Introduction
Most of us have faced moments when we were not able to concentrate on the work in hand. There were times when focusing on a task was a big challenge. However, this type of syndrome is not very common for most of us, but some people show this kind of behavior on a day to day basis. For those people showing the lack of concentration and inattentiveness on a regular basis, this type of syndrome becomes uncontrollable and persistent. Any person showing such signs may be a victim of attention deficit hypersensitivity syndrome. Attention Deficit Hypersensitivity Syndrome (ADHD) does not show any physical signs or cannot be detected by laboratory tests. In the last decade alone, the number of patients diagnosed with ADHD has gone up by almost 500% (Schwarz, 2013). Is it because of the awareness of ADHD that the rate of people suffering from the disorder is increasing so rapidly? It appears that there are many people being diagnosed as ADHD patients even though their signs and symptoms do not match with the disorder. DTC has contributed to an increase in the diagnosis of ADHD patients significantly. This essay will discuss ADHD in detail as to how DTC advertising has led to an ADHD diagnosis epidemic, the benefits and limitations of DTC in such cases and the ethical problems arising out of the DTC marketing.
What is ADHD?
One of the most common brain disorders found in children is attention deficit hyperactivity disorder (ADHD), which depending on its degree of severity, can continue through one's adolescence to even adulthood. Though there is no definite scientific explanation but boys are more likely to be affected by ADHD than girls (NIMH, 2012). Children with ADHD have difficulty staying focused and attentive to anything for long. They also tend to be hyperactive.
DTC Advertising: Benefits and Limitations
Like all processes, Direct to Consumer marketing in pharmaceutical also has its benefits and limitations. DTC is a very well-employed marketing tactic used across many industry sectors. Though DTC is an expensive marketing technique, the return from it is enormous at times. Pharmaceutical industry is a different domain completely than most of the other industries. DTC is relatively new in pharmaceutical domain. However, in the last two decades, DTC has gained huge popularity in pharmaceutical domain. There are certain pros and cons of this process.
One of the major benefits of DTC is the awareness. There was little or no awareness at all about ADHD before the pharmaceutical companies embarked upon an aggressive campaigning on ADHD. Probably, there were a lot of children whose parents perceived them to be not good at studies or hyperactive. However, in reality, those children might be suffering from ADHD (Schwarz, 2013). They could have been more successful in life with proper treatment. With ADHD DTC campaign, the awareness of ADHD was generated, and with that, children showing matching symptoms of ADHD were taken to the doctors by their parents for consultation whether or not it was a genuine case of ADHD. Many ADHD children benefitted as their parents became aware of the disease and took them to the doctors at an early stage.
However, the benefits of the DTC in pharmaceutical campaigns far outweighed the problems. For example, in most of the television advertisements, it was shown that one of the major symptoms of ADHD was the loss of concentration. The loss of concentration is not very uncommon among children, and hence, this led many parents to believe that even a small lapse in concentration of the child was a sign of ADHD (Schwarz, 2013). They immediately visited the doctors seeking ADHD medication for their children because they learned that medicines were helpful in improving concentration. In many of those cases, doctors actually prescribed ADHD medicines for the children. Even a lot of children, who were not suffering from ADHD, were actually forced to take stimulants like Concerta, Adderall, Focalin and Vyvanse (Schwarz, 2013). Despite FDA warnings about the drug companies giving misleading and partial information about the benefits and risks, many companies continued their campaigns. As a result, currently about millions of children are taking ADHD medications in USA, and many of them are not suffering from ADHD.
Another major issue with DTC is the limited amount of control FDA has over the campaigns. FDA regulation states that there should be a balanced presentation of risks and benefits in the DTC campaign. All the major risks associated with the medicines should be depicted. As most of the DTC advertising campaigns have space or time constraints, pharmaceutical companies only give away selective information, which will improve the sale of the drugs.
