Direct-to-Consumer Drug Advertisements Can Paradoxically Increase Intentions to Adopt Lifestyle Changes

Abstract

Background: Direct-to-consumer (DTC) prescription drug advertisements are thought to induce “boomerang effects,” meaning they reduce the perceived effectiveness of a potential alternative option: non-pharmaceutical treatment via lifestyle change. Past research has observed such effects using artificially created, text-only advertisements that may not adequate capture the complex, conflicting portrayal of lifestyle change in real television advertisements. In other risk domains, individual “problem status” often moderates boomerang effects, such that subjects who currently engage in the risky behavior exhibit the strongest boomerang effects.Objectives: We aimed to assess whether priming with real DTC television advertisements elicited boomerang effects on perceptions of lifestyle change and whether these effects, if present, were moderated by individual problem status.Methods: We assembled a sample of real, previously aired DTC television advertisements in order to naturalistically capture the portrayal of lifestyle change in real advertisements. We randomized 819 adults in the United States recruited via Amazon Mechanical Turk to view or not view an advertisement for a prescription drug. We further randomized subjects to judge either lifestyle change or drugs on three measures: general effectiveness, disease severity for a hypothetical patient, and personal intention to use the intervention if diagnosed with the target health condition.Results: Advertisement exposure induced a statistically significant, but weak, boomerang effect on general effectiveness (p = 0.01, partial R2 = 0.007) and did not affect disease severity score (p = 0.32, partial R2 = 0.0009). Advertisement exposure elicited a reverse boomerang effect of similar effect size on personal intentions, such that advertisement-exposed subjects reported comparatively higher intentions to use lifestyle change relative to drugs (p = 0.006, partial R2 = 0.008). Individual problem status did not significantly moderate these effects.Conclusion: In contrast to previous literature finding large boomerang effects using artificial advertisement stimuli, real television advertisements elicited only a weak boomerang effect on perceived effectiveness and elicited an unexpected reverse boomerang effect on personal intentions to use lifestyle change versus drugs. These findings may reflect real advertisements’ induction of descriptive norms and self-efficacy; future research could address such possibilities by systematically manipulating advertisement content.

Direct‐to‐consumer advertising and the advancement of the quadruple aim: A narrative review

“…27 However, a recent study found that while DTCA effectiveness for therapeutics was higher than for lifestyle changes, participants were more likely to pursue lifestyle changes over therapeutic options. 27 Another potential consequence of DTCA is regarding the stigmatization of mental illness in the presence of DTCA for antidepressants. Studies have reported mixed results regarding stigma with studies suggesting decreased, no difference, and increased stigma surrounding mental illness.…”

“…There are perhaps unintended consequences in the experience of patients related to DTCA. One potential unintended consequence of DTCA is the “boomerang effect.” 27 This effect is when the perception of effectiveness of an alternative option decreases in the presence of an advertised option. In the context of DTCA, the boomerang effect refers to a decreased effectiveness of lifestyle changes and increased effectiveness of prescription drugs 27 .…”

“…One potential unintended consequence of DTCA is the “boomerang effect.” 27 This effect is when the perception of effectiveness of an alternative option decreases in the presence of an advertised option. In the context of DTCA, the boomerang effect refers to a decreased effectiveness of lifestyle changes and increased effectiveness of prescription drugs 27 . However, a recent study found that while DTCA effectiveness for therapeutics was higher than for lifestyle changes, participants were more likely to pursue lifestyle changes over therapeutic options 27 .…”

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“…Between 1993 and 2005, spending on DTCA by pharmaceutical companies increased from $166 million to $4.2 billion, 6 reaching $4.5 billion in 2009. 7,8 In turn, drug manufacturers benefit directly from DTCA. 9 For example, Schering-Plough invested $186 million in promoting its antihistamine product Claritin (Loratadine), resulting in a swift rise in profits from resulting sales.…”

“…2 It has been suggested that the recent expansion of DTCA is responsible for the increasing cost of prescription drugs, 12 with the promotion of a single brand leading to improved sales of the entire therapeutic class. 13 Advertising of prescribed medications could increase pricing due to the high cost of advertisements, 2,7 or by generating increased demand. 12,13 However, DTCA-driven increases in prescribed drugs does not bring additional benefits in terms of health outcomes.…”