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| Journal of the New Zealand Medical Association,
20-May-2005, Vol 118 No 1215
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Advertising of medicines on New Zealand television
Pauline Norris, Lucy Nelson, Koal Lin Ling, Lucy Skellett,
Joyce Hoo, Cecilia Va’ai, Amber Gates
Consumers have a wide range of medicines available to them
in supermarkets, health food and other stores, and over the counter in
pharmacies. Many of these medicines are advertised widely in print and broadcast
media.
In New Zealand, prescription-only medicines are also
advertised to the public. These advertisements attempt to influence
consumers’ choices about medicines. This can have significant consequences
for individual and public health, as medicines can potentially either harm or
improve health.1,2
An advertised medicine may be inappropriate for a particular
person for several reasons, including:
If
advertising leads consumers to use inappropriate medicines, to use them
inappropriately, or to misdiagnose health problems (and therefore delay
treatment for serious problems), this can lead to significant health problems.
An additional concern is
medicalisation—the tendency to
regard medicines as solutions for everyday problems associated with normal life
processes.3,4
Considerable research has been done on the advertising and
promotion of medicines, and its impact on
prescribers.5 Concerns have been raised about
the quality of information contained in medicines advertisements, and the impact
of these on prescribing practice. Less research has been done on the impact of
advertising of medicines to the public, and there is little data available on
the extent of consumers’ exposure to medicines advertising.
The advertising of prescription medicines to the public has
caused considerable debate in New Zealand.6,7,8
New Zealand and the United States (US) are the only two developed countries that
allow such advertising of prescription-only medicines. There is evidence that
the US public is less becoming sympathetic to direct to consumer
advertising.9
Descriptive studies overseas have looked at the educational
value of direct to consumer advertisements for prescription products or the
appeals made in these
advertisements.10–14 These studies are
heavily focused on print advertisements. Research has also been done on
consumers’ reports of their exposure to and recall of advertisements, and
their views about direct to consumer
advertising.15–18 There is a small body
of evidence of the impact of these advertisements, although this is a difficult
topic to research.19–22
As well as advertisements for prescription-only medicines,
New Zealand consumers are exposed to a great deal of advertising of
non-prescription medicines, and (to our knowledge) there is no published
research on the impact of this. There have been no other published studies on
the extent of advertising of both prescription and non-prescription drugs to
consumers. The one exception we could find is Hardon’s study which
included the extent of radio advertising of medicines in the
Phillipines.23
In this study, we measured the frequency and distribution of
advertisements for medicines on New Zealand television over a 1-year
period.
MethodsA stratified random sample of
577.5 hours (35 days) of television was video-recorded during the period 15
November 2001 to 11 December 2002. Seven days (6:30am to 11pm) of each
free-to-air national TV channel (TV1, TV2, TV3, TV4, Prime) were recorded.
Taping started on a randomly selected date in November
2001 (Thursday 15 November), and one day of each channel was recorded in turn.
This sequence was repeated every 64 days, ensuring that each time a different
day of the week was recorded for each channel. If any taping was missed because
of technological problems or human error, the same channel was recorded at the
same time the following week. There were very few such problems, but the final
day of TV1 programming (Wednesday 4 December) was missed, so it was replaced
with TV1 Wednesday 11 December programming.
We defined medicines more broadly than the legal
definition of registered medicines. We included prescription medicines, pharmacy
medicines, herbal medicines, homeopathic medicines, and dietary supplements. We
considered medicines to be ‘products intended for humans, that claimed to
treat health problems’.
We distinguished medicines from food and drinks on the
basis that a medicine’s primary purpose is therapeutic whereas the primary
purpose of a food or drink was to satisfy hunger or thirst. Thus we classified
Lemsip (a lemon drink containing
paracetamol and phenylephrine) and
Fastburner (a meal replacement drink)
as medicines since their primary purpose is to treat colds or to reduce weight
respectively, while we did not classify
V (an energy drink including Caffeine
and Guarana) and mineral waters (with additives such as vitamins) as medicines.
We distinguished medicines from cosmetics by defining
medicines as products advertised for:
On the other hand, we defined
moisturisers, under-arm deodorants, foot deodorants, and other topical products
for dry or sensitive skin as cosmetics—and hence excluded them from the
study.
A standard form for reporting medicines advertisements
was developed. Apart from PN, all tapes were watched the authors and those
listed in the Acknowledgements, and the forms were completed whenever an
advertisement for a medicine was identified.
The date, time, channel, wording, and a description of
the visual aspects of the advertisement were recorded. Products were classified
according the New Ethicals
Catalogue,24 the
MedSafe website (www.medsafe.govt.nz) and by discussion amongst
group members (for alternative medicines and dietary supplements). Where it was
unclear what products were,
Google
searches (www.google.com) were done to find
manufacturers’ or sellers’ websites which might give active
ingredients.
