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The following information is research conducted for JOMC 50 - Electronic Information Sources
The Changing Role of Advertising and Marketing in Pharmaceutical Sales

Topic Introduction

Keywords for Research
Books, Videotapes, & CD-ROMs
Electronic Indexes and Databases Sources
Web Sources
Internet Issue Mini-Essay
Additional Web Pages

Section I: Topic Introduction

Advertisements for prescription drugs are popping everywhere today; they are on television, in magazines, on the Internet, and even in the waiting room at your local doctor’s office. In one such television ad, a small egg-like character explains the symptoms of depression and the advantages of a new drug to treat it called Zoloft®. Prevacid®, a drug for heartburn, has a commercial that informs audiences of the pill with the help of an animated pink stomach that bounces across the screen. Following each ad is a lengthy list of warnings and possible side effects. This list is determinable by the low, sharp and speedy male voice that breezes through terms like “may cause severe vomiting” or “side effects may include loss of bowel control.”

Accordingly, it would seem that such warnings of physical distress would deter consumers from a product. This is not the case. In fact, increased marketing efforts on behalf of major pharmaceutical companies have sent consumers into their physician’s office asking about or for these new drugs. This surge of patient consumerism has sparked several major issues of debate.

A first concern with increased marketing and advertising by pharmaceutical companies is that patients are somehow infringing on a physician’s medical expertise. In these cases, the doctor no longer prescribes medication solely based on her or his diagnosis and opinion of appropriate therapy. Rather, the patient comes to the doctor with a solution already in mind.

This patient pro-activeness raises the second issue of concern on the subject. If an advertisement lists symptoms to a health problem as well as a supposed effective solution all in 30 or 60 seconds, then the patient has bypassed the need for a physician’s care. A patient has self-diagnosed and found a pharmaceutical solution based on the ad. Now all the doctor has to do is write the prescription.

It is my opinion that doctors, patients, pharmaceutical companies and regulatory institutions such as the Food and Drug Administration are most concerned with this issue. The personal health of patients, the professional status and processes of doctors and the desire to increase profit margins on behalf of drug companies are all factors contributing to this issue’s significance.

As far as I can tell, increased marketing and advertising has been successful for pharmaceutical companies. FDA restrictions have mostly kept these companies in check. However, new ads seem to show up daily, partially educating and actively luring consumers to the next cutting-edge drug treatments. As long as consumers continue to respond to bouncy pink internal organs and animated depressed eggs, it should be assumed that pharmaceutical advertising will continue to expand, ultimately changing the future of pharmaceutical sales as well as the process of medical treatment.

While conducting research on this issue, I hope to further my knowledge of regulatory measures taken to control or limit pharmaceutical advertising. Also, I hope to address the concept patient-consumerism in detail. This includes statistics on actual drug sales, the effectiveness of marketing efforts in the past, and plans for the future of pharmaceutical advertising and marketing.

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Section I – b: Keywords

UNC Library Catalog
pharm? AND advertising
prescription drugs AND (sales or profits)


Academic Universe LexisNexis (guided news search)
prescription AND drugs AND NOT illegal
pharmaceuticals w/10 marketing or advertising


Search Engine on Web - <http://altavista.com/>
drug companies AND (marketing or advertising)
“food and drug administration” AND pharmaceutical

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Section II: Books, Videotapes, and CD-ROMs from UNC-CH libraries

Print sources
United States Congress House Committee on Energy and Commerce Subcommittee on Health. Recent Developments Which May Impact Consumer Access To, and Demand For, Pharmaceuticals. (Washington, D.C., 2001), 112 pgs.
(Call number - Y 4.C 73/8:107-34)


Blackett, Tom, ed., and Rebecca Robins, ed. Brand Medicine: The Role of Branding in the Pharmaceutical Industry. Basingstoke : Palgrave, 2001
(Call number - HD69.B7 B7226 2001)


Non-paper source
Avoiding the Pitfalls of Polypharmacy. 60 min. Videorecording. Network for Continuing Medical Education, Secaucus, N.J., 1999.
(Call number - NCME #749)
(Polypharmacy is the act of prescribing too many medications. It seems this practice may be compounded or perhaps in direct correlation to new overwhelming amounts of medications being marketed to doctors and consumer patients.)

