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  • Science and Society
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Cancer-related direct-to-consumer advertising: a critical review

Nature Reviews Cancer volume 11, pages 142–150 (2011)Cite this article

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Abstract

The direct-to-consumer advertising (DTCA) phenomenon has received attention because of its attempt to reach out to consumers by bypassing important gatekeepers such as physicians. The emergence of new information platforms and the introduction of genetic tests directly to the consumer have heightened the concern with DTCA and its potential consequences. These effects of DTCA are particularly important given the communication inequalities among social groups, with class, race and ethnicity influencing how people access, seek, process and act on information. This Science and Society article reviews the major issues regarding general and cancer-related DTCA and also offers data from a national survey in the United States as an example of the communication inequalities in genetic testing awareness.

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Figure 1: Structural influence model of communication for cancer-related DTCA.
Figure 2: Persisting digital divide in the United States.

References

  1. Hiatt, R. A. & Rimer, B. K. A new strategy for cancer control research. Cancer Epidemiol. Biomark. Prev. 8, 957–964 (1999).

    CAS  Google Scholar 

  2. Viswanath, K. The communications revolution and cancer control. Nature Rev. Cancer 5, 828–835 (2005).

    Article  CAS  Google Scholar 

  3. Viswanath, K. Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business (eds Thomson, G. E., Mitchell, F. & Williams, M. B.) 215–253 (Institute of Medicine, Washington D.C., 2006).

    Google Scholar 

  4. National Cancer Institute. HINTS Questions. Health Information National Trends Survey [online], (2010).

  5. Huh, J., DeLorme, D. E., Reid, L. N. & An, S. Direct-to-Consumer Prescription Drug Advertising: History, Regulation, and Issues. Minnesota Medicine [online], (2010).

  6. Brown, H. Advertising prescription drugs: Sweetening the pill. Br. Med. J. 334, 664 (2007).

    Article  Google Scholar 

  7. Cassels, A. Canada may be forced to allow direct to consumer advertising. Br. Med. J. 332, 1469 (2006).

    Article  Google Scholar 

  8. Clow, K. Integrated Advertising, Promotion, and Marketing Communications (Prentice Hall, Old Tappan, New Jersey, USA, 2006).

    Google Scholar 

  9. Gareau, P. The impact of direct-to-consumer advertising of prescription medicine on consumer's intention to perform external search (University of Guelph, Canada, 2000).

  10. Polen, H. H., Khanfar, N. M. & Clauson, K. A. Impact of direct-to-consumer advertising (DTCA) on patient health-related behaviors and issues. Health Mark. Q. 26, 42–55 (2009).

    Article  Google Scholar 

  11. Khanfar, N., Loudon, D. & Sircar-Ramsewak, F. FDA direct-to-consumer advertising for prescription drugs: what are consumer preferences and response tendencies? Health Mark. Q. 24, 77–91 (2007).

    Article  Google Scholar 

  12. Rubin, P. H. Pharmaceutical advertising as a consumer empowerment device. J. Biolaw Bus. 4, 59–65 (2001).

    CAS  PubMed  Google Scholar 

  13. Deshpande, A., Menon, A., Perri, M. & Zinkhan, G. Direct-to-consumer advertising and its utility in health care decision making: A consumer perspective. J. Health Commun. 9, 499–513 (2004).

    Article  Google Scholar 

  14. Calfee, J. E. The role of marketing in pharmaceutical research and development. Pharmacoeconomics 20, 77–85 (2002).

    Article  Google Scholar 

  15. Williams-Jones, B. 'Be ready against cancer, now': direct-to-consumer advertising for genetic testing. New Genet. Soc. 25, 89–107 (2006).

    Article  Google Scholar 

  16. Frosch, D. L., Krueger, P. M., Hornik, R. C., Cronholm, P. F. & Barg, F. K. Creating demand for prescription drugs: A content analysis of television direct-to-consumer advertising. Ann. Fam. Med. 5, 6–13 (2007).

