2. International Journal of Marketing and Human Resource Management (IJMHRM), ISSN 0976
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2. REVIEW OF LITERATURE
Much of the research undertaken on said topic was particular to US economy but huge gap is
yet to be fulfilled for the developing country like india. Gists of few of the noteworthy studies
undertaken on the said topic are given below:
In 2004, Astra-Zeneca spent $216 million promoting Crestor, almost matching the $212
million spent on Pepsi for that year (Huh and Langteau, 2007). There is growing trend of
spending on DTC advertising by pharmaceutical companies in US. According to Gagnon and
Lexchin (2008) Pharmaceutical companies spend nearly twice as much on marketing in the
U.S. as they do on research and development (R&D).
In another study taken by Sheehan (2007), Drug marketers have increased their spending on
internet to promote their drugs. In 2003, the pharmaceutical industry spent $59 million on
DTC promotion on the Internet (Choi and Lee, 2007). Searching for health-related
information has become the third most common activity for online users (Choi and Lee,
2007). Advertising spending positively correlates with increases in the number of
prescriptions written for DTC drugs (Spake and Joseph, 2007). A study reviewed by the GAO
found a median increase in sales of more than $2 for every $1 spent on advertising (United
States, 2006).
While the pharmaceutical industry is profiting from DTC advertising, it generates more
money marketing to physicians. In 2005, compared with the $4.2 billion spent on DTC
advertising, pharmaceutical companies spent $7.2 billion on promotion to physicians (United
States, 2006). In addition, every dollar spent on physician-detailing generated sales worth
approximately $1.72, except for the most aggressively marketed drugs, which generated sales
of more than $10 (Healy, 2007).
According to Food and Drug Administration (FDA) DTC advertising is consistent with the
whole trend toward consumer empowerment. They believe that there is certain public health
benefits associated with letting people know what’s available.
Federal Trade Commission and Department of Justice, DTC advertising increases consumer
and physician awareness of the potential benefits of pharmaceuticals and helps close the
information gaps among pharmaceutical manufacturers, doctors, and consumers.”
Hoffman and Wilkes (1999) express their views on basis of their experience in US that
DTCA, unreasonably increases consumer expectations, forces doctors to spend time
disabusing patients of misinformation, diminish the doctor-patient relationship because a
doctor refuses to prescribe an advertised drug, or results in poor practice if the doctor
capitulates and prescribes an inappropriate agent."
Further research is needed to know the clinical and economic impact of DTCA on healthcare
systems. The benefits of DTCA (preventive care) must be balanced against increased health
care costs caused by clinically inappropriate requests generated by DTCA
3. RESEARCH METHODLOGY
3.1. RESEARCH OBJECTIVES
To explore the scope of DTCA (prescription drugs) in Indian pharmaceutical Industry.
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3. International Journal of Marketing and Human Resource Management (IJMHRM), ISSN 0976
– 6421 (Print), ISSN 0976 – 643X (Online), Volume 3, Issue 1, January-December (2012)
To know Perception & knowledge of Indian consumers about prescription drugs
advertising.
3.2. RESEARCH DESIGN
Study is Exploratory in nature.
3.3. SAMPLE DESIGN
Sampling Population
Marketers (executives of Pharmaceutical companies), Doctors and Consumers of
Gujarat
Sampling Method
Judgment Sampling.
Sample Size – 150
Customers (Patients)(50)
Marketing mangers and sales managers(50)
Doctors(50)
3.4. PRIMARY DATA COLLECTION
Primary Data is collected with the help of questionnaire which consist of structured and
unstructured open ended questions.
3.5. LIMITATIONS
Study is restricted to Gujarat state only.
Unable to collect information from the respondents of rural areas due to time
constraint
Due to limited pharmaceutical companies within Gujarat, got less number of
marketing professional as respondents as compared to sales managers.
Samples were drawn from Rajkot & Ahmedabad.
