Aregulation of Prescription Medicine Advertising in the United States and New Zealand: A Consumer Perspective

AREGULATION OF PRESCRIPTION MEDICINE ADVERTISING IN THE UNITED STATES AND NEW ZEALAND: A CONSUMER PERSPECTIVE

Janet Hoek and Philip Gendall

Department of Marketing, Massey University, Palmerston North, New Zealand

WAPOR Conference, Phoenix, Arizona, 11-13 May, 2004

Abstract

Only two countries, New Zealand and the United States, allow direct-to-consumer advertising of prescription medicines (DTCA). The purpose of our research was to examine New Zealand consumers' views of different DTCA regulatory options and to draw some comparisons between New Zealanders' views on DTCA and those of their counterparts in the USA. A mail survey of 800 New Zealanders resulted in a processing sample of 418 cases and a response rate of 62%. The questionnaire examined advertising regulation, and provided respondents with detailed and balanced information about the New Zealand self-regulatory DTCA system. Respondents were then asked to review four options, ranging from continuation of the status quo, through to a ban on DTCA and its replacement with a free and independent health information service.

Despite the criticisms levelled at DTCA, members of the New Zealand public support its retention in a more strictly regulated format. Only around 20% favour banning it completely, and a slightly lower proportion support retention of the status quo. This suggests that New Zealand consumers do not share many of the concerns about DTCA raised on their behalf. Analysis of a series of forced choice attitude questions provides background to New Zealand consumers' opinions and suggests several regulatory initiatives that are required to ensure DTCA meets consumers' information needs. Comparison of our results with analogous US data sourced from the regular Prevention magazine surveys indicates that New Zealand regulators could benefit from studying American consumers' opinions of DTCA, and vice versa.

Our findings differ from those reported in other surveys. This highlights the vulnerability of public policy questions to variations in question wording and response options provided, and emphasises the need for policy makers to refer to well-conducted and comprehensive consumer research. Failure to do so increases the likelihood that public policy will be narrowly focused

and reflect the arguments of the most persuasive lobby groups rather than the views of those most affected by the policy.

Introduction

Advertising of prescription medicines to potential end-users (DTCA) only occurs in New Zealand and the United States, though each country has adopted a strikingly different regulatory model and processes (Hoek & Gendall, 2002a; Hoek, Gendall, & Calfee, 2004). Neither country anticipated the introduction, let alone the rapid growth, of such drug promotions (Social Audit 2000). The apparent success of DTCA in the United States, where it first appeared in the 1980s, may explain its subsequent appearance in New Zealand. The introduction of the New Zealand Bill of Rights Act in the early 1990s, which explicitly protected freedom of speech (including commercial speech), also created a regulatory environment in which DTCA could develop.

The arguments for and against DTCA have been well rehearsed and focus on empirical arguments about the effects these promotions have on patients and doctors, and their implications for health funding (Hoek & Gendall, 2002a; Hoek & Gendall, 2002b). In addition, the debate has included an analysis of the ethics of advertising products that have potentially serious consequences, which may not be fully understood by the lay consumers the advertising targets (Lexchin & Mintzes, 2002).

More recently, the debate has also examined the regulation of DTCA. In New Zealand, this debate intensified following the release of a report by a group of academic doctors (the Toop Report), which included findings from a survey of consumers. Drawing on the consumer survey, Toop and his colleagues concluded that a majority of consumers (51%) would support a ban on DTCA if they could instead access an independent health information service (Toop et al, 2003). These findings ran counter to those reported in another consumer survey, where only 11% of those surveyed supported a ban on DTCA (Hoek & Gendall, 2003).

In this paper, we examine briefly the arguments about DTCA and its alleged effects on consumers, before analysing the estimates reported in three consumer surveys that explored consumers' views of DTCA. We also examine comparable US consumer data and conclude by considering the role of survey research as a factor in public policy development.

The DTCA Debate

Provision of information

The main arguments used to support DTCA focus on its ability to provide information that consumers may not otherwise be able to access (Peyrot, Alperstein, Doren & Poli, 1998; Researched Medicines Industry, 2000; Calfee, 2002; 2003). Proponents argue that DTCA enables consumers to play a more informed role in their healthcare management, and that advertising reduces their reliance on doctors as the sole providers of health information. As a result, this argument continues, patients become better educated, better equipped to discuss their treatment with doctors, and better prepared to maintain the treatment regime they determine jointly with their doctor (Peyrot et al, 1998; Calfee, 2002; Lyles, 2002).

There is strong evidence that DTCA does increase consumers' awareness of drugs, and a majority of consumers find that this advertising helps them to have more informed discussions with their doctors (Hoek, Gendall & Calfee, 2004). However, increases in awareness may not result in better-educated consumers, and doctors themselves do not necessarily share consumers' perception that surgery discussions are better informed (Woloshin, Schwartz, Tremmel & Welch, 2001).

Thus, while there is no dispute that DTCA has increased awareness of many drugs, leading brand names such as Xenical and Viagra to become household names, there is considerable disagreement over the wider effects of DTCA. In particular, critics have argued that DTCA routinely fails to achieve an appropriate balance of information, and that this imbalance leads potential patients to form incorrect impressions about a drug's potential suitability. Considerable debate over the type, format and relevant source of information