To assess the reliability of the recording process, two
hours of each person’s viewing were randomly selected and reviewed
independently by PN. Significant under-reporting was identified in one
person’s recording, while no problems were identified in any other. All of
this person’s viewing (49.5 hours) was then repeated by PN.
The extent and distribution of advertisements were
analysed using Microsoft Excel software.
ResultsDuring the 35 days of television, we
found 340 advertisements for medicines. On average, this was 0.59 advertisements
per hour, or 1 advertisement per 102 minutes. Sixty-four different medicines
were advertised (this includes 3 formulations each, of
Nurofen and
Panadol).
Of the 64 products advertised, 12 were prescription-only
medicines, 2 were pharmacist-only medicines, and 17 were pharmacy-only
medicines; the remainder were 33 products available for general sale. Of these,
we classified 6 as dietary supplements (mostly vitamins) and 4 as alternative
medicines (such as herbal or homeopathic products).
The prescription-only products advertised during the study
period were: Viagra (sildenafil, for
erectile dysfunction), Flixotide
(flucticasone, for asthma), Propecia
(finasteride, for baldness), Xenical
(orlistat, for obesity), Zyban
(bupropion, for smoking cessation),
Vioxx (rofecoxib, an
anti-inflammatory), Losec (omeprazole,
a proton pump inhibitor for gastric problems such as reflux),
Reductil (subutramine, for obesity),
Twinrix (vaccine for Hepatitis A and
B), Detrusitol (tolterodine, for
over-active bladder), Somac
(pantoprazole, a proton pump inhibitor for gastric problems such as reflux), and
Symbicort (budesonide and eformoterol,
for asthma).
Most advertisements were for products that were available
outside of pharmacies (Figure 1). Advertisements for prescription-only products
made up 17.9% of advertisements.
Figure 1: Number of advertisements by drug
type
 The most commonly advertised products were:
Comprehensive Formula (a vitamin and
mineral supplement sold in combination with fitness equipment
‘Abslide’) Nature Bee
Pollen (a dietary supplement containing ‘potentiated’ bee
pollen), Fastburner (a meal replacement
formula for weight loss), Nicobrevin (a
nicotine-free anti-smoking aid),
Panadol (paracetamol),
Propecia (finasteride),
Sensodyne (a toothpaste to treat
sensitive teeth), and Buccaline Berna
(prophylaxis for common cold). Each of these products was advertised between 10
and 35 times during our viewing period.
The Prime TV channel showed a significantly lower number of
advertisements than the other channels (Poisson, p<0.001). Prime had 19
medicines advertisements over the period (almost all of which were on
Wednesday), while the other four channels showed between 70 and 90 (average
80.25).
More medicine advertisements were shown on Mondays (62),
Wednesdays (61), and Sundays (56) than on other days of the week (36–45),
but there appears to be no clear pattern between channels.
The channels varied in the kind of advertisements they
screened (comparing all ‘general sale products, pharmacy, and
pharmacist-only products’ with ‘prescription only products’
(chi-squared=87.7, df=8, p<0.001). On each of the channels more than a
quarter of advertisements were for general-sale medicines (Table 1). Apart from
that category, the most common categories in each channel were:
prescription-only products on TV1, pharmacy-only products and dietary
supplements on TV2, prescription-only products on TV3, dietary supplements on
TV4, and pharmacy-only products on Prime TV.
Advertisements were concentrated in different times of day.
Twenty-one percent of advertisements were in the morning (6:30am–12noon).
Almost half of all advertisements (46%) were in the afternoon
(12noon–6pm), while 33% were in the evening (6pm–11pm). Thus, in the
peak advertising time, afternoons, there were 0.74 medicines advertisements per
hour, or 1 advertisement per 81 minutes.
Few advertisements for prescription medicines were shown in
the morning (3%); more were shown in the afternoon (51%) and evening (46%).
There were more advertisements for prescription-only medicines per hour in the
evening (0.16 per hour, or 1 advertisement per 375 minutes) that at other times
of the day.
Table 1. Number and (percentage) of advertisements for
types of product on each TV channel
Pres=Prescription;
P’cist= Pharmacist; Pharm=Pharmacy; Gen=General; Altern=Alternative;
Diet suppl=Dietary supplement.
Advertisements for medicines were found in a very wide range
of programmes. Fewer advertisements were found amongst children’s
programmes. Ten advertisements (for
Robitusson [a cough mixture],
Panadol [paracetamol],
Nature Bee Pollen,
Claramax [an antihistamine for
hayfever], and a children’s vitamin formulation were found in programmes
that seemed to be directly targeted at children.
We found more than six advertisements in the following
programmes (it should be noted that some of these have daily episodes and so do
not necessarily have a high hourly rate of advertising): Athletics coverage
(from the Commonwealth games), Home and Away (Australian soap opera),
Infomercials, News, Oprah (talk show), Shortland Street (New Zealand soap
opera), The Young and the Restless (US soap opera).
