Is DTCPA beneficial or detrimental to the health of US consumers and, specifically, to patients with skin disease? Unfortunately, there are no quick answers. In a review by Ventola,2 data showed that DTCPA informs, educates, and empowers patients and encourages them to seek medical care as well as to make appointments with their doctors to discuss conditions they had not previously discussed. Data also showed that DTCPA strengthens patients’ relationships with health care providers and improves patient compliance with treatments. Importantly, DTCPA has been shown to reduce underdiagnosis and undertreatment of medical conditions and removes the stigma associated with certain diseases. Finally, DTCPA also has been shown to encourage product competition and lower drug prices.2
In contrast, data also have shown that DTCPA can lead to patient misinformation and may damage the patient-physician relationship.2 Many advertisements may overemphasize a drug’s benefits while downplaying associated risks, while others may promote an unnecessary fear of side effects. These advertisements have been criticized for causing beliefs about diseases in patients that lead to overutilization of drugs and inappropriate prescribing. Some fear DTCPA may promote new drugs before their safety profiles are fully known, which may be particularly true for first-in-class drugs. Finally, DTCPA may increase the cost of drugs in general, not only because of the amount spent on the advertisements themselves, but also because DTCPAs promote copycat drugs that do not offer any increased benefit over older and cheaper medications.
How does all of this relate to dermatology? In the last few years, we have seen the development of drugs (eg, psoriasis treatments) that offer real improvement for patients who only had access to minimally effective therapies in the past. The research pipeline is full of agents for other diseases for which we lack adequate treatments, such as atopic eczema and certain forms of skin cancer. Additionally, for patients with diseases like psoriasis and eczema who may have given up on dermatologists to provide adequate treatments, DTCPAs may give them hope and renewed interest in seeking our help.
It comes as no surprise to dermatologists and their patients that the costs for drugs used to treat dermatologic diseases have skyrocketed. Rosenberg and Rosenberg3 recently evaluated the cost of 19 dermatologic drugs from 2009 to 2015 and noted increases ranging from 60% to 1698%, the majority of which may be passed on directly to our patients.
Ultimately, there are no easy answers. Hopefully, studies evaluating the pros and cons of DTCPAs—specifically for dermatology patients—that can help dermatologists make rational decisions about how to best serve our patients in a cost-efficient manner will be forthcoming. For the time being, it is unlikely that DTCPA will be banned in the United States, as such action would surely lead to claims of unconstitutional infringement on free speech. Nevertheless, increased oversight and more stringent regulations might improve the acceptability of such advertising to those that oppose DTCPA.