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. Author manuscript; available in PMC: 2022 Feb 4.
Published in final edited form as: Health Mark Q. 2021 Jul 9;38(1):1–11. doi: 10.1080/07359683.2021.1947067

Consumers’ Experience with and Attitudes toward Direct-to-Consumer Prescription Drug Promotion: A Nationally Representative Survey

Kathryn J Aikin 1, Helen W Sullivan 1, Jennifer Berktold 2, Karen L Stein 2, Victoria J Hoverman 2
PMCID: PMC8815450  NIHMSID: NIHMS1774892  PMID: 34238134

Abstract

The way consumers get and seek health information reflects the current information landscape. To gather updated insights on consumer experiences with and attitudes towards direct-to-consumer (DTC) promotion of prescription drugs, we conducted a nationally representative survey of 1,744 US adults using a mail-push-to-web methodology with paper nonresponse follow-up. Results showed high exposure and indifferent attitudes to DTC promotion. Respondents reported DTC promotion has prompted action, particularly searches for more information, increased use of online resources, and some reported that they refused to take or stopped taking a prescription drug because they saw or heard about the drug’s side effects.

Keywords: Direct-to-Consumer, Prescription Drugs, Advertising, Exposure, Attitudes, Behavior

Introduction

In early 1980’s, pharmaceutical manufacturers began to expand their promotion of prescription drug products in the United States from their traditional healthcare provider customer base to consumers. To reach this consumer audience, manufacturers used mass media channels. What began as a slow, sometimes confusing (Donoghue, 2006; Gerald, 2010) foray into the U.S. public consciousness became highly visible with the finalization of FDA’s 1999 guidance on how to fulfill the adequate provision requirements for direct-to-consumer (DTC) broadcast ads (FDA, 1999). Surveys of consumers conducted in 1999 and 2002 found that most respondents had seen an ad for a prescription drug and many reported seeking additional information as a result of seeing an ad (Aikin, Swasy, & Braman, 2004).

In the twenty years since the guidance was finalized, DTC prescription drug ads have proliferated. Broadcast television ads in particular are highly prevalent. According to a recent analysis of prescription drug promotion (Schwartz & Woloshin, 2019), there were 663,000 direct-to-consumer (DTC) television ads in 2016, making exposure to prescription drug ads a near certainty for U.S. television-watching consumers. At the same time, the information landscape has changed, and with it the way in which consumers seek and get information about their health and potential treatments. In 1999 and 2002, the majority of those surveyed did not use the Internet as a source of information about prescription drugs (Aikin, Swasy & Braman, 2004). Many consumers now use the Internet as a source of health information (Fox & Duggan, 2013), and DTC promotion in that medium has grown correspondingly (Sullivan, Aikin, Chung-Davies, & Wade, 2016).

While DTC promotion as a whole has been increasing, however, the amount of time patients spend with their healthcare provider in the U.S. has remained fairly constant. In 1997 an analysis of the National Ambulatory Medical Care Survey (NAMCS) revealed the mean office visit time for U.S. patients with health insurance was 17.6 minutes (Mechanic, McAlpine & Rosenthal, 2001). Subsequent surveys of U.S. patient data report similar office visit times; for example, 18.5 minutes in an outpatient clinic in 2015 (Young et al., 2018) and 17.47 minutes in a urology clinic in 2017 (Donahue et al., 2017). This pressure on the patient-provider interaction may result in some patients turning toward the Internet and DTC promotion they find there as a source of health information to supplement or replace healthcare provider visits (Jacobs, Amuta, & Jeon, 2017).

Perhaps unsurprisingly, then, DTC promotion remains a much-debated form of health communication (e.g., Parekh & Shrank, 2008; Ventola, 2011); indeed, the American Medical Association (2015) has called for a ban on it. Although previous surveys of both consumers and healthcare providers found some ambivalence, noting both positive and negative effects of DTC promotion (e.g., Aikin, Swasy & Braman, 2004; Mukherjee, Limbu & Wanasika, 2013; Weissman et al., 2004), most of these surveys were conducted prior to the integration of social media and the Internet in daily life for a large percentage of the U.S. public (Pew Research Center, 2018; US Department of Commerce, 2018), and the heavy expansion of DTC promotion into these areas.