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Section III: Electronic Indexes and Databases Sources

Calfee, John E.. “Direct-to-Consumer Advertising of Prescription Drugs: Evaluating Regulatory Policy in the United States and New Zealand.” In LexisNexis Academic [database online]. Journal of Public Policy & Marketing, 2002 [cited 28 January 2003]. 16,707 words.

Calfee, J.E. “The Role of Marketing in Pharmaceutical Research and Development.” In PubMed [database online]. Washington: American Enterprise Institute, 2002 [cited 26 January 2003]. Accession no.12457428.

Heinrich, Janet. “FDA Oversight of Direct-to-Consumer Advertising is Limited.” In Lexis Nexis Academic [database online].GAO Reports, 2002 [cited 26 January 2003]. 6,598 words.

“Pharmaceutical Growth Tied to Aggressive Marketing of Existing Drugs.” In Lexis Nexis Adacemic [database online]. PR Newswire, 2003 [cited 26 January 2003]. 720 words.

Thomaselli, Rich. “Pharmaceuticals.” In Business Source Elite [database online]. Advertising Age, 2003 [cited 30 January 2003]. Accession no. 8824679. 462 words.

Scussa, Frank. “Consumer Ads Reach Peak: Growth of Spending on Direct-to-Consumer Promotion has been Curtailed as Consumer, Government, and Regulatory Pressure Mount.” In TableBase [database online]. Med Ad News: Euromoney Institutional Investor PLC, 2002 [cited 30 January 2003]. Accession no. 0745-0907. 25 pgs.

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Section IV: Web Sources

Title: Pharmaceutical Advertising and You
http://www.healthpartners.com/Menu/0,1791,3901,00.html#1
This page covers the history of drug advertisements, the creation of consumer demand, and the education of patients about prescription drugs. It is a concise summary of the major points surrounding the issue of pharmaceutical marketing. Also, this page addresses the issue of the rising cost of health care, which is a major repercussion of increased pharmaceutical advertising.
Source: HealthPartners


Title: Guide to DTC Pharmaceutical Advertising on the Internet
http://elab.vanderbilt.edu/research/papers/pdf/student_projects/DTC_Pharmaceutical_Advertising.pdf
Advertising on the Internet is a large part of pharmaceutical companies’ direct-to-consumer (DTC) marketing efforts. The report details the increasing prevalence of drug marketing on the Internet as well as certain techniques of DTC advertising. Full of detail, the report covers DTC advertising background, consumer opinion, and companies’ marketing techniques.
Source: Owen Graduate School of Management at Vanderbilt University


Title: The FDA and Commercial Speech Protections
http://www.essentialaction.org/commercialspeech/fdag.html
Basically, this page directs you to a wealth of information about pharmaceutical advertising. It serves as a home base, representing multiple opinions and studies. There are a variety of useful links including copies of testimony before the Senate and reports compiled by the Henry J. Kaiser Foundation. There is also criticism from action-oriented organizations about the FDA’s regulations.
Source: Essential Action (Although this site encourages activism, it does not take a definite side on this issue. Therefore, I have concluded that their information on my topic is unbiased.)


Title: Prescription Drug Marketing Act Regulations for Donation of Prescription Drug Samples to Free Clinics
http://www.fda.gov/cder/guidance/4932dft.htm
This is a lengthy report about the Prescription Drug Marketing Act (PDMA) prepared by the Center for Drug Evaluation and Research at the FDA, The document outlines the PDMA in relation to pharmaceutical companies’ marketing efforts to donate samples of prescription drugs to health clinics. The document sheds light on a different side of this issue than I had been considering.
Source: The FDA’s Center for Drug Evaluation and Research


Title: Direct-to-Consumer Advertising of Pharmaceuticals
http://www.ncsl.org/programs/health/rxads.htm
The National Conference of State Legislatures details numerous bills concerning direct-to-consumer advertising of pharmaceuticals. There is a chart listing a summary of the bill, bill progress status, and a link to view the bill in it entirety. Included is a brief introduction describing the history and current situation of drug marketing as well as a conclusion suggesting the future of the industry.
Source: National Conference of State Legislators

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Section V: Internet Issue Mini-Essay

