Messages in prescription drug advertising for four chronic diseases, 2003-2016: A content analysis

The objective of this study was to examine the frequency and content of messages related to pharmacological and evidence-based, non-pharmaceutical treatments in direct-to-consumer advertising (DTCA) for prescription drugs treating four chronic diseases in the United States. We used content coding to identify theory-informed categories of messages appearing in a large sample of heart disease, diabetes, depression, and osteoarthritis advertisements, appearing on national and local television between 2003 and 2016 (N = 11,347,070). The data were originally accessed in 2019 and analyzed in 2020-2021. The central message in all pharmaceutical DTCA was drug efficacy. Advertisements for diabetes and heart disease, but not depression or osteoarthritis, contained general (not central) messages about diet and exercise. Advertisements for heart disease primarily portrayed diet and exercise as insufficient for controlling the target health condition. No advertisements in our sample portrayed changes in diet or physical activity as an alternative to drugs. Pharmaceutical DTCA across health conditions employ similar strategies to promote use of the advertised drug but vary widely in whether and how they describe non-pharmaceutical treatments that complement or serve as alternatives to medications. Regulators should consider the potential spillover effects of non-pharmaceutical messages in pharmaceutical DTCA when considering future regulatory endeavors.