

                        $4.2 billion DTCA
                        $7.2 billion promoting drugs to
                        physicians
                        DTCA ~ 20% annual increase


                         US Government Accountability Office, Nov 2006




                                                                21
“Dad, you need that little purple pill”




                                          22
This is advertising-

What did you expect?




                       23
What is being sold?

Are prescription drugs just another marketable product or are
they inherently different form other products?
The answer may differ on who is responding:
•Patient,
•Health care provider,
•Pharmaceutical industry




                                                                24
In the United States

DCA is here to stay

• First amendment right

• Consumer trend favoring access to information

• Pharmaceutical industry finds it profitable




                                                  25
Direct to Consumer Advertising

Tricked or taught?
• Review of DACCA’s history, goals, impact
Transform
• Techniques to use DTCA for better patient care
Translate
• Tools to educate your patients on DTCA
Transcend
• Make personal and policy changes to lessen the influence of
  marketing on your clinical practice

                                                                26
Turning DTCA into an opportunity

Situation:
   Patient presents requesting medication for condition
   (diagnosed or not)




                                                          27
Challenges or prescriber of DTCA requests

Limited visit time / other medical problems

Accuracy of diagnosis

Appropriateness of therapy

Little or no knowledge of that medication

Possible source of conflict with patient




                                              28
Turning DTCA into an opportunity

 First, your suggestions of effective ways to respond?




                                                         29
Turning DTCA into an opportunity

Intentional communication
Patient education




                                   30
DTCA prompted requests

Objective of your response:
• Be respectful
• Affirm patients’ initiative
• Result in appropriate care
• Retain the patient in your practice
• Be time efficient




                                        31
Intentional communication template

Tasks when approaching patient
• Acknowledge pt’s initiative
• Clarify concerns
• Anticipate specific request
• Confirm diagnosis
• Educate patient on condition
• Determine best patient management
• Determine best safe, cost effective medication, if needed
• Educated patient on advertising techniques


                                                              32
You could say:




                 33
Direct to Consumer Advertising

Tricked or taught?
• Review of DACCA’s history, goals, impact
Transform
• Techniques to use DTCA for better patient care
Translate
• Tools to educate your patients on DTCA
Transcend
• Make personal and policy changes to lessen the influence of
  marketing on your clinical practice


                                                                34
Tools and Techniques

Intentional communication
Non-industry sponsored sources of information
Advertising techniques: explanations for patients
• Discussion of meaning of effectiveness, monitoring of ads,
  advertising techniques via Bingo, talking points used by other
  physicians, etc.
• Share the techniques you use to avoid being influenced by
  marketing to physicians


                                                               35
Non-industry supported sources of drug
information for patients
Consumer Union’s Best Buy Drugs
Medline Plus
Public Citizen
Therapeutics Letter Canada (free, online)




                                            36
Tools and Techniques

Intentional communication
Non-industry sponsored sources of information
Advertising techniques: explanations for patients
Discussion of meaning of effectiveness, monitoring of ads,
   talking points used by other physicians, advertising
   techniques via Bingo, etc.
Share the techniques you use to avoid being influenced by
  marketing to physicians


                                                             37
Responses to new medications requests

“I know these symptoms are bothersome to you, but…

•We just need to make sure the treatment isn’t worse than the
disease.
•I try not to have my patients be guinea pigs for new
medications.
•Newness has its place: Medicine just isn’t one of them
•They don’t advertise the ones that are flying off the shelves on
their own.


                                                                    38
Myths of advertising

Patients assume that advertised medication approved by the
FDA is safe and effective




                                                             39
Education or Confusion?

50% of patients believe all ads are pre-approved by FDA

43% of patients believe only “completely safe” drugs can be
advertised

                                          (Bell, J Fam Prac, 1999)

Patients often think that effective means the pill always works




                                                                  40
Public myths -DTCA




                              I take Lipitor instead of a generic:
                     • There is no generic form of Lipitor. If you switch it
                       will to a generic of a different medication.
                     • In clinical studies, Lipitor lowered bad cholesterol
                       significantly more than Zocor.
                     • Lipitor has over 400 ongoing or completed clinical
                       trials. In fact, Lipitor has more studies that show
                       heart-related stroke benefits “than Zocor, or any
                       other generic cholesterol medicine.
                                         Ask your doctor.


                                                                          41
Public myths – DTCA

• If the FDA approves a drug, it must be safe
   – Fact: Drugs have side effects; some of the side effects can
     be fatal. A drug is approved if its effect, including the sum
     total of its benefits and risks, is greater than the risk of the
     disease it is being used for if left untreated.
• If a drug is effective, it works for everyone
   – Fact: A drug is effective if it works better than a placebo.
     For example, Claritin is an effective anti-histamine but it is
     only 10% more effective than a placebo.
• If a famous doctor recommends this drug, it most be good.


                                                                    42
DTCA Bingo

 Fine print to small to   Medicalizes common        Subliminal sexual      False or misleading   No comparison group
          read                experiences                 images                   claim



       Insufficient       Overly dramatic visual        Fighting ’            Hidden Risk
     information to               figures                                     Information        Appeal to authority
      interpret data                                      words

                                                       Red Herring
                                                    (irrelevant, factual        No data
 Appeal to celebrity      Reference to data on          information)‫‏‬                               Occult sponsor
                                   file




 Disease “education”                               Use of generic name                           Down-plays black box
                            Cutesy characters          of competitor       No mention of drug          warning




  Brand name much                                  “p-values” to mask        Promotes self-         Inappropriate
  larger than generic        Appeal to fear          marginal clinical          diagnosis             comparison
                                                       significance




                                                                                                                        43
A famous doctor
Or even a famous person




     Cal Ripkin, Jr. is not
     hypertensive and is
     not taking PRINIVIL




Its always in the fine print.


