[Federal Register Volume 73, Number 250 (Tuesday, December 30, 2008)]
[Pages 79887-79889]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-31057]



Food and Drug Administration

[Docket No. FDA-2007-N-0451] (formerly Docket No. 2007N-0321)

Agency Information Collection Activities; Submission for Office 
of Management and Budget Review; Comment Request; Experimental 
Evaluation of the Impact of Distraction on Consumer Understanding of 
Risk and Benefit Information in Direct-to-Consumer Prescription Drug 
Broadcast Advertisements

AGENCY:  Food and Drug Administration, HHS.

ACTION:  Notice.


SUMMARY:  The Food and Drug Administration (FDA) is announcing that a 
proposed collection of information has been submitted to the Office of 
Management and Budget (OMB) for review and clearance under the 
Paperwork Reduction Act of 1995. Due to an administrative error, this 
document is being republished.

DATES: Fax written comments on the collection of information by January 
29, 2009.

ADDRESSES:  To ensure that comments on the information collection are 
received, OMB recommends that written comments be faxed to the Office 
of Information and Regulatory Affairs, OMB, Attn: FDA Desk Officer, 
FAX: 202-395-6974, or e-mailed to [email protected]. All 
comments should be identified with the OMB control number 0910-NEW and 
title ``Experimental Evaluation of the Impact of Distraction on 
Consumer Understanding of Risk and Benefit Information in Direct-to-
Consumer Prescription Drug Broadcast Advertisements.'' Also include the 
FDA docket number found in brackets in the heading of this document.

FOR FURTHER INFORMATION CONTACT:  Elizabeth Berbakos, Office of 
Information Management (HFA-710), Food and Drug Administration, 5600 
Fishers Lane, Rockville, MD 20857, 301-796-3792.

SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, FDA has 
submitted the following proposed collection of information to OMB for 
review and clearance.

Experimental Evaluation of the Impact of Distraction on Consumer 
Understanding of Risk and Benefit Information in Direct-to-Consumer 
Prescription Drug Broadcast Advertisements

    Section 1701(a)(4) of the Public Health Service Act (42 U.S.C. 
300u(a)(4)) authorizes FDA to conduct research relating to health 
information. Section 903(b)(2)(c) of the Federal Food, Drug, and 
Cosmetic Act (the act) (21 U.S.C. 393(b)(2)(c)) authorizes FDA to 
conduct research relating to drugs and other FDA regulated products in 
carrying out the provisions of the act.
    FDA regulations require that advertisements that make claims about 
a prescription drug include a ``fair balance'' of information about the 
benefits and risks of advertised products, in terms of both content and 
presentation. Ads can present information in ways that can optimize or 
skew the relative balance of risks and benefits. Both healthcare 
providers and consumers have expressed concerns to FDA about the 
effectiveness of its regulation of manufacturers' Direct-to-Consumer 
(DTC) prescription drug advertising, especially as it relates to 
assuring balanced communication of risks compared with benefits.
    One characteristic of DTC television broadcast ads is the use of 
compelling visuals. Many assert that the visuals present during the 
product risk presentation are virtually always positive in tone and 
often depict product benefits. A consistently raised question is 
whether advertising visuals of benefits interferes with consumers' 
understanding and processing of the risk information in the ad's audio 
or text.
    The manner in which required risk information is presented in DTC 
ads has been recently addressed in the Food and Drug Administration 
Amendments Act of 2007 (FDAAA). Section 901(3) of FDAAA states that the 
major statement in DTC broadcast ads ``shall be presented in a clear, 
conspicuous and neutral manner.'' Further, the Secretary of Health and 
Human Services ``shall establish standards for determining whether the 
major statement is presented in such a manner.'' FDAAA does not define 
how the objective of ``clear, conspicuous, and neutral'' is to be 
    The purpose of the proposed study is, in part, to determine whether 
the use of competing, compelling visual information about potential 
drug benefits interferes with viewers' processing and comprehension of 
risk information about drugs in DTC advertising or with their cognitive 
representations of the drugs. Positive visual images could influence 
the processing of risk-related information and the final representation 
of the advertised drug in multiple ways. First, compelling visuals 
could simply distract consumers from carefully considering and encoding 
the risk information. To the extent that compelling visuals cause them 
to attend to or to process risk information less, participants exposed 
to risk information with simultaneous compelling positive visuals 
should recall fewer risks (and perhaps fewer benefits) than do 
participants exposed to the risk information without the positive 
visuals. Second, compelling visuals may affect the way consumers think 
about the brand, specifically their attitudes toward the advertised 
brand. An attitude is simply an association between an object and a 
degree of positivity or negativity. Thus, the impact of varying visual 
displays during the presentation of audio risks may be manifested in 
varying attitudes toward the brand. This is important because brand 
attitudes may be an important determinant of future behavior toward the 
brand. In contexts where product information is complex, initial 
impressions based on more subtle processes may have as significant an 
impact on behavioral tendencies as impressions based upon more 
``cognitively-effortful'' factual information. Because visual cues are 
typically easier to process than verbal information, initial attitudes 
for this group are likely to be greatly influenced by these cues. Under 
many circumstances, people rely much less on facts that they know, such 
as the number of risks associated with, for example, ibuprofen, and 
much more on general feelings they have, such as strong positivity 
toward a brand, such as the Advil brand of ibuprofen. Compelling 
visuals during the audio risk presentation of DTC broadcast 
advertisements have the potential to lead a consumer to form a positive 
opinion of a drug for no other reason than that it is presented in the 
same context as positive images.
    Another purpose of the present study is to examine the role of 
textual elements in the processing of risk information. Sponsors often 