With this environment in mind, we undertook a survey of consumers to gather information on their exposure, behavior, and attitudes as they related to DTC promotion of prescription drugs. We had three broad research questions: (1) how much and what kind of exposure individuals in the US report to DTC promotion on television, print, and on the Internet, (2) what behaviors individuals in the US report in response to DTC promotion, and (3) what their attitudes toward DTC promotion are. To address these research questions, we revisited and updated questions asked in the 2002 FDA consumer and Prevention surveys (Aikin et al., 2004; Prevention Magazine, 2012) and incorporated questions of interest from other surveys of DTC promotion that explored patient perspectives between 1999 and 2007 (Huh, DeLorme, & Reid, 2005; Lee King, & Reid, 2015; Polen, Khanfar, & Clauson, 2009).

Methods

We employed a multi-stage design to develop the survey instrument, beginning with survey items from previous surveys where possible to create the initial pool of items. To refine the items, we solicited recommendations from an expert review panel, conducted nine cognitive interviews, and conducted a pretest with a small sample of participants (N = 23) drawn by address-based sampling. The survey asked respondents about their exposure, attitudes, and behaviors related to DTC prescription drug promotion. The survey items used the term “advertising” to refer to the broad range of prescription drug promotion for ease of respondent understanding.

The survey used address-based sampling to draw a probability-based, nationally-representative sample of U.S. households. An address-based sample of 7,232 households was drawn from the United States Postal Service Computerized Delivery Sequence File, which is comprehensive, has geographic detail, and contains close to 100% of U.S. households. We used the Hagen-Collier within household sampling scheme to identify a random adult to complete the interview (Hicks & Cantor, 2012). The survey used a mail-push-to-web methodology with paper nonresponse follow-up (Dillman, Smyth, & Christian, 2014). Initial contacts invited respondents to complete the survey online. After three contacts, non-respondents received a paper survey, which they could complete and mail back. We collected responses from 1,744 US adults in 2017, with a response rate of 28.2%. We used weighted data to compensate for differential probabilities of selection, reduce biases due to differential non-response, and make the estimates consistent with external population totals that are known from other sources. We used a classical design-based approach for weighting, beginning with base weights that are the inverse of the probability of selection, and including nonresponse and demographic weights. The demographic control totals used in the raking used American Community Survey data as the benchmark. We conducted analyses with SPSS 25.0 using the complex samples module. The survey was reviewed by the relevant Institutional Review Boards.

Results

Exposure

Most respondents (86.6%) reported seeing or hearing prescription drug advertising in the last three months. Table 1 reports sources of prescription drug promotion.

Table 1.

Weighted percentages for questions about consumer’s exposure to direct-to-consumer prescription drug promotion, from the National Survey of Health Information and Communication, 2017 (N = 1,744).

Question Yes No Not sure/Not applicable
In the last three months, do you recall seeing or hearing any ads (advertisements) for prescription drugs? 86.6 7.6 5.8
In the last three months, have you seen, read, or heard ads for prescription drugs in any of the following ways: a
 On TV (television) 98.3 1.4 0.3
 On the radio 41.1 50.5 8.5
 In a magazine or newspaper 68.7 23.8 7.5
 On the Internet 59.3 34.0 6.7
 In a letter, flyer, or announcement in the mail 24.3 67.5 8.2
In the last three months, have you seen a prescription drug advertised on:
 A search engine, such as Google or Bing 30.5 58.6 10.9
 Social media, such as Twitter or Facebook 26.1 54.4 19.6
 An online banner ad appearing at the top, bottom or side of your screen 44.5 45.6 9.9
 A streaming service, such as Hulu 10.9 61.3 27.8
In the last three months, have you watched a video online about a prescription drug at any of the following types of websites?
 A video sharing website, such as YouTube 12.7 87.3 N/A
 A prescription drug’s website 10.4 89.6 N/A
 A social networking website, such as Facebook or Twitter 9.2 90.8 N/A
 A health information website, such as WebMD.com or MayoClinic.org 18.3 81.7 N/A
 On any other type of website 11.5 88.5 N/A
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Note. The first two items were included the 2002 FDA survey (Aikin et al., 2004). The next two items were created for this survey.

a

These questions were asked of the subset of respondents who answered “yes” to the first question.

Television.