Since the early 1980s, major changes have taken place in the pharmaceutical prescription drug business. Significant technological and scientific advancements in the last two decades have made the industry among the most rapidly growing in the world. A benchmark of the changing business occurred in the early 1980s when Boots Inc. began promoting one of its prescription drugs directly to consumers. Called Rufen®, this drug marked the pharmaceutical industry’s first direct-to-consumer advertising effort. (1)

In the last 20 years, the practice of direct-to-consumer advertising has continued to evolve, incorporating new media and marketing techniques. Most recently, Internet advertising has become an outlet of considerable pharmaceutical spending as well as a source of controversy. Specifically, the marketing and selling of prescription drugs online is a major point of debate. Potential risks of buying prescription medicines online include obtaining an inappropriate medicine for your condition, receiving phony or out-of-date medicines, and receiving medicine of sub-standard quality. (2)

Consumers/patients, health care physicians, and the pharmaceutical companies themselves are the three main groups directly involved with the issue. The groups are connected in the sense that the Internet and growing technology has merged them into a general community with a similar interest in pharmaceuticals. Conversely, the groups are disconnected in that varying levels of education and influence establish gaps in the fluidity of information exchange. These gaps are responsible for mislead consumers, profitable advancements (and regulatory setbacks) for drug companies, and pressured doctors.

Through Internet ads, consumers are able to access a vast amount of information about a certain prescription drug. However, this information may sometimes be incomplete or even too technical for a regular consumer. The opposite may be true to physicians; there may not be enough information on the Internet about a certain drug. Also, due to increased awareness, patients may request unnecessary drugs based on what they have seen online. (1) Marketers seem to benefit most financially, having the ability to monitor Web site visits and modifying their efforts accordingly.

These factors are but a few of the points to consider in the controversy of Internet advertising of pharmaceuticals. While the FDA and other regulatory commissions are hard at work monitoring current ads and accessing future needs for limitations, there are some important things to remember when surfing the Internet for a prescription drug. The FDA’s Center for Drug Evaluation and Research outlines some precautionary measures: take only medicines prescribed by your doctor, buy only from sites that require prescriptions from a physician, do not buy from sites that sell prescription medicines without a prescription, and do not buy from sites that sell merchandise not approved by the FDA.


NOTES:
(1) Ashish Chandra, Susan Casas de Betancourt, and Christine Wyble, “Pros and Cons of Marketing Pharmaceuticals on the Internet,” (Conway, AK: Small Business National Advancement Center, Southwestern Marketing Association Conference Proceedings, 1999, accessed 28 January 2003); available from http://www.sbaer.uca.edu/Research/1999/SMA/99sma138.htm; Internet.
*This source has considerably credible references. These include publications such as American Medical News, US Pharmacist, Pharmacy Business, and Pharmaceutical Executive. The World Health Organization is also cited.

(2) The Center for Drug Evaluation and Research, “Buying Prescription Medications Online: A Consumer Safety Guide” (Rockville, MD: The United States Food and Drug Administration, 28 February 2003, accessed 26 January 2003): available from http://www.fda.gov/cder/drug/consumer/buyonline/guide.htm; Internet.

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Additional Web Pages:

Title: Buying Medicines and Medical Products Online
http://www.fda.gov/oc/buyonline/default.htm
Detailed list of tips and warnings about buying pharmaceuticals online. There are links to more in-depth brochures including ones about online diagnosis and new FDA warnings and regulations. Site visitors also may report illegal or problem Web sites to the FDA.
Source: The Food and Drug Administration

Title: Forked Tongue: The Pharma Industry Has Been Accused of Creating Disease to Serve Its Marketing Purposes, But Is It True?
http://www.pmlive.com/pharm_market/features.cfm?showArticle=1&ArticleID=1672
Covers the issue of consumers becoming a new type of educated hypochondriac. The article suggests that learning about new medications may make consumers over-aware or over-sensitive to potential health problems.
Source: Pharmaceutical Marketing: The Magazine for Decision Makers

Title: Direct-to-Consumer Advertising: Changing the Face of Pharmaceutical Marketing
http://www.morpacepharma.com/MPG%20Publications/DTC/DTC.home.html
Describes the way pharmaceutical advertising has changed since the FDA relaxed its rules governing direct-to-consumer advertising in 1997. The article also includes several useful statistics.
Source: MORPACE Pharma Group, Ltd.

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Contact me at hughesj@email.unc.edu