Direct-to-Consumer (DTC) Advertising of Psychiatric Drugs ...

[Pages:1]Direct-to-Consumer (DTC) Advertising of Psychiatric Drugs in Popular Magazines: How are Mental Disorders Portrayed?

Rebecca Abromitis, MLS Health Sciences Library System, University of Pittsburgh

INTRODUCTION

Direct-to-consumer (DTC) advertising of prescription medication is a controversial topic.

While the "fine print" drug information (typically located on an adjoining page) is strictly regulated by the Federal Drug Administration (FDA), the visual components of DTC print ads are guided by only a simple subjective phrase: pictorial matter should not be misleading.

The potential for visuals to sway consumer perceptions away from the information content is important to recognize.

This poster endeavors to raise awareness among medical librarians about these issues by:

Examining visual portrayals of patients with mental disorders in DTC magazine advertisements for psychiatric drugs;

Comparing observable demographics in ads with expected prevalence in the general population;

Providing pros and cons of the DTC ad debate.

METHODS

A content analysis was conducted for 11 popular magazines (257 issues) published in 2005 to obtain direct-to-consumer (DTC) prescription advertisements for psychiatric drugs that contained both:

1) photographic depictions of patients, and

2) detailed patient education and drug information (`fine print') on an adjoining page.

Popular magazines were selected from among 60 that ranked highest in total advertising and circulation revenue for the year 2004. Categories represented include women's and men's interests, business, health, home, lifestyle, general, and newsweeklies.

A hand search of the 257 magazine issues yielded:

MAGAZ I N ES

All DTC

(in order of total advertising Prescription

revenue, 2004) 1

Drug Ads

Psychiatric Drug DTC

Ad s

Psychiatric Drug DTC Ads which met

inclusion criteria

PEOPLE

156

46

30

SPORTS ILLUSTRATED

61

11

11

BETTER HOMES & GARDENS

93

17

12

READER'S DIGEST

76

5

5

GOOD HOUSEKEEPING

100

20

15

FAMILY CIRCLE

112

16

16

FORBES

13

2

2

U.S. NEWS & WORLD REPORT

125

27

26

PR EVEN TI ON

102

15

15

AARP THE MAGAZINE

15

0

0

GQ

0

0

0

TOTAL S

853

159

132

1Sourc e: Endic ott. (2005)

The 132 DTC ads for psychiatric drugs yielded 20 distinct (non-duplicate) ads for these seven psychiatric drugs which comprise the study sample:

One antidepressant: Wellbutrin

(Bupropion Hydroc hloride)

One antipsychcotic: Abilify (Aripiprazole)

One antidementia agent: Aricept

(Donepezil Hydroc hloride)

Two hypnotics: Ambien (Zolpiden Tartrate) Lunesta (Eszopiclone)

Two stimulants: Adderall

(A m p h e ta m i n e /De xtro a m p h e ta m i n e)

Concerta

(Methylphenidate Hydroc hloride)

RESULTS

In this study sample of DTC psychiatric drug ads:

Psychiatric drugs make up 13% of all advertised prescription drugs derived by a hand search of 11 popular magazines published in 2005.

Only females or only males appear in 40% of ads, and both appear in 20% of ads.

Only two races are portrayed (white and African American).

85% of patients depicted are white.

Young, white women exclusively represent patients with bipolar disorder.

99% of patients display positive affect, leading to unrealistic expectations that the drug provides an easy cure; minimal failure rates; or minimal side effects (which are known to be substantial for many psychiatric drugs).

Despite suffering considerable incidence of depression, insomnia, and ADHD: - Adolescents are not represented in antidepressant ads. - The aged are not represented in antidepressant or hypnotic ads. - Adults are not represented in stimulant ads.

DEMOGRAPHICS OBSERVED IN vs.

STUDY SAMPLE ADS

PREVALENCE OF MENTAL DISORDERS

ANTIDEPRESSANTS for treatment of depression

Ads portray: Only young or middle age heterosexual, attractive white couples.

Prevalence:

Depression affects: Whites and African

Americans in near

equal numbers. Females 2:1 over

men.

ANTIDEMENTIA AGENTS for treatment of Alzheimer's Disease

Ads portray: Females 2:1 over males; 25% of ads depict African Americans.