Of those who reported DTC exposure in the last three months, 98.3% said they had seen, read, or heard ads for prescription drugs on television. We asked all respondents if they had ever seen specific information in televised DTC ads (yes, no; Aikin et al., 2004). Most respondents reported seeing benefit information (the drug’s benefits: 90.1%; the medical condition treated by the drug: 89.7%; who could take the drug: 77.3%) and risk information (the drug’s risks or side effects: 88.1%; who should not take the drug: 83.2%). Most also reported seeing information-seeking information (questions to ask a doctor about the drug: 71.4%; how to get more information about the drug or medical condition: 68.6%). Fewer respondents reported seeing information that is less likely to appear in DTC ads, including directions for use (56.3%) and what to do in case of overdose (27.9%).

Print.

Of those who reported DTC exposure in the last three months, 68.7% said they had seen, read, or heard ads for prescription drugs in a magazine or newspaper. Few respondents (20.7%) reported ever seeing an ad in a magazine or newspaper for a prescription drug they “were especially interested in” (yes, no, don’t know; Aikin et al., 2004). We asked these respondents how much of the main ad and the page following the main ad they read (all, almost all, about half, only a little, none; Aikin et al., 2004). Typically, the main page of a print ad presents the benefits of the drug with some risk information, whereas the page following the main ad presents detailed risk information. Of the 20.7% of respondents, 42.4% reported reading “all” or “almost all” of the main ad, while 19.7% reported reading “about half” and 35.1% reported reading “only a little” or “none.” In contrast, 27.2% reported reading “all” or “almost all” of the page following the main ad, while 11.4% reported reading “about half” and 58.0% reported reading “only a little” or “none.”

Internet.

Of those who reported DTC exposure in the last three months, 59.3% said they had seen, read, or heard promotion for prescription drugs on the Internet. Few respondents (15.3%) reported ever seeing promotion on the Internet for a prescription drug they were especially interested in (yes, no, don’t know; Aikin et al., 2004). We asked these respondents how much of the benefit and risk information they read (all, almost all, about half, only a little, none; Aikin et al., 2004). Of the 15.3% of respondents, 49.0% reported reading “all” or “almost all” of the information on the drug’s benefits, while 23.3% reported reading “about half” and 22.4% reported reading “only a little” or “none.” Similarly, 54.1% reported reading “all” or “almost all” of the risks and side effect information, while 22.4% reported reading “about half” and 19.9% reported reading “only a little” or “none.”

Behavior

Information-seeking.

Approximately one-third (34.0%) of respondents said that a prescription drug ad had ever caused them to look for more health information (yes, no, don’t know; adapted from Aikin et al., 2004). Those respondents reported looking for a variety of topics, including a prescription drug for themselves (55.4%), a friend or family member (48.3%), a drug they were already taking (45.9%), or the medical condition advertised by the drug (44.6%; check all that apply; adapted from Aikin et al, 2004). The most-reported place these respondents reported looking for further information was on the Internet (68.4%), followed by talking to your doctor (64.6%), a pharmacist (37.6%), a friend, relative, or neighbor (26.8%), a nurse (16.4%), or a doctor other than your own (15.8%; check all that apply; Aikin et al., 2004; Lee et al., 2015). Few respondents reported looking for further information in a reference book (6.7%), a magazine or newspaper (4.0%), or by calling the 1–800 number in the ad (5.1%). Similarly, when we asked the full sample, using a 4-point scale (not at all likely, not too likely, somewhat likely, very likely), where they would look for further information on prescription drug risk or side effects, 90.5% said they were “somewhat” or “very” likely to talk to a healthcare provider, compared with 62.4% on prescription drug’s website, 31% for the manufacturer’s toll-free number and 20.6% in a magazine ad.

We also asked respondents if they had ever looked on the Internet for information about prescription drugs (yes, no), and if they had, whether they had ever looked on any of several types of websites (yes, no; adapted from Prevention Magazine 2012). Of the 65.2% of respondents who had looked for information about prescription drugs on the Internet, the most common place to look was a general health website such as WebMD.com or MayoClinc.org (80.1%); followed by a general information website such as Wikipedia (56.1%); a prescription drug’s website (50.2%); a website for a medical association (43.4%); a government website (37.8%); and an online discussion, Internet forum, or message board about healthcare (32.1%).

Medication adherence.

When we asked respondents if they had ever refused to take or stopped taking a prescription drug because they saw or heard about the drug’s side effects in advertising (yes, no, don’t remember; adapted from Polen et al., 2009), one quarter (25.4%) said yes.

