Abstract
Direct-to-consumer advertising of prescription medicines (DTCA), a disputed health communication strategy, has been legally developed only in New Zealand and the United States. DTCA has raised significant concerns in New Zealand, especially because it is self-regulated by the industry, which currently does not prevent it from offering incomplete and misleading information. Even in the United States, where DTCA is regulated and overseen by the Food and Drug Administration, violations by pharmaceutical companies are widespread and predominantly involve deceptive information. Given that regulation of DTCA has not been effective, the main purpose of this research was to explore how consumers respond to DTCA and whether DTCA is socially responsible. More specifically, this research aimed to examine the factors linking to individuals’ behavioural responses to DTCA, reveal the issues affecting consumers’ informed decision-making, conceptualise the characteristics of vulnerable consumers with regard to DTCA, and finally develop an ethical framework for DTCA based on the Corporate Social Responsibility model. To achieve this goal, this research comprised three studies.
Study one, built on communication inequality and the Structural Influence Model of health communication, identified factors associated with consumers’ self-reported behavioural responses to DTCA. By analysing survey data collected from a nationally representative sample of adults (n=2057), this study found that drug advertising was more likely to influence ‘at-risk’ individuals (i.e., lower-income, poorer health status, older, less educated, and ethnic minorities), and those who had more positive attitudes toward DTCA, who were more materialistic and who rely on the internet for medical information. These individuals, therefore, may be more vulnerable to drug advertising and may make poorly informed decisions accordingly. The findings raise major concerns regarding the ethicality of medicine advertising and highlight the requirement for stricter regulations to ensure that medicine advertisements offered by pharmaceutical firms are ethical. Preliminary findings from this study were presented at the EMAC Conference, 2016 and developed into a journal paper that was published in the BMJ Open in 2017.
Study two, based on the same sample as study one, extended study one and examined the link between healthy/unhealthy lifestyle habits and individuals’ responses to DTCA. This study revealed that individuals with unhealthier lifestyles were more likely to respond to DTCA and thus might be more vulnerable to DTCA. The link between unhealthy lifestyle behaviours and being influenced by drug advertising raises concerns about the misuse or overuse of medicines for health problems that may be solved with a healthier lifestyle. Individuals with risky lifestyle behaviours should be fully informed to be able to make appropriate health decisions. These findings were published in the Australian & New Zealand Journal of Public Health in 2019. Collectively, the outcomes from study one and study two informed the design of study three.
Study three focused on social responsibility, and more specifically ethicality, in DTCA in New Zealand. The study involved 29 in-depth interviews with health professionals to explore their thoughts and recommendations regarding the advertising of prescription medicines. The findings revealed that most informants had concerns regarding consumers’ autonomy in decision-making, their ability to understand/interpret the information presented, and their ability to make informed decisions. According to informants’ perspectives and experiences, consumers’ capability, self-efficacy and other characteristics could play an essential role in their fully informed decision-making. The health professionals thought that although most consumers are vulnerable to DTCA and are not able to make informed decisions, there are specific consumers who are even more vulnerable to DTCA. The unethical nature of DTCA was underlined. Of importance, the thematic analysis of informants’ opinions showed the existence of persuasion and opportunism in DTCA, which informants thought consumers would generally not be able to detect. From the findings, a framework of criteria for socially responsible DTCA was proposed to help individuals make informed decisions and improve their well-being. Recommendations pertained to the content of DTCA, types of advertising channels employed, types of advertised medications, social responsibility/ethicality of DTCA providers, as well as stricter regulations and supervision of DTCA. The research outcomes have important implications for the regulation of DTCA. The findings could also help pharmaceutical advertisers to fulfil the consumers’ right to be informed and to choose. The principal theoretical implications of this study were that the findings provided new perspectives for conceptualising socially responsible DTCA, informed decision-making and vulnerable consumers in the DTCA context. Initial findings from study three were presented at the Macromarketing Conference, 2017.
Taken together, the three studies showed that consumers, especially those who are at risk, are more likely to be influenced by DTCA and may not be able to make fully informed decisions. Moreover, findings revealed that DTCA is not socially responsible in its current form, and changes need to be made to help consumers’ informed decision-making. Recommendations drawn from the three studies, to improve the regulation and ethicality of DTCA, are presented in the concluding discussion and helped to inform a submission to the Therapeutic Products Bill, 2019.