Twenty years of DTC advertising has not seemed to be enough time to gain acceptance by physicians, consumer advocates, and politicians. In fact the anti-DTC sentiment seems to be reaching a frenzy this election cycle. I have discussed before why this is happening. In brief, it is because of the false assumptions that DTC raises drug prices, creates demand for over treatment, sets false expectations of efficacy, wastes physician time discussing drug requests, and discourages non drug alternatives.

The drug industry has largely failed to change attitudes among consumers about its image. Surveys show a lot of anti-drug company sentiment and a feeling that there is a problem in drug advertising. Despite the anti-drug company sentiment, consumers seem to rely on drug advertising for their awareness of new treatments. There is no doubt for most brands DTC is a successful investment.

The reason drug companies have PR problems is because of the fundamental issue that Americans do pay more for branded drugs than Canadians and Europeans. American prices fund drug company research budgets. It is hard to explain to Americans that they subsidize drug development for other developed countries. It is difficult to get politicians to stop bashing drug companies even though most are smart enough to recognize what would happen if the United States imposed price controls. Research would decline and government would not pick up the slack. Politicians on the left take the easy route and use prices as a campaign issue.

This PR nightmare is here to stay and drug companies are battling DTC critics as best they can. Mostly they are using tremendous lobbying clout to prevent price controls, tax penalties for DTC, and punitive patent policy.The media and advertising agency trade groups are also fighting any DTC restrictions through intense lobbying.

My recommendation for DTC marketers is to unapologetically market your products through advertising. I am convinced that DTC works because consumers learn important news through DTC and in many cases follow up with their doctors. Consumers may say they have issues with drug ads, but they act on them anyway. DTC is just the start of a consumer initiated process, and there are many opportunities to learn of alternatives to advertised drugs.

The best thing drug companies can do to blunt criticism is to make truly added value solutions that cure or control disease. Ask a Hep C sufferer if Harvoni is a miracle drug. Ask the people with HIV who now live a relatively normal life if drug companies changed their lives. Those drugs would not likely be here without the strong profit motive. DTC is not perfect and does lead to some issues for payers and doctors. On balance, DTC is a net positive and although Hilary and Bernie will disagree, DTC marketers should be proud of what they do.

I expect 2016 to be a strong year for DTC spending and could top $5 billion again. There are numerous media opportunities to improve DTC effectiveness and efficiency across mass and targeted media. These opportunities are in creating better ads and in optimizing media selection. Technology has created opportunities to do deep dives in how consumers digest DTC ads. All DTC advertisers have opportunities to get better ROI if they use the many tools suppliers have developed.

While we have gotten good at creating the basic DTC ad, can we say they are the best we can do? DTC is 20 years old but health care is changing so fast that the learning curve on what motivates consumers is still at its infancy. That makes being a consumer marketer of health products an exciting place to be despite the criticisms.

Judging by the first three quarters spending numbers from Nielsen, DTC should continue to grow in 2015 and 2016 versus the strong 2014 showing. Last year was the strongest spending in five years. DTC will probably grow more modestly in 2015 off a much higher base of $4.5 billion in 2014. DTC grew to $3.8 in 2013 from a disastrous $3.5 in 2012.

DTC spending could return to above the $5 billion level in 2016. The golden years were 2006 and 2007 with spending of $5.4 and $5.3 respectively. The financial crisis of 2008 and numerous patent expirations started a steep decline from 2009 through 2012. In fact, in 2012, some critics were predicting that DTC was in a long term decline as a promotional tactic.

What is interesting is to see television remain the dominant medium despite media gurus predicting its demise each year. I recognize the drug industry has an older demographic and that other industries are using television less than in the past. For drugs, however, television continues to take over 60% of the ad budget. There is no reason to think this proportion will change significantly in the next few years.

We know other targeted media are doing well based on other sources. Point of Care is exploding and estimated to be about $500 million, but is not measured by Nielsen. Internet is growing as well but is still a small slice of the pie at about 2% of spending. The world of DTC as media has not changed much over the last decade. Media gurus love to talk about the end of television, but drug marketers are still convinced it is where they should allocate 60-70% of their budget.

