Exploring Direct-to-Consumer Advertising and Patient Decision-Making

    • January 2, 2008

The Problem: Health communication, including direct-to-consumer (DTC) advertising, is a key influence on patient decision-making. Although Americans see up to 16 hours of DTC prescription drug advertising on television every year, little is known about the influence of these ads beyond increasing prescription requests.

Grantee Perspective: Clinical psychologist Dominick L. Frosch, PhD, had just earned his doctoral degree from the University of California, San Diego/San Diego State University (a joint program). He wanted to move beyond the small-scale, experimental confines of psychology to study health communication broadly.

Robert Wood Johnson Foundation Health & Society Scholars enabled Frosch to make the transition. “The program was a way for me to expand my perspective to focus not just on clinical care at the one-on-one level but to really think about my interests at a broader population level,” he says. “I also picked up new methodological approaches.”

Frosch started his two-year interdisciplinary fellowship in 2003, as part of the first group of Health & Society Scholars, at the University of Pennsylvania, one of six participating universities.

Results: In a qualitative study of DTC pharmaceutical advertising, Frosch collaborated with colleagues in communications, sociology, anthropology and medicine from Penn. They found that the DTC commercials had limited educational value (Annals of Family Medicine, 5(1): 2007).

“The ads use emotion rather than information to promote the drugs,” said Frosch. “They frequently leave out important facts about the causes and risks of a condition and overstate the benefit of the drugs.”

None of the commercials mentioned lifestyle changes as an alternative to medication. Most were unrealistic. USA Today, the Washington Post, NPR, ABC, NBC, WedMD and other media covered the study.

In addition, Frosch and Penn medical and psychiatric faculty studied behavioral consequences of genetic testing for obesity risk. They found that such testing may motivate people who are at increased risk to eat healthier; however, some people who learn they are at average risk may eat less healthy (Cancer Epidemiology, Biomarkers & Prevention, 14(6): 2005).

The Robert Wood Johnson Foundation (RWJF) supported this research through its grant to Penn as part of funding to universities participating in Health & Society Scholars to help them develop population health research and teaching capacity.

Under a National Cancer Institute grant, Frosch and colleagues also studied the way that people seek and scan (acquiring information from being exposed to it rather than purposively seeking information) cancer information (Health Communication, 22(2): 2007).

Penn faculty helped Frosch find the right job—on the medical school faculty at the University of California, Los Angeles—after he completed his fellowship. “A medical school was a better fit for me than a psychology department, given my very applied approach and my desire to contribute to solving acute current problems,” says Frosch.

Under RWJF's Investigator Award in Health Policy Research program, Frosch is collaborating with fellow Health & Society Scholar José A. Pagán, PhD, to study whether television pharmaceutical ads prompt more than just prescription requests. They are analyzing how these ads affect consumer health behaviors and whether they affect uninsured and insured consumers differently. This project runs from 2007 to 2010.

RWJF Perspective: RWJF created Health & Society Scholars in 2001 to build the field of population health. “There's been a growing recognition that there are social, behavioral, environmental and economic, as well as biological, determinants of health,” said Senior Program Officer Pamela G. Russo, MD, leader of RWJF's Public Health Team.

“The program seeks to integrate paradigms and knowledge from a variety of disciplines to develop an understanding of how these determinants affect the health of populations, and thereby to design interventions with greater power to reduce health disparities,” said Russo.