A split on DTC is coming

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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

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