DTC Advertising Ethical Framework
There are different players and stakeholders in the DTC advertising market. Each behaves in its own separate way under the circumstances. Each of the stakeholders wants to ensure that their interest is given preference over others. The primary stakeholders of the DTC advertising framework are the pharmaceutical companies, patients and their parents, physicians, healthcare researchers and FDA (Schwarz, 2013). There are secondary stakeholders of the ethical framework like non-profit health organizations, federal government, law makers and insurance companies. However, before getting into the ethical dilemma of each of the primary stakeholders, we will first discuss how the DTC advertising campaign process magnified a small disease into an epidemic.
How DTC Advertising Framework led to ADHD Epidemic
ADHD was an unknown disease even until the early 1980s. Dr. Keith Connors, after years of fighting, finally legitimized ADHD as a disease. ADHD was a little known disease till the early 1990s. However, the disease was known to the medical practitioners for a long time. During early 1990s, almost 600,000 American children were diagnosed with ADHD. Less than 3% of the total high school students were diagnosed with ADHD at that time (Schwarz, 2013). From the late 1990s, big pharmaceutical companies saw a big market opportunity in the space of ADHD. The ADHD drugs available at that time include Adderall and Concerta, which were proven to be helpful in making ADHD patients succeed in schools and beyond. Shire, the manufacturers of Addrell, was the first to launch a DTC campaign for ADHD. It mainly targeted school teachers, parents and physicians in its DTC campaign. Soon Janssen Pharmaceutical, the makers of Concerta, also started its own ADHD DTC campaign. These DTC campaigns primarily propagated the idea that anyone showing problem in paying attention or hyperactive behavior might be suffering from ADHD, and Addrell and Concerta could help them do well by improving their concentration level. These DTC campaigns also suggested that there was little or no side effect of the ADHD medication (Schwarz, 2013). Hyperactivity being very common among children, many parents sought the help of doctors to ask for ADHD medication for their children. Many doctors also recommended ADHD medication to the children. From 600,000 in the early 1990s, the number of children diagnosed with ADHD medication has escalated up to 3.5 million in 2010. A whopping 15% of the high school children were diagnosed with ADHD in 2010 (Schwarz, 2013). ADHD is only the second most diagnosed disease among children in USA after asthma. These numbers definitely suggest that there is an ADHD epidemic going on in USA, but it is really not the case.
Now that we have seen that DTC advertising campaign in its current form is unable to function the way it should, the next point of discussion will be upon stakeholders and their ethical dilemma.
Parents of the Patients of ADHD
Pharmaceutical companies are in an industry that deals with the life of people. Hence, they should be more careful while creating a DTC. An advertising campaign directly impacts the consumer behavior. For example, in case of ADHD, millions of parents started thinking that their children had ADHD being influenced by the advertising campaigns. Some definitely benefitted from the campaigns, but many were unnecessarily alerted by the way those DTC campaigns portrayed ADHD. They rushed to their physicians demanding ADHD medication for their children. In this case, the main victims of the DTC process are the children. They suffered because the DTC campaign presented a partial and misleading picture of the disease. They also suffered because their parents took hasty decisions based on an advertisement and not on balanced information. The main issue, in such cases, is that because of a non-robust DTC process many children are suffering. Is it ethical for the pharmaceutical companies to create such misleading campaigns just for the sake of increasing the sale of their products? However, the big ethical question, in this case, is that is it ethical for the parents to make decision about their child’s life based on one DTC advertising campaign they probably have watched for 10 seconds on television (Schwarz, 2013)? Is it not proper to ferret out more information about the disease as a whole before making false expectation for the patient?
