Digital Direct-to-Consumer Advertising: A Perfect Storm of Rapid Evolution and Stagnant Regulation Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters"

The Use of Direct-to-Consumer (DTC) Pharmaceutical Advertisements in Televised and Print Formats as a Teaching Tool in a Pharmacy Curriculum

The overall goal of this study was to employ direct-to-consumer advertisements (DTCAs) as a teaching tool in a Doctor of Pharmacy (PharmD) curriculum. The objectives of this pilot study were to investigate the following questions: 1. Do DTCAs generate student curiosity about the advertised drug and associated disease? 2. Can DTCAs help students understand and reinforce various pharmacological aspects of the drug? 3. How do students perceive DTCAs? A DTCA-based teaching tool was employed in a pharmacology course taken by P2 (second professional year) PharmD and final year (U4) Bachelor of Science (BS) in Pharmacology–Toxicology students. A voluntary online survey was administered to students to determine the effectiveness of this tool. Survey data were analyzed quantitatively and qualitatively. 70–85% of responding students indicated that this teaching tool was an effective visual aid for learning pharmacology and correlating the drug to disease state, mechanism of action, and adverse effects. Moreover, themes identified from the qualitative analysis suggest that this teaching tool may be useful to enhance patient counseling skills in students. The initial implementation of this DTCA-based teaching tool proved to be successful, and a similar approach can be easily implemented in other pharmacotherapy and laboratory courses. Further studies are needed to determine if this approach can improve patient counseling skills.

Are direct messages (texts and emails) from wagering operators associated with betting intention and behavior? An ecological momentary assessment study

BACKGROUND AND AIMS

Direct messaging via text messages (texts) and emails is a widely used method to advertise sports and race-betting offers. However, they have attracted little research, as this advertising is not in the public domain. This study aimed to determine whether betting expenditure is related to receiving direct wagering messages, and the specific inducements they promote. We hypothesized that receiving direct messages, particularly texts, would be related to betting expenditure within 24 hr.

METHODS

In this ecological momentary assessment study, regular sports (n = 98) and race (n = 104) bettors from Australia completed short daily surveys over 1 week that captured exposure to direct messages, betting behavior in the previous 24 hr, and betting intention for the next 24 hr. Respondents were asked to forward any texts and emails received to the researchers, who coded them for inducement content.

RESULTS

Longitudinal analyses found that receiving emails was positively associated with betting intention, whereas texts were positively associated with higher likelihood of betting and betting expenditure. These effects persisted when controlling for problem gambling status and signature betting events. Refund stake and bonus odds inducements were positively associated with likelihood of race betting (although not in multivariate models), as were bonus winnings inducements for sports betting.

DISCUSSION AND CONCLUSIONS

Direct messages, particularly texts, are powerful marketing tools, encouraging a nearly immediate, and arguably impulsive, betting response, which may increase gambling-related problems. Overseeing this private form of advertising presents challenges to regulators, and to public health efforts that aim to reduce gambling harm.

Trade Agreements and Direct-to-Consumer Advertising of Pharmaceuticals

There is growing international concern about the risks posed by direct-to-consumer advertising (DTCA) of prescription pharmaceuticals, including via the internet. Recent trade agreements negotiated by the United States, however, incorporate provisions that may constrain national regulation of DTCA. Some provisions explicitly mention DTCA; others enable foreign investors to seek compensation if new regulations are seen to harm their investments. These provisions may thus prevent countries from restricting DTCA or put them at risk of expensive legal action from companies seeking damages due to restrictions on advertising. While the most recent example, the Trans-Pacific Partnership Agreement (TPP), collapsed following US withdrawal in January 2017, early indications of the Trump Administration’s trade policy agenda signal an even more aggressive approach on the part of the United States in negotiating advantages for American businesses. Furthermore, the eleven remaining TPP countries may decide to proceed with the agreement in the absence of the United States, with most of the original text (including the provisions relevant to DTCA) intact.

How Affiliation Disclosure and Control Over User-Generated Comments Affects Consumer Health Knowledge and Behavior: A Randomized Controlled Experiment of Pharmaceutical Direct-to-Consumer Advertising on Social Media

Background

More people are seeking health information online than ever before and pharmaceutical companies are increasingly marketing their drugs through social media.

Objective

The aim was to examine two major concerns related to online direct-to-consumer pharmaceutical advertising: (1) how disclosing an affiliation with a pharmaceutical company affects how people respond to drug information produced by both health organizations and online commenters, and (2) how knowledge that health organizations control the display of user-generated comments affects consumer health knowledge and behavior.

Methods

We conducted a 2×2×2 between-subjects experiment (N=674). All participants viewed an infographic posted to Facebook by a health organization about a prescription allergy drug. Across conditions, the infographic varied in the degree to which the health organization and commenters appeared to be affiliated with a drug manufacturer, and the display of user-generated comments appeared to be controlled.

Results

Affiliation disclosure statements on a health organization’s Facebook post increased perceptions of an organization-drug manufacturer connection, which reduced trust in the organization (point estimate –0.45, 95% CI –0.69 to –0.24) and other users who posted comments about the drug (point estimate –0.44, 95% CI –0.68 to –0.22). Furthermore, increased perceptions of an organization-manufacturer connection reduced the likelihood that people would recommend the drug to important others (point estimate –0.35, 95% CI –0.59 to –0.15), and share the drug post with others on Facebook (point estimate –0.37, 95% CI –0.64 to –0.16). An affiliation cue next to the commenters' names increased perceptions that the commenters were affiliated with the drug manufacturer, which reduced trust in the comments (point estimate –0.81, 95% CI –1.04 to –0.59), the organization that made the post (point estimate –0.68, 95% CI –0.90 to –0.49), the likelihood of participants recommending the drug (point estimate –0.61, 95% CI –0.82 to –0.43), and sharing the post with others on Facebook (point estimate –0.63, 95% CI –0.87 to –0.43). Cues indicating that a health organization removed user-generated comments from a post increased perceptions that the drug manufacturer influenced the display of the comments, which negatively affected trust in the comments (point estimate –0.35, 95% CI –0.53 to –0.20), the organization (point estimate –0.31, 95% CI –0.47 to –0.17), the likelihood of recommending the drug (point estimate –0.26, 95% CI –0.41 to –0.14), and the likelihood of sharing the post with others on Facebook (point estimate –0.28, 95% CI –0.45 to –0.15). (All estimates are unstandardized indirect effects and 95% bias-corrected bootstrap confidence intervals.)

Conclusions

Concern over pharmaceutical companies hiding their affiliations and strategically controlling user-generated comments is well founded; these practices can greatly affect not only how viewers evaluate drug information online, but also how likely they are to propagate the information throughout their online and offline social networks.