    Article  Google Scholar 

  17. Bell, R. A., Kravitz, R. L. & Wilkes, M. S. Direct-to-consumer prescription drug advertising, 1989–1998 - A content analysis of conditions, targets, inducements, and appeals. J. Fam. Pratc. 49, 329–335 (2000).

    CAS  Google Scholar 

  18. Bell, R. A., Wilkes, M. S. & Kravitz, R. L. The educational value of consumer-targeted prescription drug print advertising. J. Fam. Pract. 49, 1092–1098 (2000).

    CAS  PubMed  Google Scholar 

  19. Kaphingst, K. A., Rudd, R. E., Dejong, W. & Daltroy, L. H. Comprehension of information in three direct-to-consumer television prescription drug advertisements among adults with limited literacy. J. Health Commun. 10, 609–619 (2005).

    Article  Google Scholar 

  20. Kaphingst, K. A., Rudd, R. E., Dejong, W. & Daltroy, L. H. Literacy demands of product information intended to supplement television direct-to-consumer prescription drug advertisements. Patient Educ. Couns. 55, 293–300 (2004).

    Article  Google Scholar 

  21. Huh, J. & Langteau, R. Presumed influence of DTC prescription drug advertising. Commun. Res. 34, 25–52 (2007).

    Article  Google Scholar 

  22. Lipsky, M. S. & Taylor, C. A. The opinions and experiences of family physicians regarding direct-to-consumer advertising. J. Fam. Pract. 45, 495–499 (1997).

    CAS  PubMed  Google Scholar 

  23. Bell, R. A., Kravitz, R. L. & Wilkes, M. S. Direct-to-consumer prescription drug advertising and the public. J. Gen. Intern. Med. 14, 651–657 (1999).

    Article  CAS  Google Scholar 

  24. Abel, G. A., Lee, S. J. & Weeks, J. C. Direct-to-consumer advertising in oncology: A content analysis of print media. J. Clin. Oncol. 25, 1267–1271 (2007).

    Article  Google Scholar 

  25. Abel, G. A. et al. Direct-to-consumer advertising in oncology. Oncologist 11, 217–226 (2006).

    Article  Google Scholar 

  26. Abel, G. A., Burstein, H. J., Hevelone, N. D. & Weeks, J. C. Cancer-related direct-to-consumer advertising: awareness, perceptions, and reported impact among patients undergoing active cancer treatment. J. Clin. Oncol. 27, 4182–4187 (2009).

    Article  Google Scholar 

  27. Berg, A. O. et al. Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: Recommendation statement. Ann. Intern. Med. 143, 355–361 (2005).

    Article  CAS  Google Scholar 

  28. Lowery, J. T., Byers, T., Axell, L., Ku, L. S. & Jacobellis, J. The impact of direct-to-consumer marketing of cancer genetic testing on women according to their genetic risk. Genet. Med. 10, 888–894 (2008).

    Article  Google Scholar 

  29. Mouchawar, J. et al. Impact of direct-to-consumer advertising for hereditary breast cancer testing on genetic services at a managed care organization: A naturally-occuring experiment. Genet. Med. 7, 191–197 (2005).

    Article  Google Scholar 

  30. Mouchawar, J. et al. Assessing controversial direct-to-consumer advertising for hereditary breast cancer testing: Reactions from women and their physicians in a managed care organization. Am. J. Manag. Care 11, 601–608 (2005).

    PubMed  Google Scholar 

  31. Tracy, E. E. Prospects and problems of direct-to-public genetic tests. Per. Med. 5, 511–520 (2008).

    Article  Google Scholar 

  32. Gray, S. Direct-to-consumer marketing of genetic tests for cancer: Buyer beware. J. Clin. Oncol. 21, 3191–3193 (2003).

    Article  Google Scholar 

  33. Gollust, S. E., Hull, S. C. & Wilfond, B. S. Limitations of direct-to-consumer advertising for clinical genetic testing. J. Am. Med. Assoc. 288, 1762–1767 (2002).

    Article  Google Scholar 

  34. Ameer, B. & Krivoy, N. Direct-to-consumer/patient advertising of genetic testing: a position statement of the American College of Clinical Pharmacology. J. Clin. Pharmacol. 49, 886–888 (2009).

