In April of this year, an op-ed piece in the New York Times questioned the amount of money spent on direct-to-consumer pharmaceutical advertising that claims to educate patients, but that the author believes lack information he feels would be helpful to (and desired by) the patient, specifically, a cost comparison, statistics on serious adverse events and clinical trial information.
The author recommends including a “scorecard” (similar to food labels) at the end of each commercial and embedded within print advertisements that details:
- All the drugs within the class
- The average monthly cost for the patient of each drug in the class
- The number of patients needed to be treated with each drug for one person to receive a benefit (or “number needed to treat/NNT”)
- Clinical trial information
- Whether the advertised drug is an improvement over the drugs in its class
In part, I agree with the article that it is important to keep healthcare costs as affordable as possible for patients. I also agree that patients should be as educated as possible about their condition and treatments. However, I think that the author’s recommendation contains flaws as it does not take into consideration that:
- The intent of any promotion to a consumer is to educate about the availability of a new medication and to encourage communication with their physicians about this option. It is why we hear or read “ask your doctor if Product X is right for you” in these communications. The purpose is not to provide comprehensive information to be digested from a 30-second commercial or a print ad.
- The treatment decision process is multifactorial and for which cost, clinical trial results and other available options are only part of the equation. Besides efficacy, safety, tolerability, dosing, etc., there are other important factors physicians (and patients) consider that could not be included in an ad or commercial – such as patients’ ability to comply, other medications patients take for concomitant conditions (and for which a drug interaction could occur), formulary coverage, and individual patient tolerance/acceptance of the medication, just to name a few.
- Despite the egalitarian nature of his recommendation, many patients may not be able to fully understand the information in the scorecard and to act appropriately upon it. The average patient is unaccustomed to the data included in clinical trials (regardless of how “consumerized” the presentation may be), the concept of the “number needed to treat” to achieve effect, etc. and therefore may just default to considering cost only. Some of the criticism of pharmaceutical promotions to patients is that these ads lead to unnecessary discussion with physicians because patients do not understand the message of current communications. Social media may exacerbate the issue as patients could in turn post inaccurate information online and therefore perpetuate misconceptions which could be brought into the exam room and even potentially impede proper treatment.
- Additional and (most likely) unfamiliar information could further complicate matters and potentially increase healthcare costs as physicians will need to take extra time to explain matters to patients, field questions, and address patient resistance due to misconceptions.
Based on my experience in advertising, strategic planning and the pharmaceutical industry, I recommend using the “scorecard” differently:
- I agree it should still be developed by the FDA, or some other objective third party. But it should be expanded to include dosing, administration, side effects, and other relevant clinical information so that physicians could use it as a tool for educating patients about their treatment options and involving them in the decision-making process where appropriate. Utility in this regard respects the expertise of the physician, allows for dialogue about patient preferences, and encourages patient interest in treatment.
- A reference to the scorecard on the FDA’s website could be made in commercials and print advertisements – much like 800#s and product websites are currently referenced – so that patients can refer to this information if desired. Each scorecard should be labeled to encourage patients to bring this information to their next physician visit about their condition.
Increasing patient knowledge and interest in their condition and treatment is an important goal. However, the challenge remains to do this in a way that assists the physician while engaging the patient with meaningful information.
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