[[Page 79888]]

superimposed text (``supers'') onto the screen to clarify spoken 
information or to provide extra information that is not included in the 
audio. For example, information that fulfills certain requirements 
(such as adequate provision statements, for example ``See our ad in * * 
*'') and limits claims of product use may appear. Providing verbatim 
text repetition of the risks required to be in the audio portion in 
broadcast ads may facilitate processing the risks, but only if viewers 
pay attention to the text. Viewers' attention may be affected by both 
the prominence of the textual information and the combined effects of 
text prominence and different visual information. The proposed study 
examines these associations.
    A final purpose of this study is to provide FDA with information on 
defining the presentation of the major statement as ``clear, 
conspicuous, and neutral'' as required by FDAAA. We have limited data 
about how consumers perceive risk and benefit information in DTC 
broadcast ads as a function of exposure to different content and 
presentations. Therefore, we do not fully understand the influence of 
visual and textual factors on the conveyance of a balanced or 
``neutral'' picture of the product.
    This study will investigate the impact of visual distraction and 
the interplay of different sensory modalities (oral, visual) used to 
present risk and benefit information during a television prescription 
drug advertisement. Data from this study will provide useful 
information for FDA as it considers whether it is appropriate to 
develop guidance to help improve how broadcast ads present a 
prescription drug's risks and benefits. This study will also provide 
preliminary data on how FDA might interpret the ``clear, conspicuous, 
and neutral'' standard. The data should help us plan whether additional 
research is needed to develop the standards called for in FDAAA.
    Overview: To investigate the overall and interactive role of visual 
images and text presentations during the audio presentation of risk 
information in television DTC ads, we will create a variety of ads for 
a new (fictitious) brand of high blood pressure medication. The ads 
will vary only in the type of information shown on screen during the 
presentation of required risk information (the ``major statement''). We 
will conduct pretesting to determine whether participants will view one 
version of the test ad two times or if the test ad will be viewed in 
the context of other ads (``clutter reel''). Respondents will answer 
questions about the test ad, including information about product risks 
and benefits, whether they intend to ask the doctor about the product, 
basic comprehension of the risk and benefit information, and their 
general attitudes toward the product. This experimental design will 
allow for comparisons between conditions in a controlled presentation 
where only the visual information varies.
    Design: The study includes two primary designs that, taken 
together, investigate three different variables.
    A one-way, five condition design will examine the impact of degree 
of consistency between visuals presented during orally presented 
(audio) risk information. The visuals will be either very consistent, 
somewhat consistent, neutral, somewhat inconsistent, or very 
inconsistent with the audio risk information. The consistent conditions 
will visually reinforce the product risks by presenting the words of 
the risks on the screen as they are being spoken. The inconsistent 
conditions will reinforce the product's benefits by presenting visuals 
that suggest blood pressure being decreased from high to normal levels. 
The degree or magnitude of consistency will be manipulated by including 
fewer pieces of information, interspersed with images of the fictitious 
drug logo. A control or ``neutral'' condition will consist of showing 
the brand logo during the entire audio risk presentation.
    The second design will be a two-way factorial design combining each 
level of one independent variable with each level of a second 
independent variable. The first variable consists of three levels of 
visual ``tone''--neutral, mildly positive, and highly positive. The 
second variable consists of three levels of prominence of ``supers''--
level one, level two, and no super (control).
    Because the control cell in each of the 2 designs will overlap 
