Introduction

Economists have long emphasized that in health care, identification of the consumer is ambiguous. Is it the patient, the physician acting as a professional agent on behalf of the patient, or is it the third-party payer? In most but not all countries, pharmaceutical manufacturer sales representatives, called “detailers,” are permitted to visit physicians in their offices and provide them with promotional material. Representatives from pharmaceutical manufacturers also interact with public-sector payers such as ministries of health, as well as with private-sector payers, such as insurers and self-insured employers in the United States.

Currently only two countries, the United States and New Zealand, permit pharmaceutical manufacturers to market directly to consumers, where consumers are defined as potential ordinary patients and not as health care providers. The United States also now permits direct-to-consumer advertising (DTCA) for prescribed medical devices. Whether DTCA should be permitted at all, permitted but only with much more stringent regulation, or replaced with public health announcements, are issues on which much has been written and continue to be controversial in the United States and in New Zealand. There is also a considerable literature surveying consumers' and physicians' perceptions of DTCA.

Rather than revisiting the various debates, controversies, and survey findings, I summarize the accumulated empirical evidence in this chapter: What have we learned to date about the composition, overall size, and impacts of DTCA in the United States?