                                44
Tools and Techniques

Intentional communication
Non-industry sponsored sources of information
Advertising techniques




                                                45
Tools and Techniques

Intentional communication

Non-industry sponsored sources of information

Advertising techniques: explanations for patients

• Discussion of meaning of effectiveness, monitoring of ads,
  talking points used by other physicians, advertising
  techniques via Bingo, etc.

Share the techniques you use to avoid being influenced by
  marketing to physicians

                                                               46
Direct to Consumer Advertising

Tricked or taught?
• Review of DACCA’s history, goals, impact
Transform
• Techniques to use DTCA for better patient care
Translate
• Tools to educate your patients on DTCA
Transcend
• Make personal and policy changes to lessen the influence of
  marketing on your clinical practice


                                                                47
Countering the effects of marketing

Policies

Self regulation by the industry

Limiting / eliminating role of sponsor in research and publication

Awareness and critical evaluation of promotional materials

Independent sources of information on drugs

Opting out of the sales of your prescribing information

Productive conversations with drug reps/ patients

                                                                 48
Remember

When faced with a choice of prescribing a medication-




                                                        49
Choice of Medications

Employ appropriate healthy skepticism

Consider why this medication is being advertised now

Consider how this medication is being advertised




                                                       50
Choice of Medications

Remember tried and true medications, generic medications


Assume that, despite your rational, scientific, skeptical approach,
you may be influenced by marketing, not unlike the rest of us
(your colleagues).




                                                                 51
“STEPS” for evaluating new information

S= Safety
T= Tolerability
     Look for “pooled drop-out rate”
E= Effectiveness- Studies showing new drug is better than
    current choice
P= Price
S= Simplicity of use

       (Preskorn SH, Advances in antidepressant therapy, San Antonio” Dannemiller Memorial Education Foundation, 1994)



                                                                                                                   52
Look to reliable information sources with less
conflict of interest




                                                 53
Evidence – based sources of drug information
for professionals
OHSU www.ohsu.edu/drugeffectiveness/
National Guideline Clearing house AHRQ (free, online)
Consumer Union’s Best Buy Drugs (free, online)
Therapeutics Letter Canada (free, online)
The RxFiles Canada (free, online)
Medical Letter ($89/year)
Prescriber’s Letter ($88/year)
Cochrane Databse ($265/year)
Lexicomp ($75-150/year)
Micromedix ($$ institutional subscription)

                                                        54
Non-industry supported CME

Agency for Healthcare Research and Quality (AHRQ)

Centers for Disease Control and Prevention (CDC)

National Institutes of Health (NIH)

Food and Drug Administration (FDA)

Pharmedout.org

Many, if not all of the above CME are free



                                                    55
56
U.S. Senate Finance Committee Report April,
2007
“Drug companies routinely fund educational grants to support
programs that favorably discuss the companies’ newer and more
lucrative products, thereby encouraging physicians to prescribe
those products and, ultimately, driving sales”

In 204, commercial support of CME exceeded $1 billion

All 23 drug companies surveyed funded educational grants




                                                              57
More from Finance Committee Report

“…unlikely that this sophisticated industry would spend such
large sums… but for the expectation that the expenditures would
be recouped by increased sales.”


“…difficult to quantify the risk of kickbacks related to industry-
sponsored education where companies overpay high-proscribing
physicians as ‘consultants’ or ‘speakers’ for minimal work to
develop educational material or teach at education programs”




                                                                 58
Finance committee report

Information presented often encourages physicians to change
their prescribing practices to favor certain drugs.

When the favorable message is delivered in context of
education- even if corporate sponsorship is disclosed- there is an
imprimatur of credibility and independence.

Off-label promotion risk poses greatest threat to Federal health
care programs and beneficiaries… also the most difficult to
demonstrate conclusively



                                                                   59
Wrap up




          60
What is Direct-to Consumer Marketing?

Promotional advertising of pharmaceutical products directly to
consumers via
•Magazine & newspaper ads
•Television & radio ads
•Product placement
•Web sites & other internet sites
Goal: Educate and/or sell products



                                                                 61
Intentional communication

Tasks when approaching patient

Acknowledge pt. Initiative

Clarify symptoms

Confirm diagnosis

Education patient on condition

Determine best patient management & best Rx., if needed

Ongoing education of patient on advertising techniques

                                                          62
Tools and Techniques

Intentional communication

Non-industry sponsored sources of information

Advertising techniques: explanations for patients

Discussion of meaning of effectiveness, monitoring of ads,
advertising techniques via Bingo, talking points used by other
physicians, etc.

Share the techniques you use to avoid being influenced by
marketing to physicians


                                                                 63
How much do drug rep interactions and gifts directly
or indirectly influence prescribing patterns?




                                                       64
How much do drug rep interactions and gifts directly
or indirectly influence prescribing patterns?




                                                       65

				
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