Direct-to-Consumer Advertising of Pharmaceuticals: An Integrative Review - Innovation and Marketing in the Pharmaceutical Industry - page 629

DTCA on time effi ciency, requests for specifi c interventions, health outcomes, and
the doctor-patient relationship. They found that DTCA has complex effects on
quality of care and health service utilization. DTCA results in patients making
almost as many inappropriate requests as appropriate ones. In a fi nding echoing
Mintzes et al. ( 2003 ), physicians reported that they often acquiesced to patient
requests even if they were clinically inappropriate, as long as the patient was not
harmed.
An interesting, positive indirect effect of DTCA on physician behavior is found by
Young et al. ( 2008 ) who report that physicians engage in more shared decision
making behavior when faced with patients who request either general or brand-
specifi c medications.
Robinson et al. ( 2004 ) found in a mail survey of 523 Colorado physicians and 261
national physicians, and a telephone survey of 500 Colorado households, that most
physicians have negative views of DTC pharmaceutical advertising. They believe
that advertisements do not provide enough information on cost, alternative treatment
options, or adverse effects. Interestingly, less than a quarter of the physicians believed
that these ads changed their prescribing practices.

21.3.3 Welfare Effects of DTCA and Government Regulation

21.3.3.1 Is DTCA Market Share Stealing or Category Expanding?

A key question about DTCA is the nature of its impact on drug sales: does DTCA
expand the category, or does it primarily lead to stealing market share from competing
drugs in the category? This question is not only relevant to assess the nature of
competition between fi rms that invest in DTCA but also central to the debate about
the societal effects of DTCA and hence to public policy and regulation.
Consistent with the argument of proponents that DTCA plays an important
informational role, DTCA should mainly have a category expanding effect on
drug sales. Further, it should be cost effective in reducing underdiagnosis or under-
treatment. However, consistent with opponents' arguments, DTCA should mainly
affect a drug's market share within a therapeutic class and/or it should not be cost
effective even if it has a category expanding impact. We review next the literature
pertinent to this debate.
Using data from insurance claims of high cholesterol patients, Wosinska ( 2002 )
concludes that DTCA increases the likelihood of a drug being prescribed by physi-
cians but only for drugs on the formulary. She also fi nds that the marginal impact of
DTCA on prescription choices is signifi cantly lower than that of detailing. Narayanan
et al. ( 2004 ) examine aggregate sales and marketing promotions of second-
generation antihistamines from April 1993 through March 2002. They report that
whereas DTCA has a signifi cant effect on category sales, detailing does not. In contrast,
both detailing and DTCA affect drug market shares, but detailing has a much larger
effect than DTCA in generating market share. Fischer and Albers ( 2010 ) suggest
a new method for measuring primary demand effects with aggregate data at the