Prevalence: Alzheimer's affects: Females at a higher

rate than males for all

age ranges. African Americans at

higher rates than

whites.

ANTIPSYCHOTICS for treatment of bipolar disorder

Ads portray: Only young, white females.

Prevalence: Bipolar disorder is

slightly more prevalent in ages 30-44, African Americans, and females.

HYPNOTICS for treatment of insomnia

Ads portray:

Only white males and females, ages 30-40.

Prevalence:

Insomnia affects: Females at slightly

higher rates than males. Ages 18-49 at slightly higher rates.

STIMULANTS for treatment of ADHD

Ads portray:

97% of ads depict white males, ages 9-17.

Prevalence:

ADHD affects: African Americans at

slightly higher rates

than whites. Males 3:1 over

females. Predominately ages

9-17.

Note: sources for prevalence are listed in follow ing sections.

Prevalence CHARACTERISTIC %

SEX1 Male Female

AGE2 18-29

3.6 - 12.7

(range)

8.7 - 25.0

(range)

15.4

30-44

19.8

45-59

18.8

> 60

10.6

RACE3

African American

11.6

White

17.7

1Source: Karpiak et al. (2005) 2Source: Kessler et al. (2005) 3Source: U.S. Public Health Service,

Office of the Surgeon General (2001)

DEPRESSION

Ad depicts elated white couple in their 30's in a recreational setting. Caption: "An antidepressant with a low risk of weight gain and sexual side effects? Yes! WELLBUTRIN XL."

Family Circle. 2005 Aug 9;118(9): 55

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Prevalence CHARACTERISTIC %

SEX

Male

11

Female

4

Ad for Adderall shows a happy white mother hugging 10 year old son, who is holding a B+ test grade. Caption: "Finally!"

AGE 4 - 8 9 - 12 13 - 17

Ad shows a smiling African

4.1

American female teenager studying with friends.

9.7

Caption: "With Concerta I see

Tracy, not her ADHD." 9.7

RACE

African American 8.6

White

Source: Visser et al. (2005)

7.7

Better Homes & Gardens. 2005; 83(1):73

Family Circle. 2005 Sep 6;118(10):129

Prevalence CHARACTERISTIC Bipolar 1 Bipolar 2

BIPOLAR DISORDER

SEX

%

%

Male

0.7

0.4

Female

0.9

0.5

AGE

18-29 30-44 45-64

1.1

0.7

Ad for Abilify depicts young white woman, back to camera, looking down a

1.4

0.6

long empty path.

0.3

0.2

Caption: "Treating bipolar disorder takes understanding."

> 65

0.1

0.1

RACE

African American

1

0.6

White

0.8

0.4

Source: Weissmann et al. (1991) Bipolar 1 disorder DSM-IV criteria: at least one manic episode

Bipolar 2 disorder DSM-IV criteria: history of hypomanic and full major depressive episodes.

Sports Illustrated. 2005 Dec 12; 103(23):26.

THE DEBATE OVER DIRECT-TO-CONSUMER ADVERTISING

OF PRESCRIPTION DRUGS

PROPONENTS claim that ads: Are a legitimate form of

patient information. Reach untreated populations. Increase consumer

knowledge. Strengthen patient-physician

relationship. Stimulate consumer thinking

regarding important health

issues.

OPPONENTS claim that ads: Do not provide an unbiased

source of information. Downplay drug risks. May increase the sales of

advertised brands. Lead consumers to believe

there is a relationship

between the photograph and

how the drug works. Produce unrealistic

expectations of the benefits of

the drug.

SLEEP DISORDERS: INSOMNIA

Prevalence % any sym ptom of

CHARACTERISTIC insom nia* (m ean)

SEX

Male

25

Fem ale

31

Ad for Ambien is a split scene showing a smiling young white woman at work, and a bed that has been slept in. Caption: "A full day starts here."

AGE 18-29 30-49 50-64

30

Ad for Lunesta shows white

middle aged male sleeping.

29

Caption: "Peaceful, restful sleep."

27

> 65

27

* Insomnia symptoms inc lude: diffic ulty falling asleep; awake a lot during the night; woke too early and c ouldn't get bac k to sleep. Sourc e: National Sleep Foundation (2005)

Better Homes & Gardens. 2005; 83(4):145

Better Homes & Gardens. 2005; 83(8):75

ALZHEIMER'S DISEASE

Ad for Aricept shows white grandmother, in her 80's, squeezing grandson's cheeks and kissing him. Caption: The #1 face squisher takes the #1 prescribed Alzheimer's drug.

