Psoriasis and Direct-to-Consumer Advertising: A Useful Tool in Reducing Stigma?

Written by Gemma Boak  |  [email protected]

The beginning of warmer weather brings optimism for most people as they emerge from winter. However, for those of us living with a highly stigmatised skin disease, it can be a challenging transition from the safety of long trousers and jumpers to the vulnerable realm of shorts and t-shirts. Also, swimwear can be an unspeakable terror at the best of times, but even more so when you are living with psoriasis.

With this in mind, the impact of advertising prescription medication was brought to my attention when an advert sponsored by a pharmaceutical company unexpectedly graced my television screen. Fellow psoriasis patients living in the USA (and New Zealand) may not have batted an eyelid. Pharmaceutical adverts are commonplace in America, where the average television viewer watches >16 hours of drug adverts a year,¹ but direct-to-consumer advertising (DTCA) of prescription-only drugs is prohibited in Europe.² How then was this advert allowed to be broadcast in the UK?

According to the U.S. Food and Drug Administration (FDA), pharmaceutical adverts fall into three categories:³

1. Product claim: the product is named and claims are made about the safety and efficacy of the drug.
2. Reminder: adverts name the drug but do not define its uses.
3. Help-seeking adverts: adverts may describe a disease or condition but do not name a drug or make any claims.

The advert on my television did not advertise a prescription drug, but advertised that people living with psoriasis had treatment options available and recommended people visit their doctors. This is sound advice, and evidence from studies conducted in the USA show that these advertisements can be beneficial. Research by the FDA showed that exposure to adverts prompted 25% of people surveyed to visit their doctor to discuss a condition they had not previously reported.⁴ So, should we be more open to the idea of detailed drug-specific adverts in the UK?

Can Drug Adverts Help to Increase Awareness of Psoriasis and Reduce Social Stigma?

In order to increase awareness and reduce social stigma, advertisements must inform viewers of what psoriasis is. People need to know that it is not an infectious disease; instead, psoriasis is an immune-mediated condition. This will help reduce the social stigma surrounding psoriasis. In 2007, a study analysed adverts shown during the evening news and during prime-time viewing hours. Researchers identified that only 26% of the adverts shown described the causes of the condition, 26% identified the risk factors, and 25% indicated prevalence. None of the adverts mentioned lifestyle change as an alternative to treatment, and only 19% mentioned it in addition to medication.⁵ While viewers may have learned about the available medications, the lack of educational focus on the disease more broadly did little to address the common misconceptions leading to social stigma.

Research into social stigma and DTCA is focussed mostly on mental health. One line of thought supports that the medicalisation of depression reduces social stigma; however, this does not appear to be the case. A number of studies have found no difference in attitudes towards mental health^6-8 and, in some cases, DTCA worsened public attitude.^6,9

In the name of research, I turned to YouTube to watch adverts published in the USA for drugs to treat psoriasis. As someone who has never seen adverts for prescription drugs, it was both shocking and illuminating. Initially, the list of side effects had me staring open-mouthed. By the third advert, I was distracted by a woman walking in the park, and by the fifth, I noticed I had stopped paying attention to the undifferentiated block of words listing the side effects. This is not uncommon; when visual messages do not match verbal messages, the visual message predominates.¹⁰ This is also not ideal from an educational standpoint.

What About Advertising in Print and on the Internet?

The FDA legislation still covers advertisements in print and on the internet, and drug information must include information about side effects. Due to the more voluntary nature of in-print advertising, I find this type of data transfer less invasive. In these circumstances, it is easy to flip past pages in a magazine or avoid clicking if you do not want to know more. However, in the context of fighting stigma, the voluntary nature of accessing the information is likely to reduce the impact of any wider educational message.

Pharmaceutical-sponsored websites can also provide useful information, which is important when almost half of patients in the USA search for information online before their visit to a healthcare professional.¹¹ Entering a consultation with more knowledge and a more unobstructed view of treatment goals can lead to more involved discussions with healthcare providers and enables patients to ask more informed questions.¹² A person who is more informed and confident about their condition is more likely to talk openly and, as a result, educate others.

Are Pharmaceutical Companies the Best Place to Start to Fight Social Stigma?

When debating the educational content of DTCA, there is concern over the conflict of interest between providing health information to patients and selling drugs.¹³ Analysis of advertisements in the USA has shown that education is not a priority, although these are only the adverts assessed in scientific studies; of course, assessing the effectiveness of this complex medium is not within the parameters of most scientific studies.^5,14 It was clear from my reading and observations that drug adverts tend to lean towards promoting drug benefits in vague qualitative terms while outlining side effects in a less effective communication style, as observed in other studies.¹⁴ It seems that the majority of Europeans agree that DTCA is not appealing enough to change legislation. Following a public consultation in 2007, 22 of the 27 European member states voted against plans to modify legislation.¹⁵

Final Thoughts

I believe that there is not enough evidence that DTCA would help to educate the population about psoriasis or to reduce social stigma. The adverts I watched made me feel unhappy with my condition, and they would have negatively impacted my evening had I been relaxing with my family watching television. I enjoyed the advert with the jolly man dancing and the recommendation to see your doctor. Let’s leave it there, shall we?

REFERENCES

1. Brownfield ED et al. Direct-to-consumer drug advertisements on network television: An exploration of quantity, frequency, and placement. J Health Commun. 2004;9(6):491-7.
2. Directive 2001/83/EC of the European Parliament and of the council of 6 November 2001 on the community code relating to medicinal products for human use. Article 88. Available here.  Last accessed: 15 May 2018.
3. FDA. Basics of drug ads. 2015. Available at: https://www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising/ucm072077.htm. Last accessed: 15 May 2018.
4. Dieringer NJ et al. Self-reported responsiveness to direct-to-consumer drug advertising and medication use: Results of a national survey. BMC Health Serv Res. 2011;11(1):232.
5. Frosch DL et al. Creating demand for prescription drugs: A content analysis of television direct-to-consumer advertising. Ann Fam Med. 2007;5(1):6-13. Erratum in: Ann Fam Med. 2007;5(2):179.
6. Payton AR, Thoits PA. Medicalization, direct-to-consumer advertising, and mental illness stigma society and mental health. Soc Ment Health. 2011;1(1):55-70.
7. Brown SA. The effects of direct-to-consumer-advertising on mental illness beliefs and stigma. Community Ment Health J. 2017;53(5):534-41.
8. Pescosolido BA et al. “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry. 2010;167(11):1321-30.
9. Corrigan PW et al. How does direct to consumer advertising affect the stigma of mental illness? Community Ment Health J. 2014;50(7):792-9.
10. Grimes T. Mild auditory-visual dissonance in television news may exceed viewer attentional capacity. Hum Commun Res. 1991;18(2):268-98.
11. Auton F. Opinion: The case for advertising pharmaceuticals direct to consumers. Future Med Chem. 2009;1(4):587-92.
    12. Aikin KJ et al. Patient and Physician Attitudes and Behaviors Associated With DTC Promotion of Prescription Drugs—Summary of FDA Survey Research Results. 2004. Available here. Last accessed: 30 May 2018.
    13. Meek C. Europe reconsidering DTCA. CMAJ. 2007;176(10):1405.
12. Frosh DL et al. A decade of controversy: Balancing policy with evidence in the regulation of prescription drug advertising. Am J Public Health. 2010;100(1):24-32.
13. Direct-to-consumer advertising under fire. Bull World Health Organ. 2009;87(8):576-7.