DATA ANALYSIS & INTERPRETATION
Table 1: CLINICAL ISSUES (Mean Values)
Clinical Issues Marketers Physicians Endusers
DTCA would encourage patients to attend 2.94 2.41 3.61
physicians for preventive health care.
DTCA would result in increasing diagnoses 2.76 2.94 3.29
of under-diagnosed conditions
DTCA would result in improving treatments 2.88 2.47 3.81
of under treated conditions
1=strongly disagree; 5 =strongly agree
From the above mean values we can say that most of the marketers & physicians disagreed
that DTCA will help patients to give clinical benefits by making them more conscious for
preventive health care and diagnosis of under-diagnosed condition. While consumers believe
that DTCA helps them to provide knowledge about treatments, make them concerned about
prescribing medication and results in diagnoses of under-diagnosed condition.
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Table 2: PSYCHO-SOCIAL ISSUES (Mean Values)
Psycho-Social Issues Marketers Physicians Endusers
Give patients confidence to talk to their 3.53 3.82 4
doctors about their concerns
Promote unnecessary fear of the side effects 2.68 3.82 3.03
Exposure to personally relevant DTCA 2.94 3.65 3.48
would encourage patients to disclose health
concerns to their doctor
1=strongly disagree; 5 =strongly agree
Most of the physicians, consumers & executives agreed that DTCA will give them
psychological benefits & personally relevant DTCA would develop confidence and
encourage consumers to disclose their health concerns to physicians. Physicians also agreed
that DTCA would promote unnecessary fear of side effects in the mind of consumers, while
executives and consumers disagreed that DTCA will promote unnecessary fear of side
effects, but it helps them in providing useful information on the risks of prescription
medication.
Table 3: EFFECT ON DOCTOR PATIENT RELATIONSHIP (Mean Values)
Effect on doctor-patient relationship Marketers Physicians Endusers
Promote unnecessary visits to doctors & cause 3 3.41 2.68
patients to take up more of their doctors’ time
DTCA would enhance the doctor-patient 3.03 3.12 3.19
relationship & communication
DTCA would damage the doctor-patient 2.65 3.12 2.58
relationship
DTCA pressures physicians to use drugs; they 2.88 3.12 2.77
might not ordinarily use
1=strongly disagree; 5 =strongly agree
Consumers and executives disagreed that DTCA will not promote unnecessary visits to
doctors and will not influence prescription behaviour of physicians. Rather it would help in
enhancing doctor-patient relationship & communication. While according to physicians
DTCA will promote unnecessary visits to them and might damage relationship with patients
and also it will affect their prescription behaviour.
Table 4: EFFECT ON HEALTH CARE SYSTEM (Mean Values)
Effect on health care system Marketers Physicians Endusers
DTCA contributes to rising drug costs, by 3.03 3.94 3.52
promoting newer, more expensive drugs.
DTCA discourages the use of generic products 2.59 3.47 2.92
DTCA promotes healthy competition among 2.97 3.88 3.87
DTCA contributes to rising health care costs 2.76 3.65 3.55
without commensurate health gains such as
unnecessary tests, referrals to specialists, self
medication.
DTCA should not be allowed in India. 3.06 3.47 3.32
1=strongly disagree; 5 =strongly agree
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Most of the physicians and consumers believe that DTCA would give rise to drug cost,
discourages to use of generic products and promotes the healthy competition among
pharmaceuticals companies, while executives disagreed that it will decreases the use of
generic products. Physicians, Consumers & Executives all agreed that DTCA will contributes
to rise health care costs without commensurate with health gains, which leads to increase in
self-medication, more refers to specialist and frequent change in medication. So, with respect
to pharmaceutical industry they all opined that DTCA should not be allowed in India.
