Biomedical Engineering Reference
In-Depth Information
disorder, anxiety, depression, obesity, diabetes, and erectile dysfunction demonstrates a
range of symptoms that consumers are asked to identify in an attempt to self-diagnose.
The conventional wisdom behind this strategy is that the more people know about the
symptoms of a condition, the more they will self-diagnose.
However, many of those who need care still do not seek it. Gidengi (
2012
) reports
that even though people's perceptions of risk for H1N1 appeared to increase with its
actual incidence through the first year of the pandemic, among those who remained
unvaccinated, intentions to be vaccinated dropped from 50 to 16 %. In a defense for
DTC advertising, Manning (
2006
) reports high rates of nonacceptance (i.e., filling
in a prescription) of high cholesterol (10 %), high blood pressure (15 %), and dia-
betes (11 %), with a large drop off in the percentage of patients continuing with
prescriptions (e.g., non-persistence for diabetes was as high as 37 % after 1 year of
having filled a prescription and rose to 51 % at 18 months). Diabetes is estimated to
affect 16 million Americans, a number expected to grow by 42 % by 2025; with as
many as 8 % of these cases undiagnosed (Franse et al.
2001
). Cancer is also under-
diagnosed: between 1998 and 2005, 27 % of men in the United States met the crite-
ria for underdiagnosis of prostate cancer (Graifa et al.
2007
), with the number as
high as 30.3 % in a sample from Austria and Italy (Pelzer et al.
2007
).
Compounding the issue of noncompliance and discontinuance of treatment, as
advertising in the DTC space becomes crowded, consumers may begin to tune out
these advertisements in the manner that they tune out the number of other ads
directed toward them. This would reduce the efficacy and efficiency of drug-related
advertising. From a consumer welfare and public policy point of view as well as
from the point of view of the pharmaceutical industry, this suggests that DTC adver-
tising may need to be made more effective. Central to its efficacy is a better under-
standing of how consumers assess risk.
One of the routes that pharmaceutical (and other) companies use to help consum-
ers assess whether or not they are at risk is to provide a set of symptoms and ask
people to identify which of the symptoms they or someone they know possess
(Menon et al.
2002
). On the other hand, other persuasion messages use base rates as
a route to get consumers to accept their risk level and seek treatment. For example,
an advertisement in a New York City subway car with a beach visual highlighted the
odds of a shark attack (less than 1 in 10 million) against the odds of cancer, which
is 1 in 5 people.
2
A poster in the Department of Motor Vehicles office in California
in June 2011 highlights the dangers of texting while driving by listing the number
of deaths per year from cobras (
n
= 5), Uzis (
n
= 2,076), cancer (
n
= 1,655), floods
(
n
= 30), and texting (4,829). The poster goes on to say that traffic accidents are the
leading killer of teens ages 16-19, ending more than 5,200 lives each year. They are
careful to separate out the fact that more than two-thirds of these deaths had nothing
to do with drugs or alcohol, implying that as many as 3,000 deaths were due to
everyday driving behaviors and distractions. Therefore, it is important to examine
how asking people to identify symptoms or presenting people with base rates will
help them assess their overall levels of risk. This is the purpose of this chapter.
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