The changing face of direct-to-consumer print advertising: Policy and content issues

Background: Over $US4.2 billion was spent on direct-to-consumer (DTC) advertising of prescription drugs in 2008 in the US for all media, which was down from $US5 billion in 2007. However, third quarter 2009 sales were already rebounding and faring the bad economic situation better than most other categories, according to TNS Media Intelligence data. Print DTC advertising and its regulatory environment has changed so much over the past decade that an updated, comprehensive study of its content is needed to identify current public policy concerns, including the use of emotional versus rational appeals, information content, fair balance and presentation of risk information. Objectives: To identify the medical and drug information presented, the format of risk and benefit information, format of the brief summary, types of advertising appeals and selling messages utilized, and the degree to which DTC print advertisements were meeting US FDA guidelines. Methods: A content analysis study of 1735 print DTC advertisements from nine popular magazines with large distribution between 2000-7, identified benefit and risk information to assess their level of fair balance and categorise each advert into one of five categories: lawbreaker, bare minimum, DTC main pack/Peloton, chase and proactive/break away. In order to assess the impact of DTC guidelines released by the FDA in 2004, advertisements were compared for the periods 2000-3 and 2004-7. Results: Emotional rather than rational appeals were used in 55%of all adverts. From 2000 to 2003 (n = 656) there were 4 lawbreakers (0.6%), 16 bare minimums (2.4%), 631 in the DTC main pack/Peloton group (96%) and no advertisements in the proactive group. From 2004 to 2007 (n = 1079) there was 1 lawbreaker (0.1%), 51 bare minimums (4.7%), 931 in the DTC main pack/Peloton group (86.3%), 72 in the chase group (6.7%) and 24 in the proactive/break-away group (2.2%). Conclusions: This study found that emotional appeals were used to a greater degree than rational appeals in DTC print advertisements from 2000 to 2007. While critics have expressed concerns about the overuse of emotional appeals in DTC advertisements, it should be noted that most advertisements in the sample used a combination of rational and emotional appeals, rather than just one appeal to the exclusion of the other. After developing a five-tiered classification scheme, this study found that DTC print advertisements are doing a satisfactory job of meeting the FDAs fair balance requirement, but are not doing any more than is necessary. As detailed in the results, very few are lawbreakers, slightly more do very little beyond that and the vast majority stick to what everyone else is doing. DTC advertising seems to be a 'safety in numbers' approach to communication.