Advertisements for prescription medicines were also found in
a wide range of programmes. Twenty-nine programmes (news broadcasts, soap
operas, movies, comedies, documentaries, a fishing programme, and a cooking
programme) included one advertisement for a prescription medicine. Those which
included more than one prescription medicine advertisement included reality TV
shows, dramas, soap operas, comedies, and documentaries. Eleven advertisements
for prescription drugs were found during sports coverage.
DiscussionAlthough we attempted to
standardise reporting and ensure inter-rater reliability, some problems may
still exist. Special events occurring during the study period may also
potentially influence the results. The study included such a large sample of
television, which allowed us to detect the significant variation between the
extent of medicines advertising between channels and between days of the week.
Any future attempts to monitor the extent of medicines advertising must take
this variation into account. There also appeared to be seasonal variation in
types of products advertised, but we were able to minimise this by studying a
whole year’s television.
We identified a large number of medicines advertisements.
While viewers on average would be exposed to less than one medicine’s
advertisement per hour, those who watch particular channels at peak-viewing time
may be exposed to considerably more advertisements. In addition, there are
medicines advertisements on radio and in print media, which increase the level
of consumers’ exposure to advertising.
We found a variety of different forms of medicines
advertising. Programmes were sometimes sponsored by medicines’
manufacturers (eg Propecia sponsored a
rally driving event during our study period). Advertisements for these
programmes then also contain the product name. A pharmacy marketing group also
produces a ‘Family Health Diary’, which, while ostensibly educating
consumers about common health problems, usually advertises several
medicines.
Advertisements were frequently repeated. For example, in one
8-hour period on TV4 there were eight advertisements for
Nicobrevin and four advertisements for
Berocca. Some products had two or three
different advertisements that they repeated in sequence. Studies that assess the
impact of advertising on consumers must take account of this repetition: viewers
may often be exposed to several advertisements for one product during one
viewing session. People who watch particular types of programmes may also be
exposed to higher levels of medicine advertising. For instance, there appears to
be a high level of advertising of prescription medicines during sports coverage.
Indeed, this is likely to be part of a targeting strategy by manufacturers and
advertisers.
This study cannot determine the impact of medicines
advertisements on consumer behaviour. Previous studies on advertisements for
prescription medicines have strongly suggested that advertisements have a
powerful effect on consumers. Most research has focused on prescription-only
medicines. Everett found that, when faced with a hypothetical situation, about
one-third of his respondents said they would ask their doctor for a medicine
they saw advertised.19
In Bell, Wilkes, and Kravitz’s study, 15% of people
said they would consider terminating their relationship with their doctor if
they refused their request for an advertised
drug.20 And, in another study, 32% of consumers
who had seen a DTC advertisement had talked to their doctor about an advertised
medicine. Twenty-six percent had asked for a prescription for the advertised
medicine; and of these, 71% received the
prescription.16
Mintzies et al, in study of patient visits to primary care
physicians, found that doctors were ambivalent about the choice of treatment
they gave in 40% of cases, and about 50% of cases where the patient had
requested an advertised drug.22 Using a
quasi-experimental, interrupted time-series research design, Basara found a
significant increase in the number of new prescriptions for a product during and
after it was advertised direct to consumers.25
In a New Zealand survey, around 10% of consumers reported that an advertisement
had prompted them to ask for a prescription-only medicine. Most of these had
received the medicine they asked
for.8
There are fewer studies looking at the effect of advertising
on non-prescription medicines on consumers. In New Zealand, pharmacists have
reported that consumers request pharmacist-only medicines after seeing
advertisements for them.26
In summary, further research should be undertaken on the
whole range of medicines advertisements directed at consumers, their impact on
consumer behaviour, and their public health consequences. This should include
examining the health-related claims made in advertisements, whether those
advertisements meet regulatory requirements and guidelines, and how the
advertisements are evaluated by consumers.
Of special mention, while our study focused on medicines, we
also noticed that health claims were made for a range of non-medicine products:
such as magnetic underlays for beds. We suggest that these health claims should
be subject to similar regulations as those made in medicines advertisements.
Author information:
Pauline Norris, Senior Lecturer and Leader: Clinical/Pharmacy Practice Research;
Lucy Nelson, Exchange student; Koal Lin Ling,
4th year student; Lucy Skellett,
4th year student; Joyce Hoo,
4th year student; Cecilia Va’ai,
4th year student; Amber Gates,
4th year student, School of Pharmacy,
University of Otago, Dunedin
Acknowledgements:
Karen Morris, Emily Toner, and Nicola Schumacher also watched some of the
television coverage. University of Otago funded the project. The University of
Nottingham School of Pharmacy (UK) arranged the exchange programme through which
Nicola Schumacher and Lucy Nelson became involved in the project.
Correspondence:
Pauline Norris, School of Pharmacy, University of Otago, PO Box 913, Dunedin.
Fax: (03) 479 7034; email: pauline.norris@stonebow.otago.ac.nz
References:
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