The Social Medicine Portal

Direct to Consumer Advertising (DTCA)

Direct to consumer advertising (DTCA) of prescription medications is a relatively new and controversial marketing practice. Public health researchers and sociologists are beginning to explore the possible impact of these marketing practices on the epidemiology of some diseases. Is it possible that this marketing strategy propels the social construction of targeted disorders, like depression? For example, advertisements bring attention to specific symptoms (i.e., loss of interest or pleasure) and encourage consumers to label such symptoms as a disease (i.e., depression). Furthermore, is it possible that this approach to disorder construction has profound implications for public health? Advertisements stimulate the rapid uptake of new medications that may have unforeseen harmful effects and have targeted a specific audience that perpetuates disparities in access to care.

Web Resources:

Healthy Skepticism, one of the best sites for critical thinking on the pharmaceutical industry offers an extensive bibliography concerning DTCA on their website.

Disease mongering by the pharmaceutical industry has received a good deal of attention over the past few years. Lynn Payer’s Disease-Mongers: How Doctors, Drug Companies, and Insurers are Making You Feel Sick is a clear and passionate critique of how the “medical industrial complex” makes healthy people sick. A shorter introduction can be found in the 2004 article by Ray Moynihan, Iona Heath and David Henry’s article, Selling Sickness: The Pharmaceutical Industry and Disease Mongering, (British Medical Journal, April 13, 2004). A more recent collection of articles on the topic is listed on Anne T.-V’s blog.

For a look at DTCA related to Irritable Bowl Syndrome and women’s health see the Our Bodies Ourselves website.

DTC Perspectives, a pharmaceutical trade journal provides the industry point of view on DTC. The journal can be downloaded for free and makes very interesting reading.

The Center for Drug Evaluation and Research site for FDA has survey results related to DTCA.

No Free Lunch: Saying No to Drug Reps

Under the banner “Just Say No to Drug Reps” the No Free Lunch campaign challenges doctors to give up their dependency on drug companies.

The site uses a alcoholism motif, beginning with a modified CAGE screening test:

• Have you ever prescribed Celebrex?
• Annoyed by people who complain about lunches & free gifts?
• Is there a medication loGo on the pen you are using right now?
• Do you drink your morning Eye-opener out of a Lipitor coffee mug?

Two or more “yes” answers may indicate a problem. But fortunately the campaign can help you with your dependence problem.  Visitors can take a pledge to abstain from accepting gifts from drug companies and be listed on a “drug free doctor” database. There is even a “pen amnesty”!

No Free Lunch is the brainchild of Dr. Bob Goodman, a New York internist.  Among the other resources on the site are:

• A FAQ page explaining why physicians should not accept gifts from drug representatives.
• A list of suggested advocacy activities.
• Slide presentations and an extensive bibliographic listing regarding physicians and drug promotion.
• An opportunity to purchase “No Free Lunch” themed pens, mugs and t-shirts.
• Links to resources for unbiased information on drugs and resources.
• Links to resources for patients who are having trouble purchasing their medicines.
• Links to other sites critiquing big Pharma, including the British and Italian “No Free Lunch” campaigns.

So, it’s really not all that complicated to deal with drug representatives. Just say no.