Overall advertising spending aimed at ordinary people tripled between 1996 and 2000 to nearly $2.5 billion a year.
The finding cast some doubt on a perception among some health insurers and other groups that direct-to-consumer advertising for prescription drugs has mushroomed into a dominant promotional method that distracts doctors and leads to needless prescriptions.
Drug companies spent $1.6 billion in 2000 on television advertisements for Viagra, Claritin, Allegra and other brand-name drugs that have become household names, the team, led by Meredith Rosenthal of the Harvard School of Public Health, found.
They collected data from independent consulting firms and found in 2000, the latest year for which reliable data were available, television and prints ads accounted for some 16 percent of the $15.7 billion spent by the industry on drug promotion. The firms spent $1.6 billion spent on TV ads and $900 million for print ads.
In contrast, 80 percent of the money was devoted to visits to doctors by drug company representatives, free sample distribution and medical journal advertising.
Drug advertising geared to the public has sparked a debate that "is emotionally and economically charged," said Dr. Jeffrey Drazen, editor of the Journal.
Its supporters contend the ads educate the public and improve the quality of care by encouraging people with medical problem to seek help.
Detractors say the ads encourage patients to pressure their doctors for certain drugs -- usually expensive brand-name drugs - and doctors, unwilling to alienate patients, often give in even when the medication is unnecessary.
A 1997 survey of doctors found that 71 percent thought the ads would pressure their colleagues into giving drugs they would not normally prescribe.
Rosenthal and her team said the advertising budgets show — the attempt to appeal to patients directly is "relatively modest" and far less prevalent than critics say.
She said, "The perception that direct-to-consumer ads have become the principal marketing tool for prescription drugs may be because the recent increase in direct-to-consumer spending has been on television ads, which are highly visible."
The researchers said "no evidence" is available on whether patients are getting inappropriate drugs as a result of the advertising.
They noted that most of the spending appears to be geared toward promoting newer drugs that have few side effects and are used to treat chronic conditions.
In an editorial in the Journal, Dr. Sidney Wolfe of the Public Citizen Health Research Group said "there is evidence that many drug advertisements are not balanced or accurate," yet the Food and Drug Administraton doesn't have the staff to police the ads.
But Alan Holmer of the Pharmaceutical Research and Manufacturers of America said in a counter-editorial the advertising "does not replace the physician-patient relationship; its purpose is rather to encourage an informed discussion between patient and physician."
Twenty drugs accounted for 59 percent of all pharmaceutical industry spending on consumer prescription drug ads in 2000. The 20 medicines, followed by their purpose and advertising spending on them in 2000, are:
1. Vioxx, arthritis, $161 million
2. Prilosec, stomach ulcers, $108 million
3. Claritin, antihistamine, $100 million
4. Paxil, antidepressant, $92 million
5. Zocor, high cholesterol, $91 million
6. Viagra, impotence, $90 million
7. Celebrex, arthritis, $79 million
8. Flonase, nasal spray for allergies, $78 million
9. Allegra, antihistamine, $67 million
10. Meridia, weight loss, $65 million
11. Flovent, asthma, $63 million
12. Pravachol, high cholesterol, $62 million
13. Zyrtec, antihistamine, $60 million
14. Singulair, asthma, $59 million
15. Lipitor, high cholesterol, $59 million
16. Nasonex, nasal allergies, $53 million
17. Ortho Tri-Cyclen, oral contraceptive, $47 million
18. Valtrex, genital herpes, $40 million
19. Lamisil, toenail fungus, $39 million
20. Prempro, hormone for osteoporosis, menopause symptoms, $38 million
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