Attitudes

Respondents expressed both positive and negative attitudes toward DTC promotion. For instance, 61.0% agreed “somewhat” or “strongly” that DTC advertising increases awareness of new drugs. However, 68.3% agreed “somewhat” or “strongly” that ads for prescription drugs make the drugs seem better than they really are. See Table 2 for results regarding consumer attitudes.

Table 2.

Weighted percentages for questions about consumer attitudes from the National Survey of Health Information and Communication, 2017 (N = 1,744).

Question Disagree strongly Disagree somewhat Neither agree nor disagree Agree somewhat Agree strongly
Ads for prescription drugs help me make better decisions about my health. 21.0 15.3 41.3 17.9 4.4
Ads for prescription drugs help make me aware of new drugs. 9.1 4.7 25.2 41.4 19.6
Ads for prescription drugs encourage me to look for information about potentially serious medical conditions I might be at risk of developing. 16.9 14.2 33.5 24.5 10.9
Ads for prescription drugs make me worry about my health. 27.2 14.9 35.5 15.6 6.9
Ads for prescription drugs make it seem like the drug will work for everyone. 12.4 17.4 25.1 30.0 15.0
Ads for prescription drugs make the drugs seem better than they really are. 3.5 2.8 25.4 34.8 33.5
Ads for prescription drugs do not give enough information about the possible benefits and positive effects of using the drug. 8.2 15.8 33.9 26.5 15.6
Ads for prescription drugs do not give enough information about the possible risks and negative effects of using the drug. 6.6 13.6 24.0 32.4 23.5
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Note. These items were included in the 2002 FDA survey (Aikin et al., 2004).

We asked participants how much they trusted prescription drug advertising in different media, using a 4-point scale (not at all, slightly, somewhat, a lot) adapted from a prior survey (based on Huh et al., 2005). Most respondents reported distrusting DTC promotion:72.8% of respondents said they trusted DTC advertising on television “not at all” or “slightly.” Similar levels of distrust were reported for the other media formats: 82.1% reported they did not trust radio DTC advertising, 78.1% reported they did not trust it on the Internet, 76.8% reported they did not trust it in a magazine or newspaper, and 80.9% did not trust DTC advertising in letter, flyer, or announcement in the mail.

Discussion

In this survey we explored exposure, behaviors, and attitudes related to DTC prescription drug promotion. Consumers reported a tremendous amount of exposure to this form of promotion in 2017. Approximately 87% of respondents reported seeing or hearing a prescription drug advertisement in the past three months, an increase over 2002 where 81% reported exposure (Aikin et al., 2004). This is consistent with previous research showing an increase in prescription drug promotion submissions to FDA over time (Schwartz & Woloshin, 2019; Sullivan et al., 2016).

Our survey results suggest a contradiction between respondents’ attitudes about this type of promotion and their behaviors. Respondents’ attitudes indicate that they are largely indifferent toward and do not trust DTC promotion. Nevertheless, many reported that it has prompted action on their part, particularly in searches for more information. This all plays out in an information seeking landscape that is drastically different from 2002. Consistent with the penetration of social media and the Internet into daily life, we found that respondents reported digital media as a source for information searches about prescription drugs much more than in 2002 (68% versus 38%). Once online, respondents consult a variety of sources. Among the 65% of respondents who said they had ever looked on the Internet for more information about prescription drugs, 80% said they went to a general health website like WebMD, 56% said they went to a general information site such as Wikipedia, and 50% said they have gone to the drug’s website. Meanwhile, lower percentages of respondents reported relying on the health care provider as a source of information compared to 2002. Specifically, among those who looked for more information, we observed declines in those who had consulted their doctor (64.6% versus 89%) or a nurse (16.4% versus 40%) for information about prescription drugs. These findings are consistent with analyses of Health Information National Trends Survey (HINTS) data that documented a general increase in Internet searches for health information, and the observation that reliance on healthcare providers as a source of information is becoming concentrated among certain groups, such as older populations, those with less education, and Hispanics (Jacobs et al., 2017).

