Consumers appear to have taken careful note of the recent major troubles among prescription drug makers, according to an annual survey on direct-to-consumer advertising released yesterday.
"This has been quite a challenging time for direct-to-consumer advertising," said Larry Hugick, chairman at Princeton Survey Research Associates International, which conducts the survey for Rodale's Prevention and Men's Health magazines.
The sharpest challenge came in October, when Merck announced that it would stop selling Vioxx, its widely advertised arthritis and pain medication that was being taken by nearly two million people worldwide, because a new study found that it doubled patients' risk of heart attack and stroke.
Consumer and government alarm rose in December, when Pfizer said it would stop advertising Celebrex, its best-selling arthritis pain reliever, after a study showed that high doses were associated with an increased risk of heart attacks.
Direct-to-consumer advertising has become the public face of the pharmaceutical industry since 1997, when the Food and Drug Administration loosened its rules to permit the ads. Drug companies spent almost $4.2 billion to advertise to consumers last year, up 121 percent from $1.9 billion five years earlier, according to estimates by TNS Media Intelligence.
The findings of the eighth annual Rodale survey, which was conducted nationally among 1,504 adults from Dec. 28 to Jan. 12, suggest consumers are paying less attention to the likely benefits of advertised drugs - and increasingly scrutinizing the potential risks.
Results of the study, which has a margin of error of 3 percentage points, were presented at a luncheon in Midtown Manhattan for ad agencies, drug companies and others.
About 79 percent of respondents said they recalled risk information from drug commercials on television, up 3 percentage points from the year before. At the same time, 71 percent of respondents said they recalled benefit information from drug commercials, a 4 point decline.
Among those who asked their doctors about an advertised drug, the share who asked directly for the drug fell 5 percentage points, to 21 percent. That finding suggested increased reservations among consumers, Mr. Hugick said at the presentation.
The survey also indicated that the more consumers found the risk information to be useful, the more likely they were to ask for the advertised drug. "Good risk information is good business for pharmaceutical companies," Mr. Hugick said.
A health industry consultant said the news might not be all bad. Peter J. Pitts, senior vice president for health affairs at Manning, Selvage & Lee and senior fellow for health care studies at the Pacific Research Institute, said the results hinted at some benefits from the fiascos of last year.
"If people understand that drugs have risks, that is a step in the right direction," he said. "If companies can understand that and use that information to create better advertising, that's a good thing."
The survey presenters yesterday said some results demonstrated the benefits of the ads. About 15 percent of those surveyed, for example, said they talked with a doctor about an illness for the first time after seeing a drug advertisement, the same percentage reported in last year's survey.
And the percentage of consumers who have asked their doctors about advertised drugs has remained relatively steady, rising to 34 percent from 31 percent in 1997. The steady results, even as drug advertising to consumers has boomed, undermines some critics' contention that the ads create artificial demand, Mr. Hugick told the audience.
But the presentation did not linger long on the positive. Kathryn J. Aikin, the senior researcher at the Food and Drug Administration's division of drug marketing, advertising and communication, followed Mr. Hugick to tell the crowd, "We are very concerned about the direction that D.T.C. seems to be taking." (The division provided technical assistance to the survey.)
Not enough consumers are aware of the risk statements that are required in drug advertising, Dr. Aikin said.
She complained about recurring problems in direct-to-consumer advertising, like unsubstantiated comparative claims between drugs, misleading or distracting visual elements and graphics, nearly illegible text describing risks, and minimal mentions of the role of health care providers or a drug's prescription status.
"The risk information is just as important as your benefit information," Dr. Aikin said. "It is a characteristic of your product."
The final presenter, James H. Davidson, a lobbyist who has represented clients like the American Association of Advertising Agencies and the National Association of Broadcasters, told those attending, "You are all headed into a perfect storm."
The public image of the drug industry has deteriorated greatly since direct-to-consumer advertising took off in 1997, Mr. Davidson said, adding that government policy on prescription drug advertising could be affected by Congressional disputes over Medicare or even drug re-importation from countries like Canada as a response to rising drug costs.
Critics said the common practices of consumer drug advertising were being widely questioned. "I hope we're in a new era of transparency, but the public is not going to get fooled again," said Rob Schneider, director of PrescriptionforChange.org, a Consumers Union project focused on issues like drug safety. "Consumers want to know that regulators are doing their jobs and drug companies are not hiding bad results."
For all its implications, the survey provided few concrete clues for the coming year. "What does it mean for the future?" Mr. Hugick asked. "It is hard to say, because chances are next year the environment will be different. How different, we don't know."
Nat Ives, The New York Times. March 25, 2005
Copyright © 2005 The New York Times Company. All rights reserved.