Direct-to-Consumer Advertising of Pharmaceuticals: An Integrative Review - Innovation and Marketing in the Pharmaceutical Industry - page 632

In the USA, pharmaceutical companies must adhere to FDA regulatory guidelines
which call for all DTC advertising to be accurate, to provide substantial evidence
for any claims that are made, to provide a balance between the risks and benefi ts of
the advertised drug, and to maintain consistency with labeling approved by the
FDA. Questions such as the effi ciency of regulation and its impact on drug sales and
on social welfare have drawn researchers' attention in the past decade.
Based on a time-varying coeffi cient model, Stremersch and Lemmens ( 2009 ) fi nd
that differences in regulation of the pharmaceutical industry substantially contribute
to cross-country variation in sales. Specifi cally, they report that prohibition of DTCA
tends to hurt sales.
Campbell ( 2011 ) discusses the potential effects of a ban on DTCA of new
prescription drugs. She argues that a ban or moratorium on DTCA may lead to
reduced awareness of the drug's availability among individuals who would benefi t
from it. She further points out that a moratorium on DTCA might affect other
marketing strategies used by drug manufacturers (like detailing to physicians) and
the quantities and prices of drugs sold. Chen ( 2011 ) estimates physicians' choice
and learning process and uses a policy simulation to study the effect of a ban on
DTCA. The fi nding is that if drug advertising is prohibited, diffusion of new drugs
will be slowed down to different degrees. The effect is stronger for the relatively
better new drugs in the therapeutic class.

21.3.3.5 Compliance

Noncompliance with prescribed drug regimens is a very signifi cant and widespread
problem. Noncompliance has adverse consequences for the patient, the drug
manufacturer, as well as society (Wosinska 2005 ). Given the proven success of
advertising in infl uencing consumer attitudes and behaviors in a variety of contexts,
encouraging compliance with prescribed therapy would seem to be a natural and
desirable role for DTCA.
The relationship between advertising exposure and compliance is complex.
Bowman et al. ( 2004 ) argue that, on the one hand, a positive relationship is expected
because advertising serves a reminder role and reinforces positive compliance behav-
ior. On the other hand, patients who feel empowered by advertising may make changes
to their dosage schedule without consulting their physician, thereby leading to a nega-
tive relationship. They also conjecture a role for patient heterogeneity:
if DTCA attracts marginal consumers to the treatment—those who have minimal
symptoms—the average level of compliance in the category may be reduced by
increased advertising. In their data for four categories and three segments of consumers,
results are mixed.
Wosinska ( 2005 ) uses prescription claims data to examine compliance in the
category of cholesterol-lowering drugs. Contrary to many industry surveys, she fi nds
that the impact is small in economic terms. However, since the goal of the advertising
was primarily acquisition of new patients and not improving compliance, she considers
this a spillover effect. She also fi nds that brand advertising spills over to improved
compliance of users of other brands in the category. A negative effect on compliance