Do the internet and popular culture provide international direct-to-consumer drug advertising? A social-media based pilot survey

Background: Direct-to-consumer prescription drug advertisements (DTCDA) encourage patients to request specific drugs from prescribers. Over $2.5 billion is spent each year on such promotion, and published evidence suggests that DTCDA increases the number and cost of prescriptions written for advertised drugs. Although only the United States and New Zealand allow DTCDA, use of the internet for information and marketing, and exposure to drug brands from media and popular culture raises the possibility of global exposure to drug marketing, regardless of national prohibitions. This pilot study sought to evaluate name recognition and access to internet DTCDA in a sampling of nations where such marketing is illegal.

Methods: 10 informants in the following 9 countries participated in data gathering: Argentina, Australia, Costa Rica, Germany, India, Netherlands, Panama, Thailand, United Kingdom. Each informant was asked to access DTCDA internet marketing sites (consumer drug name followed by “.com”), and each asked three additional contacts (for a total of 30 persons) if they were familiar with any of the three following drugs: Lipitor, Viagra and Tamiflu.

Results: US based DTCDA websites were accessible from all countries sampled. Of 31 people sampled, 39% (12) were familiar with all three drugs, an additional 42% (13) were familiar with at least two of the three. In 67 of 99 (68%) of inquiries, respondents were familiar with the queried drug, with Viagra being the most familiar (88%), followed by Tamiflu (76%) and Lipitor (39%). Respondents were more likely to be college educated and above average-income than the average resident of their country of origin.

Conclusion: Many patients around the world have knowledge of drug brands, and quick and easy access to English-language, internet-based DTCDA. Although the drug names queried were US brands, and may be available under other names in the countries sampled, 81% of international respondents were familiar with at least 2 of 3 drugs mentioned. Sources of this knowledge were not assessed, but several are suspected. Tamiflu, for example, receives widespread coverage in news reports about pandemic flu, and Viagra has been featured in popular movies and television shows. While marketing is principally an active process of delivering messages in the places that people frequent and the language they speak, at least two general questions warrant further consideration: Does media-generated knowledge of drug names and easy access to consumer-focused marketing messages constitute passive DTCDA, and does this combination of exposures conflict with national laws prohibiting DTCDA?