User:Rothschild.e/sandbox

Evaluation
I evaluated the Direct-to-Consumer Advertising page[]. The article does a good job of presenting the general idea of what direct-to-consumer advertising is. The author also does a good job of remaining neutral. However, not a lot of specifics are given. The article is very surface level. Lastly, the citation links that I checked worked. Rothschild.e (talk) 16:48, 25 July 2017 (UTC)

Wiki Article Outline
I would like to improve the existing Direct-to-consumer advertising page. The current article is very general and no specific facts are given. My plan is to add specifics along with a section on how direct to consumer advertising effects the relationship patients have with doctors.

Introduction

a. The introduction does a good job of describing the general concept of DTCPA

Nations Permitting DTC-this section needs some work only dates are given

a. Add the reason why the US changed DTCPA law in 1997. Now FDA does not approve advertisements before they are on TV.

b. Add a brief discussion as to why the EU voted against allowing DTCPA

Controversy in the US-specific data from research studies is not given in this section, I would like to add this.

a. Benefits

1. Promotes talking to doctors: 30% of Americans indicate they talk with their doctor about a medicine they saw advertised. Of that 30%, 44% report their      doctor prescribed the medication that they requested.

2. Economics: DTCPA informs consumers of new treatment options, generating new doctor visits and thereby reducing the rate of undiagnosed illnesses

3. Public Health: 10% increase in advertising increases the rate of drug adherence by roughly 1% to 2%.

b. Cons

1. Economics: DTCPA misleads patients into demanding heavily advertised drugs, leading to artificially inflated drug prices and unneeded or suboptimal treatments.

2. Promotes talking to doctors: Talking to your doctor increases likelihood of being prescribed a medication by 44%.

3. Public Health: DTCPA has contributed to illicit drug use of certain pharmaceutical drugs, as drug addicts seek out certain prescriptions based on their greater knowledge of drugs available on the market.

Effect of DTCPA on Doctors

a. $28 increase in monthly DTCPA expenditures leads to one patient visit within 12 months.

b. New doctor visits due to a DTCPA leads to prescription of the medication 44% of the time.

c. Doctors are prescribing medication and spending very little time with patients. Those patients tend to think they have symptoms that they are seeing on TV.

d. Geographical differences based on DTCPA: the effect of geographical advertising on drug prescriptions.

Proposed Bibliography

1.     Alpert, A. (2017) Cause and Effect: Do Prescription Drug Ads Really Work?. University of Pennsylvania Wharton. http://knowledge.wharton.upenn.edu/article/prescription-drug-ads/

2.    Fain, K.M., Alexander, G. C. (2014) Mind the Gap: Understanding the Effect of Pharmaceutical Direct-to-Consumer Advertising. NIH Public Access, Med Care. 291-293. Doi:10.1097/MLR.0000000000000126

3.    Lizuka, T., Jin, G. Z. (2005). The Effect of Prescription Drug Advertising on Doctor Visits. Journal of Economics & Management Strategy, Volume 13 Issue 3, 701-727. doi.10.1111/j.1530-9134.2005.00079

4.    McKinaly, J. et al. (2014) Effect of Patient Medication Requests on Physician Prescribing Behavior: Results of a Factorial Experiment. NIH Public Access, Med Care. 294-299. doi:10.1097/MLR.0000000000000096

5.    Ventola, C. L. (2011). Direct-to-Consumer Pharmaceutical Advertising-Therapeutic or Toxic?. Pharmacy and Therapeutics, volume 36. (669-684). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278148/

Nations permitting DTC (in addition to the existing text)
United states: The Food and Drug Administration’s division of Drug Marketing, Advertising and Communications is responsible for regulating direct-to-consumer pharmaceutical advertising. In 1962 the FDA was given the right to regulate prescription drug labeling and advertising, but specific regulations were put in place in 1969. The 1969 regulations were much strict than they are today due to changes in regulations in 1997 which stated that pharmaceutical companies only had to include major risks and could direct viewers somewhere else to get summary information. In 2004 the FDA further relaxed regulations. Now, a significant percentage of pharmaceutical advertisements are not submitted to the FDA for pre-approval.

Types of Pharmaceutical Advertising (new section)
There are three types of direct-to-consumer pharmaceutical advertisements:

Help-seeking ad: This type gives information about a medical condition and encourages patients to talk to their primary care physicians but does not mention a product.

Reminder ad: This includes the product name, dosing strength and price but does not include any claims.

Product claim ad: This is the most common type of advertising. This type will mention the product, efficacy and safety claims.

Each category has a different FDA imposed regulation.

Controversy in the US (in addition to existing section)
Arguments in favor state that DTCPA informs consumers of new treatment options, generating new doctor visits and thereby reducing the rate of undiagnosed illnesses. Research has explored the impact of advertising on patients’ willingness to complete --or adhere to their treatment regimen. Surveys show that increased advertising has had a positive impact on the degree to which people are willing to adhere to a given course of treatment – but only among those who are already patients, a 10% increase in advertising increases the rate of drug adherence by roughly 1% to 2%.