Better Homes & Gardens. 2005; 83(3):81

Prevalence by Age and Sex

CHARACTERISTIC Male Female

AGE

%

%

65

0.6

0.8

85

11

14

90

21

25

95

36

41

Source: DSM-IV-TR (2000)

Incidence (per 1,000) by Age & Race

CHARACTERISTIC White

African Am erican

AGE

%

%

< 75

5.9

10.8

75-79

16.7

11.6

80-84

28

46.3

> 85

48.9

74.6

Source: Fitzpatrick et al. (2004)

DISCUSSION: HOW ARE MENTAL DISORDERS

PORTRAYED ?

In this small descriptive study, the demographics portrayed in the aggregate ads do not adequately reflect the prevalence of mental disorders in the general population. Only ads for the antidementia drug Aricept moderately correspond to prevalence rates for Alzheimer's disease by sex, age, and race. Consumers generally recognize that emotional appeals are used to market products, including medications. However, those consumers with impaired decisional capacity -- a hallmark of mental disorders -- may be especially vulnerable to the imagery contained in DTC ads. Consequently, marketing of psychiatric drugs has greater potential for negative impact on the health of these patients. According to a 2002 FDA survey, 41% of patients do not read any of the brief summary (the "fine print") for medications advertised in magazines. The ad imagery and its underlying allusion may speak louder than words to these consumers. In addition, ad portrayals that do not provide balanced information could lead to, or reinforce stereotypes (e.g., certain mental disorders afflict only females, or only whites), or provide false expectations about the drug's efficacy (e.g., 99% of patients display positive affect).

KEY FACTS: DIRECT-TO-CONSUMER

ADVERTISING

? Pharmaceutical companies spent $4 billion+ in 2004 on DTC advertising.

The United States and New Zealand are the only countries that permit DTC advertising.

REFERENCES

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text Revision (DSM-IV-TR). Washington, DC: American Psychatric Association; 2000. Endicott, RC. Magazine 300. Advertising Age. 2005;76(39):S1-5. Fitzpatrick AL, Kuller LH, et al. Incidence and prevalence of dementia in the Cardiovascular Health Study. J Am Geriatr Soc. 2004 Feb;52(2):195-204. Hollon MF. Direct-to-consumer marketing of prescription drugs: a current perspective for neurologists and psychiatrists. CNS Drugs. 2004;18(2):69-77. Karpiak CP, Norcross JC. Lifetime prevalence of mental disorders in the general population. In: Koocher GP, et al. editors. Psychologists' desk reference. 2nd ed. New York: Oxford University Press; 2005. p. 3-7. Kessler RC, Berglund P, et al. Lifetime prevalence and age-of-onset distributions of DSMIV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602. National Sleep Foundation. Summary findings of the 2005 Sleep in America poll [Web document]. 2005 [cited 2006 April 10]. Prescription drug advertising, 21 C.F.R. ? 202 [Web document]. 2005 [cited 2006 April 10]. United States Public Health Service Office of the Surgeon General. Mental health: culture, race and ethnicity: a supplement to mental health: a report of the surgeon general. Rockville, MD: Department of Health and Human Services; 2001. Visser SN, MS, Lesesne CA. Mental health in the United States: prevalence of diagnosis and medication treatment for attention-deficit /hyperactivity disorder--United States, 2003. Morbidity and mortality weekly report. CDC surveillance summaries. 2005 Sep 2; 54(34):842-7 Weissman MM, Bruce ML, Leaf PJ, et al. Affective disorders. In: Robins L, Regier D editors. Psychiatric disorders in America : the epidemiologic catchment area study. New York : The Free Press; 1991. p. 53-80. Welch Cline RJ, Young HN. Marketing drugs, marketing health care relationships: a content analysis of visual cues in direct-to-consumer prescription drug advertising. Health Commun. 2004;16(2):131-57. Young D. FDA examines direct-to-consumer advertising data. Am J Health Syst Pharm. 2003 Dec 1;60(23):2420-1.

Acknowledgement:

The author thanks Ammon Ripple, MLS, for guidance and suggestions.

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