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Drinking from the Firehose: Analysis of Educational Content in Direct-to-Consumer Advertising for Overactive Bladder
Kevin Koo, MD, MPH, MPhil, E. Ann Gormley, MD.
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
BACKGROUND: Several recent overactive bladder (OAB) medications have been marketed on television. Proponents claim that direct-to-consumer advertisements promote condition and treatment awareness; critics argue that ads are too confusing or biased to be educational, particularly for patients with low health literacy. This study examines the educational content of recent OAB advertising on television to assess patients' likelihood of learning from commercials.
METHODS: Two databases of broadcast news programs were queried with 20 trade and generic names of prescription drugs FDA-approved for OAB to identify ads that aired 2009-2015. Ads were examined for product content (indication, benefits, risks, side effects) and several literacy domains: fact density (number of facts given per second); use of medical jargon; distracting factors during presentation of risks; readability of text and graphics; and compliance with the FDA requirement to direct viewers to more information about the advertised products.
RESULTS: Eight advertisements for four products were identified: fesoterodine, mirabegron, onabotulinumtoxinA, and solifenacin. Ads presented an average of 3.3 OAB symptoms, 3.1 drug benefits, 9.5 risks, and 5.8 side effects in 60 seconds. Nearly all ads (88%) contained hard-to-read text or graphics, including key facts such as clinical efficacy data, contraindicated comorbidities, or warnings about urinary retention. 38% of ads used medical jargon and did not explicitly state that the product may not work for all patients. Mean fact density was 0.4 benefits per second and 0.6 risks and side effects per second. 89% of ads presented risks in one continuous segment, and all ads increased speed or used a different voice when discussing risks; these factors are known to downplay consumer attention. During the voiceover presenting risks, all ads simultaneously displayed at least one and up to three additional data streams (e.g., contraindications as scrolling text, product website flashing onscreen). Although all ads met FDA requirements for more information, in most ads (62%) the information was illegible or only briefly legible. When these references were displayed at the end of the ad alongside other information (eg, dosing options, free trial offer), mean fact density rose substantially to 1.6 facts per second. In most ads (62%), the name of manufacturer was obscured or difficult to read.
CONCLUSIONS: Viewers of direct-to-consumer advertisements for OAB drugs had 50% less time to absorb risks and side effects compared to drug benefits. The majority of ads had one or more hard-to-read graphics and multiple audiovisual elements that could distract or minimize viewers’ attention to drug risks. The findings raise concern about OAB patients’ ability to obtain balanced information from television advertising, which may adversely impact help-seeking and treatment decision-making.
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