The pharmaceutical industry's character—its products,
messages, promo channels and even its audiences—have been determined by
governmental regulation and trade conventions practiced by media and
manufacturers. The advent of DTC represents a drastic change for the industry.
In the early 1900s, pushed by the AMA's campaign against
fraudulent patent medicines which held an appalling position in healthcare, the
passage of the Food and Drug Act of 1906, and the muckraking journalism that
exposed the dangers of unregulated medicines, the industry accepted an MD-only
promo approach. If a product advertised to the public it could not advertise in
AMA journals. The AMA also acted as an unofficial drug approval agency before
the FDA was created through its Council on Pharmacy and Chemistry and its
publication, New and Non-Official Remedies.
Throughout much of the last century, this approach, at one
time called “ethical drug” advertising, concentrated on selling to MDs only, as
opposed to public advertising by “proprietary” drug companies. Early on,
companies made a choice between these two approaches. A number split into
MD-only Rx divisions and non-Rx divisions that advertised to the public on
non-Rx products for colds, indigestion, headache, etc. Others went entirely
proprietary.
This MD-only arrangement ended with the arrival of DTC in
the early 1990s. FDA regulation did not prohibit consumer advertising of Rx
products. It only required burdensome disclosure regulations and fair balance
requirements. Certain manufactures saw a marketing opportunity even with these
burdens and took the first step in breaking the MD-only convention with “disease
awareness” ads to create a favorable environment for product launches and
branded print ads, with the added expense of extra pages of summary text. Since
then, there has been an expansion of DTC into TV and the broader use in
different channels.
With DTC, it is clear to all that the industry has undergone
a fundamental change in its marketing strategy. The consumer audience has been
added to the professional prescriber—a 180 degree shift. If we are to judge from the past, this
change could lead to a divide among Rx companies into DTC and non-DTC
companies. We saw this when the ethical drug category was created and,
interestingly, we saw it with the marketing by professional-oriented companies
for extended periods in the past of non-prescription products to MDs and
pharmacists only for brands like Coricidan, Maalox, Robitussin and Tylenol.
This approach made these brands market leaders and very profitable without the
expense of consumer advertising.
What will also prompt this decision at some companies is the
sizable expense that DTC represents. Small- to mid-sized companies can't keep
up with the millions that Big Pharma pours into DTC. They will look for an
alternative. Additionally, they can play on MD negatives toward DTC and also
the erosion that DTC has caused in the Rx industry's status with the public.
They will find it practical and profitable to stand aside from DTC and present
their brands to the MD on the selling point that they are “MD-only.”
William Castagnoli was co-founder of Medicus and a former
executive director of the Medical Advertising Hall of Fame