Pharmaceutical Companies
DTC campaigns are costly requiring copious investment from the pharmaceutical companies. Because of this reason, many companies try to make sure that the product does well in the market. They also invest in magazines and physicians to publish favorable articles on the product. They make sure that the DTC campaigns are well supported by the research articles published in healthcare communities and the universities. This makes the campaign credible to the physician community as well. Many of the those articles published only highlight the benefits of the drug and limit the discussion on the side effects as there is no rule from FDA on the publications or research works. These articles in medical journals and popular magazines influence the opinion of general public and medical fraternity (Schwarz, 2013). Resultantly, more consumers start demanding the products from their physicians and more physicians show willingness to prescribe the medicines being influenced by the good reviews. It seems that the whole process is manipulated by a party trying to sell its product. Again the question that arises is if it is ethical for the pharmaceutical companies to hire experts to write positive reviews of its products.
Physicians
The whole process fails if the physicians are not influenced by the DTC campaign or do not buckle under the false expectation of the patients or relatives of the patients. Although there is no statistical evidence, but looking at the hugely increased ADHD cases in the last 10 years it seems that may be some physicians might have loosened the criterion for the diagnosis of ADHD. DTC and the false expectations from the patients have created a situation where physicians are led into relaxing the diagnosis criterion. This is definitely unethical. Under all circumstances, physicians should uphold their professional behavior while dealing with a patient.
FDA
Finally, FDA is another party which often does not use its power to curb some of the improper DTC advertising campaigns. FDA has its own agenda. FDA often does not have enough budgets to make people aware of a certain disease or syndrome. Even if budget is available, in most of the cases those budgets are eaten away by a few nationwide disease campaigns like anti-smoking, anti-heroine, AIDs and cancer awareness. Often FDA, despite knowing that diseases like asthma or ADHD are very common among children, does not spend money in spreading awareness about those diseases (Schwarz, 2013). This is primarily because of the fact that these diseases do not kill as many people as cancer or smoking does every year. However, FDA knows that it is ethically wrong not to make people aware of such diseases. That is why when companies like Shire comes up with advertising campaigns for ADHD, FDA ignores the misleading information showcased in those DTC advertisements allowing them to run in media. Though it is true that DTC campaigns help in spreading awareness, the misleading information conveyed in those advertisements often creates false expectations for the patients and their parents. FDA, thus, fails to make sure that DTC advertisement campaigns are not overly misleading. This is ethically wrong from the strongest stakeholder of the whole healthcare industry group. If FDA works properly, then it is highly unlikely for any misleading DTC campaign to hit the market.
Conclusion
Attention deficit hyperactivity disorder (ADHD) is a problem found in many children and adults across the world. Children with ADHD show some common symptoms of hyperactivity, inattention and difficulty in getting along with others. DTC in the area of ADHD has started in the early 1990s, and since then the number of cases of ADHD has seen a meteoric rise. From the statistics, it may seem that USA is currently undergoing an ADHD epidemic.
DTC campaigns have their positive and negative impacts. DTC campaigns definitely help create awareness among the general mass about a disease and its consequences. On the other hand, because of its misleading information many get influenced and false expectation is built about the product. However, to control the DTC process, FDA regulations are not successful enough. Participation from all the stakeholders is important. It is absolutely necessary that doctors, patients, universities and health care organizations all come together to monitor the process of DTC process. DTC process needs to be more focused on giving education than giving selective information to boost up sales. DTC process, if run properly, will help increase awareness and also will also help people take rational healthcare decisions.
References
National Institute of Mental Health (NIMH). (2012). Attention Deficit Hyperactivity Disorder. Retrieved on 11th January 2014 from <http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.shtml?utm_source=REFERENCES_R7#pub1>
Biederman, J., Faraone, S. V., Keenan, K., Knee, E., et al. (1990). Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 526-533. Retrieved on 11th January 2014 from <http://www.ncbi.nlm.nih.gov/pubmed/2387786>
Martin, B. (2007). Causes of Attention Deficit Disorder (ADHD). Psych Central. Retrieved on 11th January 2014 from <http://psychcentral.com/lib/causes-of-attention-deficit-disorder-adhd/0001202>
Schwarz, Alan (2013). The Selling of Attention Deficit Disorder. New York Times. Retrieved on 11th February 2014 from < http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html?_r=0>