We found that one quarter of our respondents reported stopping or refusing to take a prescription drug because of DTC promotion. Previous research on DTC promotion and adherence has found mixed effects. In a 2005 survey with a convenience sample of Internet users, 18% said they stopped taking their medication because of side effects described in DTC advertising (Polen et al., 2009). Similarly, Green and colleagues (2017) found an association between DTC exposure and decreased medication adherence in mental health clinic patients. In contrast, another study found that 26% of surveyed online depression group members said DTC advertising reminded them to take their prescribed medications (Bell, Taylor, & Kravitz, 2010), and a recent study found no influence of DTC exposure on adherence (Im & Huh, 2018). Research with economic data suggests that the relationship between DTC promotion and medication adherence is complicated and may depend on the ad campaign (Wosinska, 2005). These issues could benefit from more in-depth examination to determine how and why DTC promotion affects adherence.

This survey had a few limitations. First, our survey had a low response rate, consistent with the decline in response rates seen across surveys (National Research Council, 2013). We conducted a non-response bias analysis and addressed potential non-response bias via weighting. Second, respondents could complete the survey in Spanish over the phone, but we did not have a Spanish-language questionnaire fully integrated into data collection. This limits the inferences to English-speaking audiences. Finally, DTC ad exposure is self-reported; respondents may have misremembered their actual exposure. This survey should be followed up with research studying more direct measures of exposure (e.g., Niederdeppe, Byrne, Avery, & Cantor, 2013).

This survey provided the opportunity to delve into a variety of prescription drug promotion-related topics for which current national estimates did not previously exist in the U.S. In particular, this survey offers objective, U.S. population-level estimates about the extent of exposure to prescription drug promotion on the Internet. Other available exposure estimates typically rely on proprietary data or annual advertising spending information from the commercial sector. This survey also updates information at the U.S. population level about the impacts of prescription drug promotion and provides new insights about how U.S. consumers are searching for information about prescription drugs. These findings may provide information to guide stakeholders as they determine how to allocate resources for DTC-promotion policy, outreach, and research in the United States.

Acknowledgments

Support: This work was supported by the Office of Prescription Drug Promotion, US Food and Drug Administration under a contract.

Footnotes

Declaration of Interest Statement: No potential conflict of interest was reported by the authors.

