Internet marketing of neuroproducts: new practices and healthcare policy challenges.

Direct-to-consumer advertising (DTCA) of healthcare products refers to a variety of marketing practices based on a combination of information and promotion strategies directed at consumers through different media such as radio and television broadcasts, newspaper and magazine ads, and, more recently, through the Internet. The principal form of marketing used by the pharmaceutical industry is the distribution of free samples to physicians1 but DTCA is an increasing part of global promotional spending for prescription drugs.2 Latest estimates suggest that DTCA now represents an annual $3.2 billion enterprise for the U.S. pharmaceutical industry. Findings from the literature show that these substantial efforts are geared toward the newer pharmaceuticals for chronic conditions with huge market potentials. The lion’s share is going to the 20 most prescribed pharmaceuticals.3 Psychiatric and neurological illnesses are currently one of the main targets of prescription-drug DTCA, and, generally speaking, the Internet is having a substantial impact on the practice of psychiatry and neurology.4 In a study on “DTCA visits,” that is, visits where the patient initiated discussion about a prescription drug advertised on broadcast media, anxiety, depression, and pain were found to be prevalent target conditions.5 Moreover, it has been shown that the Internet per se is more often used by patients with self-reported stigmatized conditions (e.g., anxiety, depression, herpes, or urinary incontinence) than by patients with nonstigmatized conditions (e.g., cancer, heart problems, diabetes, and back pain) to get health information, communicate with healthcare professionals, and utilize healthcare based on Internet information.6 Some psychiatric conditions such as depression often go unrecognized and, arguably, DTCA could help in the recognition of symptoms and in the promotion of well-being. However, these claims must be carefully considered given the fact that psychiatric and neurological illnesses can impair decisional capacity and leave the patient in a state of vulnerability. Hence, the traditional claims that DTCA benefits the patient by enhancing autonomy needs to be carefully assessed and must be balanced with reports suggesting that DTCA can affect clinical presentation by shaping descriptions of symptoms and understanding of treatment.7 Although DTCA has been most extensively discussed in the context of prescription drugs, the impact of DTCA promotion of healthcare products