Effect on Doctor and Patient Relationship:  (new section)
In a study performed by scholar JB McKinlay, it was found that DTCPA prompts consumers to talk with their doctors about medications they have seen advertised. McKinlay notes that 30% of Americans indicate they talk with their doctor about a medicine they saw advertised. Of that 30%, 44% report their doctor prescribed the medication that they requested. When consumers approach their doctor about a condition they believe they have, or are requesting a change in medication for a condition they already have, often their first and most persuasive source of information was a DTCPA. This leads consumers to direct their doctors’ visits from the start by prompting a conversation about a certain medicine. The result is that doctors are prescribing medicine to patients when it might not be entirely appropriate, because their patients are pleading for a specific treatment, and convinced that they suffer from a certain illness. Other scholars have mirrored McKinlay’s study and found that every $28 increase in monthly DTCPA expenditures leads to one patient visit within 12 months. Moreover, a recent study done by Abby Alpert compared young people living in West Palm Beach, Florida and Denver, Colorado to examine the effect of advertising on the rate of prescriptions. Using insurance data, Alpert found that people living in West Palm beach were exposed to drug advertisements more often than their counterparts living in Denver so much that a 10% increase in advertising expose increased the number of prescriptions by 5%. Drug advertisements have also caused a large spillover effect. There is an increase in whole classes of drug being prescriptions based on advertisements.

History of DTCPA
Direct-to-consumer pharmaceutical advertising (DTCPA) laws and regulations in the United States have gradually become more relaxed since they were first introduced in the 1960s. Consequently, expenditures on advertisements for prescription drugs in the United States have grown to approximately $.4.5 billion per year.

In 1962 Congress gave the Food and Drug Administration (FDA) the authority to regulate prescription drug labeling and advertising, but the FDA did not establish implementing regulations until 1969. Pharmaceutical companies shifted the focus of their marketing efforts to licensed medical doctors in the 1970s, as the FDA mandated that only doctors could prescribe medicine.

After a series of Patient Rights campaigns in the 1970s persuaded a large segment of the population to be actively involved in their own medical care, the drug company Pfizer launched the first pharmaceutical direct-to-consumer campaign in 1980, promoting its brand but not marketing any prescription medication. In 1981, Boots aired the first targeted drug advertisement for the drug Rufen, promoting the pain killer as a cheaper alternative to leading brands. Soon after Merck launched a campaign promoting its pneumonia vaccine.

DTC marketing significantly increased starting in 1997, after the FDA suggested ways pharmaceutical companies could meet what had previously been a legally vague regulatory provision; the FDA also exempted certain types of advertisements from providing a full summary of major side effects and contraindications of a drug’s effectiveness. In 2004, the FDA further relaxed DTCPA regulations to require only a brief description of the drug and its side effects -- provided that consumers could access full summary information elsewhere.

Economic
Supporters of DTCPA argue that advertisements increase competition which leads to lower prescription drug prices and new development, citing, for instance, that between 1997 to 2001, spending on research and development in the US increased 59% while spending on promoting drugs directly to patients increased 145%. However, other experts have asserted that funding for R&D is determined by several other factors.

Public Health
Arguments in favor of DTCPA assert that advertising informs consumers of new treatment options, generating new doctor visits and thereby reducing the rate of undiagnosed illnesses.

DTC advertising, among other patient education initiatives, can educate consumers and patients about therapeutic options that may not have been proactively mentioned by their healthcare professional. Proponents of DTCPA claim this provides a vital opportunity for the public to be aware of what is available to them and to engage in an educated discussion with their doctor. According to one study, every additional $28 spent on DTCPA prompts one patient visit within the following 12 months. Another study observes that DTCPA promotes communication between patients and their doctors about medications. Thirty percent of Americans indicate they talk with their doctor about a medicine they saw on TV.

In addition, surveys show that increased advertising has had a positive impact on the degree to which people adhere to a given course of treatment – but only among those who were already on medication prior to exposure to DTCPA. Among this population, a 10% increase in exposure to drug advertising increases the rate of adherence between 1% and 2%.

Economic
Some studies have asserted that DTCPA misleads patients into demanding heavily-advertised drugs, leading to superfluous or sub-optimal treatment. For example, the Centers for Disease Control and Prevention have determined that 47% of all antibiotics prescribed in the United States are unnecessary, imposing significant additional costs on affected households. Another study found that young people living in West Palm Beach, Florida found that a 10% increase in advertising expose increased the total number of prescriptions by 5%; a higher percentage change than in Denver, Colorado – where DTCPA expenditures per person are lower. Critics also argue that resources spent on DTCPA could otherwise be spent on developing new drugs and medical therapies. Nine of the 10 largest pharmaceutical companies worldwide spend more money on sales and marketing than on research and development. US pharmaceutical companies are estimated to have spent 5.2 billion dollars on prescription dug advertising in 2015 most of which was spend on television advertising.

Public Health
When consumers approach their doctor with a health concern, or to request a change in medication for a condition they already have, often their first and most persuasive source of information was a pharmaceutical advertisement. This leads consumers to direct their doctors’ visits from the start by prompting a conversation about a certain drug or course of treatment. Doctors may be more likely to prescribe the medicine patients requested even when it may not be the most cost-effective, medically sound or safe course of treatment. Of those patients who sought medical treatment because of an advertisement, 44% report their doctor prescribed the medication that they requested. When new drugs are marketed directly to patients, the use of these drugs accelerates, even though trials and testing may not have yet had enough time to identify long-term side effects or rare reactions to the drug. Recently-released drugs usually are only tested in small pre-marketing clinical trials.

New demand for a particular drug can also create adverse public health harm. A higher rate of antibiotic consumption – driven in part by DTCPA -- is creating anti-biotic resistant infection strains that in turn pose a public health hazard.

DTCPA has contributed to illicit drug use of certain pharmaceutical drugs, as drug addicts seek out prescriptions based on their greater knowledge of drugs available on the market.