Table 5: FACTORS OF DTCA
FACTORS THAT DRIVES DTCA FACTORS THAT DRIVES
TOWARDS DTCA AGAINST DTCA
Preventive health care. Fear of the side effects
Diagnoses of under-diagnosed Promote unnecessary visits to doctors
conditions Rising drug costs
Improving treatments Damage the doctor-patient
Give Psychological confidence relationship
Encourage patients to disclose health Influence prescription behaviour
concerns Increase in self medication
Enhance the doctor-patient Doubts regarding prescription
relationship & communication medications
Discourages the use of generic Increase confusion and difficult to
products understand
Knowledge about risk (prescription
medications)
To reduce the number of factors which drives towards and against DTCA, we have done
“FACTORIAL ANALYSIS” with the help of SPSS software (SPSS 16 version). And the
output is given below.
FACTOR ANALYSIS
Table 6: KMO and Bartlett's Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .682
Bartlett's Test of Approx. Chi-Square 248.870
Sphericity Df 78.000
Sig. .000
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Table 8: Total Variance Explained
Extraction Sums of Rotation Sums of
Initial Eigen values
Com Squared Loadings Squared Loadings
pone % of % of Cumul
nt % of Cumulat Cumulat
Total Total Varian Total Varianc ative
Variance ive % ive %
ce e %
1 3.070 23.616 23.616 3.070 23.616 23.616 2.959 22.758 22.758
2 2.345 18.039 41.656 2.345 18.039 41.656 1.991 15.317 38.075
3 1.366 10.507 52.163 1.366 10.507 52.163 1.567 12.054 50.129
4 1.098 8.446 60.609 1.098 8.446 60.609 1.362 10.480 60.609
5 .944 7.259 67.868
6 .784 6.032 73.900
7 .673 5.179 79.079
8 .658 5.058 84.137
9 .539 4.143 88.280
10 .458 3.519 91.799
11 .409 3.144 94.944
12 .380 2.920 97.864
13 .278 2.136 100.000
Extraction Method: Principal Component Analysis
Figure 1: Scree Plot
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Table 9: Rotated Component Matrix
Component
1 2 3 4
@_Preventive_health_care .757 -.040 -.284 .058
@_Diagnoses_of_underdiagnosed_conditions .662 .091 -.110 -.086
@_Improving_treatments_ .768 -.169 .065 .080
@_Give_Psychological_confidence_ .793 .143 -.044 -.078
@_Fear_of_the_side_effects .161 .368 .171 .567
@_Encourage_patients_to_disclose_health_concerns_ .654 .053 .066 .060
@_Promote_unnecessary_visits_to_doctors___ .230 .605 .128 .382
@_Enhance_the_doctorpatient_relationship__ .299 .116 -.733 .208
@_Damage_the_doctorpatient_relationship -.140 .419 .596 -.068
@_Influence_prescription_behaviour .220 .116 .653 .410
@_Rising_drug_costs -.020 .791 -.106 .116
@_Increase_in_self_medication -.023 .763 .188 -.151
@_Increase_confusion_and_difficult_to_understand .250 .132 .228 -.785
Extraction Method: Principal Component Analysis.
Rotation Method: Varimax with Kaiser Normalization.
Interpretation of Factorial analysis
Here result of KMO test is 0.680 and four factors detects 60.609% of effect on the variables.
So, there is a high degree of communalities among the variables. Hence we can compress
above given 16 factors to four major factors. Among these four factors two are driving
towards DTCA while other two drives against DTCA.
Table 10: RESULT OF FACTOR ANALYSIS
FACTORS THAT DRIVES DTCA FACTORS THAT DRIVES
TOWARDS DTCA AGAINST DTCA
Health consciousness for treatment of Rising drug costs and self medication.
under-diagnosed conditions. Increase confusion and fear of side
Psychological confidence which leads effects.
to improving treatments.
