Direct to Consumer Advertising and Empowerment: an experiment ICH - - PowerPoint PPT Presentation

Direct‐to‐Consumer Advertising and Empowerment: an experiment

ICH meeting Michel Schneider Lugano, Università della Svizzera italiana 20.10.09

DTCA for prescription drugs

Direct‐to‐Consumer Advertising

What is it? Advertising, allowed only in the US and in New Zealand, in different forms (Print, TV, Internet), to promote prescription drugs to the public

A controversial topic

Stakeholders: ‐ consumers ‐ government ‐ health experts (physicians, pharmacists…) ‐ drug companies At stake: ‐ Health ‐ Money (a lot)

Total U.S. pharmaceutical industry spending on DTCA 1996‐2005 (taken from Donohue (2006))

(REAL ADS, ~1950)

Inform public/patients /consumers about (new) treatment and diseases Encourage people to look for medical attention for untreated conditions Push people to seek more information from

• ther sources

Confuses patients by presenting promotional messages as educational Make patients ask for more expensive medications Medicalize normal human experience Lead to preference toward branded, advertised prescription over more affordable, effective treatments Present unbalanced information about risks and benefits

Arguments pro and contra DTCA for prescription drugs

Empower patients PRO CONTRA Influence patient‐ physician relationship

Important questions

To what extent can DTCA be considered as educational, while it has to be promotional and persuasive? What kind of information do patients need, in order to take well‐ informed decision regarding their health?

Educational potential of DTCA

Content analysis emotional appeals are far more prevalent than rational appeals in the promotional portion of print DTCA (Main, Argo and Huhman, 2004) information about risk factors for or prevalence of the disease, and about the population at risk is rarely provided (8‐25% of the ads) (TV ads, Frosch et al., 2007) FDA speaks of an imbalance between risks and benefits, created by an overwhelming focus on the benefit side

Educational potential of DTCA

Consumers misconceptions about DTCA (Bell et al., 1999) 50% of the respondents thought that DTC ads had to be submitted to the government for prior approval 43% thought that only completely safe drugs could be advertised 21% that only extremely effective drug could be marketed to the public 22% that ads of prescription drugs with serious side effects had already been banned attitude toward DTCA positively correlated with the beliefs that those misconceptions were true

Educational potential of DTCA

Physician’s point of view mixed results DTC ad could have a positive effect (lead to better discussion with patients, increase patients awareness of treatment) DTC ad could have a negative effect (need to correct misconceptions, request of unnecessary drugs)

What kind of information?

Consumers' preferences compulsory policies instead of voluntary or no disclosure ones (for information such as causes of the disease, other available treatment) numerical reporting of incidence level of side‐effects (over non‐ numerical), side effects ordered from highest to lowest in probability, number of patients who discontinued the treatment Consumers' need ???

Patient empowerment and literacy

Building on Schulz and Nakamoto model of health empowerment both concepts are useful to explain patients health behaviours and

• utcomes

in the case of DTCA for prescription drugs, it is very important to assess if empowerment and health literacy moderate the effect of DTCA for instance, people having high level of health literacy may respond differently to advertising than people with low level of health literacy

• r people scoring high in empowerment may be more likely to seek a

treatment than people having lower scores, after exposure to DTCA

My project – 3 facets

effect of exposure to DTCA for antidepressant drugs on people’s definition of depressive disorders, perceived treatment options for depressive disorders, and perceived role of the physician when deciding to take a drug or not DTCA for antidepressants vs. “Balanced and complete information” effects Exploration of the role of people’s empowerment and health literacy in the case of exposure to DTCA and/or other sources of information

The experiment

Expose participants to either DTCA for antidepressant, a more complete and balanced source of information,

• r both (or nothing, control group)

ask them to read and evaluate a vignette case of a person experiencing unclear depressive symptoms (i.e. according to the standards of the APA, it will not be clear if the person present a “clinical” depressive disorder, and if she needs some kind of treatment or not 2 weeks later, measurement of empowerment and health literacy, and questions about personal history regarding depression

Design

2 (presence/absence of DTCA for antidepressant drug) x 2 (presence/absence of a more complete and balanced source of information about depressive disorders), between subject Control group: No information about depressive disorders Group 1: DTCA for antidepressant drug Group 2: More balanced source of information Group 3: DTCA and more balanced source of information Outcomes people’s definition of depressive disorders, perceived treatment options for depressive disorders, and perceived role of the physician regarding the decision to take a prescription antidepressant or not

Outcomes variables

Task: evaluate a vignette‐case of a person suffering from unclear depressive symptoms Naming of the problem (open‐ended question) Giving advice to the person in the vignette about what she should do (open‐ended) Choosing the best‐suited category for the problem (multiple choice question) Choosing the best suited‐advice in a list (close‐ended) Measurement of the perceived need of a physician in order to decide if it would be a good thing for the vignette case person to take an antidepressant

Hypotheses

H1: exposure to DTCA for antidepressant, and to the more balanced source of information, will make participants more likely to categorize the ambiguous case as “depressed” (instead of using other categories like stressed, tired, sad…), than participants without any source of information about depression H2: participants exposed to the more balanced source of information are less likely to choose the category “clinical depression” in a multiple choice question for the case, than participants exposed to DTCA only H3: participants exposed to DTCA only are more likely to choose antidepressants as the preferred treatment for the case, than participants of all other groups H4: participants exposed to DTCA are more likely to say that they may ask a doctor about a prescription antidepressant in the future, than participants not exposed to DTCA (however, here strong influence of the personal history regarding depressive symptoms)

Next steps

Creation of the material advertisement for antidepressant drug, pretest fake brochure about health ambiguous case, pretest for ambiguity Preparation of scales empowerment (ex. Empowerment among users of mental health services, Rogers et al., 19997) health literacy for depressive disorders (construction with experts) personal history regarding depression …

Thank you for your attention