References

  1. Aikin KJ, Swasy JL, & Braman AC (2004). Patient and physician attitudes and behaviors associated with DTC promotion of prescription drugs–summary of FDA survey research results. Food and Drug Administration. Center for Drug Evaluation and Research. https://www.fda.gov/media/112016/download [Google Scholar]
  2. American Medical Association. (2015). AMA calls for ban on DTC ads of prescription drugs and medical devices. https://www.ama-assn.org/press-center/press-releases/ama-calls-ban-dtc-ads-prescription-drugs-and-medical-devices
  3. Bell RA, Taylor LD, & Kravitz RL (2010). Do antidepressant advertisements educate consumers and promote communication between patients with depression and their physicians? Patient Education and Counseling, 81(2), 245–250. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dillman DA, Smyth JD, & Christian LM (2014). Internet, phone, mail, and mixed-mode surveys: The tailored design method (4th ed.). Hoboken, NJ: John Wiley & Sons. [Google Scholar]
  5. Donohue J (2006). A history of drug advertising: The evolving roles of consumers and consumer protection. The Milbank Quarterly, 84(4), 659–699. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Donahue R, Russell D, de Riese C, Smith C, de Riese WT, & Medway A (2017). Patients willing to wait: Arrival time, wait time and patient satisfaction in an ambulatory urology clinic. Urology Practice, 4(1), 1–6. [DOI] [PubMed] [Google Scholar]
  7. Food and Drug Administration. (1999). Guidance for Industry: Consumer-Directed Broadcast Advertisements. https://www.fda.gov/media/75406/download
  8. Fox S & Duggan M (2013). Health online 2013. Pew Research Center’s Internet & American Life Project. https://www.pewinternet.org/2013/01/15/health-online-2013/ [Google Scholar]
  9. Gerald MC (2010). The rise and fall of celebrity promotion of prescription products in direct-to-consumer advertising. Pharmacy in History, 52(1), 13–23. [PubMed] [Google Scholar]
  10. Green CE, Mojtabai R, Cullen BA, Spivak A, Mitchell M, & Spivak S (2017). Exposure to direct-to-consumer pharmaceutical advertising and medication nonadherence among patients with serious mental illness. Psychiatric Services, 68(12), 1299–1302. [DOI] [PubMed] [Google Scholar]
  11. Hicks W, & Cantor D (2012, May). Evaluating methods to select a respondent for a general population mail survey. Paper presented at The Annual Meeting of the American Association for Public Opinion Research, Fort Lauderdale, FL. [Google Scholar]
  12. Huh J, DeLorme DE, & Reid LN (2005). Factors affecting trust in on-line prescription drug information and impact of trust on behavior following exposure to DTC advertising. Journal of Health Communication, 10(8), 711–731. [DOI] [PubMed] [Google Scholar]
  13. Im H, & Huh J (2019). Relationship between exposure to direct-to-consumer prescription drug advertising (DTCA) and patients’ belief accessibility and medication adherence. Health Communication, 34(9), 975–983. [DOI] [PubMed] [Google Scholar]
  14. Jacobs W, Amuta AO, & Jeon KC (2017). Health information seeking in a digital age: An analysis of health information seeking behavior among U.S. adults. Cogent Social Sciences, 3, 1302785. [Google Scholar]
  15. Lee M, King KW, & Reid LN (2015). Factors influencing consumers’ attitudinal and behavioral responses to direct-to-consumer and over-the-counter drug advertising. Journal of Health Communication, 20(4), 431–44. [DOI] [PubMed] [Google Scholar]
  16. National Research Council. (2013). Tourangeau R, Plewes TJ, editors. Nonresponse in social science surveys: a research agenda. Washington, DC: The National Academies Press. [Google Scholar]
  17. Niederdeppe J, Byrne S, Avery RJ, & Cantor J (2013). Direct-to-consumer television advertising exposure, diagnosis with high cholesterol, and statin use. Journal of General Internal Medicine, 28(7), 886–893. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Mechanic D, McAlpine DD, & Rosenthal M (2001). Are patients’ office visits with physicians getting shorter? New England Journal of Medicine, 344(3), 198–204. [DOI] [PubMed] [Google Scholar]
  19. Mukherjee A, Limbu Y, & Wanasika I (2013). A review of research on direct-to-consumer advertising of prescription drugs: Directions for future research. International Journal of Pharmaceutical and Healthcare Marketing, 7(3), 226–243. [Google Scholar]
  20. Parekh N, & Shrank WH (2018). Dangers and opportunities of direct-to-consumer advertising. Journal of General Internal Medicine, 33(5), 586–587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pew Research Center. (2018). Internet / broadband fact sheet. https://www.pewinternet.org/fact-sheet/internet-broadband/
  22. Prevention Magazine. (2012). 2012 DTC Survey: A New Era for DTC. Emmaus, PA: Rodale. [Google Scholar]
  23. Polen HH, Khanfar NM, & Clauson KA (2009). Impact of direct-to-consumer advertising (DTCA) on patient health-related behaviors and issues. Health Marketing Quarterly, 26, 42–55. [DOI] [PubMed] [Google Scholar]
  24. Schwartz LM, Woloshin S (2019). Medical marketing in the United States, 1997–2016. JAMA, 321(1), 80–96. [DOI] [PubMed] [Google Scholar]
  25. Sullivan HW, Aikin KJ, Chung-Davies E, & Wade M (2016). Prescription drug promotion from 2001–2014: data from the US Food and Drug Administration. PloS One, 11(5), e0155035. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. US Department of Commerce. (2018). Computer and internet use in the United States: 2016. https://www.census.gov/content/census/en/library/publications/2018/acs/acs-39.html
  27. Ventola CL (2011). Direct-to-consumer pharmaceutical advertising: Therapeutic or toxic?. Pharmacy and Therapeutics, 36(10), 669. [PMC free article] [PubMed] [Google Scholar]
  28. Weissman JS, Blumenthal D, Silk AJ, Newman M, Zapert K, Leitman R, & Feibelmann S (2004). Physician report on patient encounters involving direct-to-consumer advertising. Health Affairs, W4, 219–233. DOI 10.1377/hlthaff.W4.219-233. [DOI] [PubMed] [Google Scholar]
  29. Wosinska M (2005). Direct-to-consumer advertising and drug therapy compliance. Journal of Marketing Research, 42, 323–332. [Google Scholar]
  30. Young RA, Burge SK, Kumar KA, Wilson JM, & Ortiz DF (2018). A time-motion study of primary care physicians’ work in the electronic health record era. Family Medicine, 50(2), 91–99. [DOI] [PubMed] [Google Scholar]

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