    Article  Google Scholar 

  35. Mouchawar, J., Ellis, J., Ritzwoller, D., Hensley-Alford, S. & Laurion, S. Impact of direct-to-consumer advertising for hereditary breast cancer testing on genetic services at a managed care organization: A naturally occurring experiment - Reply to letter from Marc Williams. Genet. Med. 7, 514–514 (2005).

    Article  Google Scholar 

  36. Goddard, K. A. B. et al. Public awareness and use of direct-to-consumer genetic tests: results from 3 state population-based surveys, 2006. Am. J. Publ. Health 99, 442–445 (2009).

    Article  Google Scholar 

  37. Hamilton, J. G., Lobel, M. & Moyer, A. Emotional distress following genetic testing for hereditary breast and ovarian cancer: a meta-analytic review. Health Psychol. 28, 510–518 (2009).

    Article  Google Scholar 

  38. Hogarth, S., Javitt, G. & Melzer, D. The current landscape for direct-to-consumer genetic testing: legal, ethincal and policy issues. Annu. Rev. Genomics Hum. Genet. 9, 161–182 (2008).

    Article  CAS  Google Scholar 

  39. Gupta, S. Do at-home DNA tests work? CNN Living [online] (2009).

  40. United States Federal Trade Commission. At-home genetic tests: a healthy dose of skepticism may be the best prescription. Facts for consumers [online], (2006).

  41. Pollack, A. Walgreens delays selling personal genetic test. The New York Times [online], (2010).

  42. Agency for Healthcare Research and Quality. National Healthcare Disparities Report (Department of Health and Human Services, Rockville, Maryland, USA, 2003).

  43. Krieger, N. Defining and investigating social disparities in cancer: critical issues. Cancer Causes Control 16, 5–14 (2005).

    Article  Google Scholar 

  44. Lynch, J. W., Smith, G. D., Kaplan, G. A. & House, J. S. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. Br. Med. J. 320, 1200–1204 (2000).

    Article  CAS  Google Scholar 

  45. National Cancer Institute. Cancer Health Disparities. (Department of Health and Human Services, Rockville, Maryland, USA 2010).

  46. Ramanadhan, S. & Viswanath, K. Health and the information non-seeker: a profile. Health Commun. 20, 131–139 (2006).

    Article  Google Scholar 

  47. Finnegan, J. R. & Viswanath, K. Health Behavior and Health Education: Theory, Research, and Practice (eds Glanz, K., Lewis, M. & Rimer, K.) (Jossey-Bass, San Francisco, California, USA, 2002).

    Google Scholar 

  48. Chao, B. A. Evaluating the educational content of direct-to-consumer fulfillment materials. Am. J. Health-Syst. Pharm. 62, 620–625 (2005).

    Article  Google Scholar 

  49. Manhattan Research. Pharmaceutical Advertisements Leave Consumers Wanting More; While Television Creates Awareness, the Internet Promotes Learning for More Than 13 Million. PRNewswire [online] (2004).

  50. Kontos, E. Z., Emmons, K. M., Puleo, E. & Viswanath, K. Communication inequalities and public health implications of adult social networking site use in the US. J. Health Commun. 15, 216–235 (2010).

    Article  Google Scholar 

  51. Tu, H. & Cohen, G. Striking jump in consumers seeking health care information. Center for studying health system change [online], (2008).

  52. Huh, J. & Cude, B. J. Is the information “fair and balanced'' in direct-to-consumer prescription drug websites? J. Health Commun. 9, 529–540 (2004).

    Article  Google Scholar 

  53. Mayer, R. N., Huh, J. & Cude, B. J. Cues of credibility and price performance of life insurance comparison Web sites. J. Consum. Aff. 39, 71–94 (2005).

    Article  Google Scholar 

  54. Ray, T. Myriad launches TV ads to educate women about BRCA risks, sell BRACAnalysis tests. Genomeweb [online], (2007).