In fact we are now seeing television used for drugs that never would have considered it a few years ago. Highly targeted disease states are now using television. Cancer, Hepatitis, and Insomnia for the blind, are just a few now using television. High cost drugs like Opdivo for lung cancer recognize that the payback is there using a broad awareness medium.

With rising DTC spending comes renewed criticism that DTC is causing high consumer prices and over use. Critics were happiest when they though DTC would die a slow death. Now that it is growing again, the spending data will be used as political ammunition. The DTC Industry needs to keep close watch on the calls for a ban, or severe restrictions. The spending numbers show drug makers know using DTC has become critical to create a blockbuster drug. It is nice to see DTC recognized by drug marketers as a must do component of a large drug launch. While DTC may not be appropriate for all branded drugs, it certainly is right for most.

Those of us involved in DTC need a thick skin to deal with constant criticism from politicians, consumerists, physicians, news media, and insurance payers. At least the rising spending makes it easier to take and that uptrend should continue.

Who is Stuart Elliott and why should we care what he thinks? Let me back up a bit. Stuart Elliott was the advertising reporter for the New York Times for over 20 years. He left in 2014 to write for Media Village.com. In a column written on 12/9 Mr. Elliott said he no longer supports DTC. The piece is titled “ Madison Avenue Has Overdosed on Prescription Drug Ads.”

Mr. Elliott says he was a long time supporter of DTC ads. He now thinks they should be reconsidered. He cites the American Medical Association( AMA) call for a ban as a major reason. He also uses the criticism on high drug prices as a reason to end advertising. He thinks ending DTC may help the image of drug companies.

Whenever a long time DTC supporter changes positions it is significant and concerning. As a veteran advertising reporter Mr. Elliott certainly has the experience to weigh in credibly on DTC. I must, however, take issue with his column. Clearly I have my biases toward DTC, as the CEO of a company doing DTC conferences. That bias being revealed I think the facts support the drug industry in not reconsidering use of DTC.

All advertising for profit making companies is designed to increase sales. The fact that DTC does increase sales is apparently the reason critics want it banned. AMA does not like that patients ask for branded drugs potentially increasing use of higher cost drugs over cheaper alternatives. While DTC may lead to patient initiated discussion, I am not apologetic to doctors that patients want to be involved in drug selection. DTC advertising creates inquiries and discussion but doctors have the ultimate power what is prescribed.

Second, there is no basis to think ending DTC will improve the drug industry image. That position seems to based on the faulty assumption that advertising raises prices and takes money away from R&D. The reported $5 billion in DTC spending is really about 3.5 billion in actual spending because drug companies pay less than the reported estimates. That 3.5 billion is just a bit over 1% of drug revenue, not much of a price decrease if it was all used to provide price support . To think cutting all DTC would reduce consumer prices is just not true. If that DTC spending was banned sales would drop by about 10 billion, if we assume a 2 to 1 ROI on current DTC spending. Why would drug companies cut prices if they are losing revenue?

Consumer advocates and politicians complained about drug company pricing prior to DTC. They complained about patent life being too long before DTC. They complained about inadequate clinical studies before DTC. They complained about drug sales forces before DTC. Drug companies have been characterized negatively for decades, long before DTC. Unless drug companies charge generic prices for their branded drugs and never cause a drug related death, there will be critics.

Mr. Elliott says an outright ban might be phased in and maybe we should consider a two year moratorium on DTC ads for new products. Most companies already wait at least a year before they run ads. I am sure considering an extra year is a subject for reasonable discussion between industry and regulators.

What is interesting in this flip flop position is the failure to mention free speech. Mr. Elliott does not discuss why he feels a lawful product should be denied commercial free speech. His rationale that DTC creates image problems and that the AMA is against it, does not address free speech protection. I ask him where he draws the line? Does he think other industries with image problems should stop advertising? There are many advertised products such as cigarettes, alcohol, video games, birth control, and fast food that have numerous critics.

So, Mr. Elliott, while I understand the AMA reasons for being against DTC, I would hope you would investigate whether ending it would actually lower prices or raise the drug industry image. I think the facts are against either of Mr. Elliott’s anti-DTC argument.