Hematology-Related Direct-to-Consumer Advertising: A Content Analysis and Verification of Claims from Print Media.

Background: Patient-directed marketing of hematology medications is an increasingly prevalent and controversial practice. Content analysis of hematology-related direct-to-consumer advertising (DTCA), with attention to how benefit and risk/side effect information is presented as well as assessment of the appeals and claims made, is essential to understanding its potential effect on patient outcomes.

Methods: We reviewed all DTCA for hematological medications appearing in 2005 in the largest circulation patient-focused bleeding-disorder and cancer magazines (Hemaware and CURE), as well as a sample of popular magazines. We assessed the Flesch reading ease score (FRES) for the benefit and risk/side effect text presented in each advertisement. Ranging from 0 to 100, a FRES of 65 or higher is considered understandable for the average person. We also assessed the proportion of text dedicated to, and the largest type size of, benefit and risk/side effect information, as well as the nature and content of the advertisements’ appeals. We then attempted to link the advertisements’ main efficacy or safety appeal to the hematological literature based upon references available from a Medline search for the claim and the drug name.

Results: Of 134 total ads reviewed, 20 unique advertisements were analyzed (the remainder were repeats). Overall, the ratio of number of words devoted to benefit text versus risk/side effect text was 1.33. The mean FRES for benefit information was 39.0, while the mean FRES for risks/side effects was 23.7, a difference of 15.3 [95% CI: 6.4, 24.2]. The mean largest benefit type size was 6.1 mm, while the mean largest risk/side effect type size was 2.3 mm, a difference of 3.8 mm [95% CI: 1.7, 5.6]. 65% of ads made appeals to social-psychological enhancements (eg: regaining a normal life). 88% of the ads made appeals to efficacy, and 53% to safety; we were able to verify all of these except one through Medline.

Conclusion: Hematology print DTCA is difficult to read. When compared to risks/side effects, benefits often comprise more text, appear in larger typeface, and are presented in language that is somewhat more readable. Appeals to efficacy and safety are common, and, for the most part, easy to verify with Medline. Although the ultimate effects of hematology DTCA for patients and providers remain to be elucidated, awareness of its characteristics is a vital first step toward better informing its regulation.