  55. Genetics and Public Policy Center. Myriad Genetics launches BRCA testing ad campaign in Northeast. Genetics and Public Policy Center [online], (2007).

  56. Tichenor, P. J., Donohue, G. A. & Olien, C. N. Mass media flow and differential growth in knowledge. Public Opin. Q. 34, 159–170 (1970).

    Article  Google Scholar 

  57. Cantor, D. et al. Health Information National Trends Survey (HINTS) 2007: Final Report. (Westat, Rockville, USA, 2009).

    Google Scholar 

  58. DiMaggio, P., Hargittai, E., Neuman, W. R. & Robinson, J. P. Social implications of the Internet. Annu. Rev. Sociology 27, 307–336 (2001).

    Article  Google Scholar 

  59. Zillien, N. & Hargittai, E. Digital distinction: status-specific types of internet usage. Soc. Sci. Q. 90, 274–291.

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Acknowledgements

The authors would like to thank the Dana-Farber/Harvard Cancer Center for support to K.V.

Author information

Authors and Affiliations

  1. School of Public Health Department of Society, Emily Z. Kontos and K. Viswanath are at the Lung Cancer Disparities Center, Harvard University, Human Development and Health, 401 Park Drive, Room 403F, Boston MA 02215, USA.,

    Emily Z. Kontos & K. Viswanath

  2. K. Viswanath is also at the Dana-Farber Cancer Institute, 44 Binney Street, Boston MA 02115, USA.,

    K. Viswanath

Authors
  1. Emily Z. Kontos
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Correspondence to K. Viswanath.

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Supplementary information

Supplementary information S1 (table)

Multivariable logistic regression of odds of being aware of genetic testing (model 1) and finding medical statistics hard/very hard to understand (model 2) (PDF 203 kb)

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FURTHER INFORMATION

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Glossary

Appalachia

A region in the eastern United States that has long struggled with poverty owing to the negative effect of logging and coal-mining firms that were established in the area, starting in the 1930s.

Behavioural Risk Factor Surveillance System

(BRFSS). A state-based system of health surveys fielded by the US Centers for Disease Control and Prevention starting in 1984 that collects information on health risk behaviours, preventive health practices, and health care access primarily related to chronic disease and injury.

Genetic counselling

An educational process by trained professionals providing information, support and referral to testing services to individuals with a family history of a variety of medical disorders.

Health Information National Trends Survey

HINTS. A system of national health surveys fielded by the US National Cancer Institute focused on reporting the cancer communication behaviours and trends of American adults. It has been fielded every 2–3 years, beginning in 2003.

Knowledge gap hypothesis

A communication theory that suggests that information flow into a society is more likely to be acquired by high socio-economic groups at a faster rate than lower socio-economic groups, thus widening gaps in knowledge between them.

Managed care organization

(MCO). A health care provider or group of medical service providers with contracts with insurers or self-insured employers to provide a wide variety of health care services to enrollees.

Patient-centred medicine

A philosophy of practicing medicine that is based on a partnership between clinicians and patients that is characterized by informed, shared decision making, development of patient knowledge, self-management skills and preventive behaviours.

Pure Food and Drug Act

A US federal law that provided federal inspection of meat products and outlawed the manufacture, sale or transportation of adulterated food products and poisonous patent medicines.

Tamoxifen and Raloxifene

Members of a drug class known as selective oestrogen receptor modulators (SERMs). Studies suggest that they might have a role in the prevention of breast cancer in women who have not yet developed breast cancer.

US Federal Trade Commission

(FTC). An independent consumer protection agency of the US government. Before 1962, the FTC had jurisdiction over all advertising, including prescription drug advertising.

US Food and Drug Administration

(FDA). A federal agency of the US government responsible for protecting and promoting public health through the regulation and supervision of several items, including food safety, tobacco products, vaccines, medical devices and prescription and over-the-counter pharmaceutical drugs.

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Kontos, E., Viswanath, K. Cancer-related direct-to-consumer advertising: a critical review. Nat Rev Cancer 11, 142–150 (2011). https://doi.org/10.1038/nrc2999

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