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CONCLUSION
On the basis of data collected to know consumer perception, knowledge and behaviour about
DTCA of prescription drug, we came to conclusion that there are certain benefits and harm
associated with DTCA. Key benefits of DTCA are preventive care for under diagnosed
conditions and patient’s psychological confidence for improving treatments which must be
balanced against adverse factors like self medication, rising drug costs, confusion and fear of
side effects. From the study we can say that it will still take five to six years down the line for
an innovative concept like DTCA (prescription drugs) to be accepted in Indian market.
BIBLIOGRAPHY
Almasi, E.A., Stafford, R.S., Kravitz, R.L., Mansfield, P.R. 2006. “What Are the Public
Health Effects of Direct-to-Consumer Advertising? PLoS Med. 3(3):e145.
Bradford, WD, A Kleit, P Nietert, T Steyer, and S Ornstein (2006), “Effects of Direct-to-
Consumer Advertising of Hydroxymethylglutaryl Coenzyme A Reductase Inhibitors on
Attainment of LDL-C Goals ”, Clinical Therapeutics, 28(12):2105-2118.
Calfee, J, C Winston, R Stempski (2002), “Direct to Consumer Advertising and Cholesterol
Lowering Drugs ”, Journal of Law and Economics,45(2):673-690.
Dave, D, and H Saffer (2010), “The Impact of Direct-to-Consumer Advertising on
Pharmaceutical Prices and Demand ”, NBER Working Paper 15969.
David, G, S Markowitz, and S Richards (2009), “The Effects of Pharmaceutical Marketing
and Promotion on Adverse Drug Events and Regulation ”, NBER Working Paper 14634.
Deborah F. Spake and Mathew Joseph. “Consumer opinion and effectiveness of direct-to-
consumer advertising”, Journal of Consumer Marketing, Vol. 24, No. 5, 2007, pp. 283-292.
Frosch, DL, PM Krueger, RC Hornik, PF Cronholm, and FK Barg (2007), “Creating Demand
for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising ”,
Annals of Family Medicine, 5(1):6-13.
Frosch, D..L, Grande, D., Tarn, D.M., Kravitz, R.L. 2010. “A Decade of Controversy:
Balancing Policy with Evidence in the Regulation of Prescription Drug Advertising.”
American Journal of Public Health. 100(1):24–32.
Foucault, Michel. 1963. The Birth of the Clinic: An Archaeology of Medical Perception.
New York: Vintage Books.
Greg Finlayson and Ross Mullner(2005), “Direct-to-consumer advertising of prescription
drugs: Help or hindrance to the public's health?”, Journal of Consumer Marketing, Vol. 22,
No. 7, 2005, pp. 429-431.
Iizuka, T, and GZ Jin (2005), “The Effect of Prescription Drug Advertising on Doctor Visits
”, Journal of Economics and Management Strategy, 14(3):701-727.
Kravitz, RL, RM Epstein, MD Feldman, CE Franz, R Azari, MS Wilkes, L Hinton, P Franks
(2005),“Influence of patients’ requests for direct-to-consumer advertised antidepressants: a
27
10. International Journal of Marketing and Human Resource Management (IJMHRM), ISSN 0976
– 6421 (Print), ISSN 0976 – 643X (Online), Volume 3, Issue 1, January-December (2012)
randomized controlled trial ”, Journal of the American Medical Association, 293(16):1995-
2002. Erratum in: JAMA 294 (19), 2436.
Rosenthal, M, E Berndt, J Donohue, A Epstein, R Frank (2003), “Demand Effects of Recent
Changes in Prescription Drug Promotion”, in DM Cutler and AM Garber (eds.), Frontiers in
Health Policy Research, Volume 6 , MIT Press.
Sejung Marina Choi and Wei-Na Lee(2007), “Understanding the impact of direct-to-
consumer (DTC) pharmaceutical advertising on patient-physician interactions: Adding the
web to the mix”, Journal of Advertising, Vol. 36, No. 3, Fal 2007, pp. 137-149
Shaw, A (2008), “Direct-to-Consumer Advertising of Pharmaceuticals”, ProQuest Discovery
Guides, March.
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