(neutral, no supers), both designs together will amount to a total of 
13 separate ``cells'' and corresponding versions of advertisements for 
the fictitious brand.
    In a separate sub-experiment, five selected cells taken from across 
the two designs will assess implicit attitudes using the Attitude 
Misattribution Procedure (AMP). The questions asked of the participants 
in the AMP conditions will be reduced in number to account for the 
additional time needed to administer the AMP.
    Eligible participants for the study (n=2,400, following pretesting) 
will be recruited from Synovate Inc.'s online Internet panel. They will 
be 40 years of age or older to increase the likelihood of including 
members of the population most likely to have high blood pressure. At 
least 30 percent of the recruited sample within each of the designs 
will have equal to or less than a high school education. The 
composition of participants in each format condition will be balanced 
with respect to gender (50% female, +[sol]- 10%). Panel members who 
meet age and education requirements will not be screened further for 
disease condition.
    Dependent Measures: The primary dependent variables are recall and 
comprehension of risk and benefit information. We will also investigate 
behavioral intention and attitudes toward the fictitious brand. In a 
separate sub-experiment using only five cells throughout both designs, 
we will use the AMP, in addition to some explicit measures, to collect 
implicit attitude measures that should not be affected by social 
desirability biases.
    In the Federal Register of August 22, 2007 (72 FR 47051), FDA 
published a 60-day notice requesting public comment on the information 
collection provisions. Thirty commenters responded. In total, this 
amounted to approximately 29 distinct comments that specifically 
referenced the study. Of these, 12 were not PRA related. As a result of 
the comments that were PRA-related, FDA made extensive modifications to 
the study's methodology and design. As reflected in these 
modifications, we agreed to do the following: Change from a mall-
intercept to an Internet administered procedure, limit use of the AMP 
to a sub-experiment consisting of only five of the experimental 
conditions, add questions addressing the advertised (fictitious) drug's 
benefits, and make certain changes to the wording of the questions. 
Changing the administration procedure also allows us to double our 
sample size and test more conditions. In response to comments received 
both from the commenters and from our peer reviewers, we also decided 
to conduct significantly more pretesting than originally planned, to 
address the suggestion that the test ad should be embedded in a clutter 
reel of other ads and to test the validity of the stimulus 
manipulations (the mocked up advertisements). We disagreed, primarily 
because of time and complexity constraints, with suggestions to do the 
following: (1) Add more independent variables, (2) recruit a different 
set of participants, (3) change the use of Chinese characters in the 
(now more limited) AMP-measured conditions, (4) add certain additional 
dependent measures, (5) increase or decrease the number of behavioral 
intention questions (both were requested), (6) control for baseline

[[Page 79889]]

attitudes (because this is not needed in an experimental design and we 
are using a fictitious drug for the stimulus materials), or (7) get 
industry approval and public comment on the mocked up ads.
    FDA estimates the burden of this collection of information as 

                                 Table 1.--Estimated Annual Reporting Burden\1\
                      No. of         Annual Frequency       Total Annual        Hours per
21 CFR Section     Respondents         per Response          Responses           Response         Total Hours
21 U.S.C.                   1,600                     1              1,600                .03                 48
21 U.S.C.                     800                     1                800                .16                128
 , pretesting
21 U.S.C.                   4,800                     1              4,800                .03                144
21 U.S.C.                   2,400                     1              2,400                .25                600
 , study
Total                                                                                                        920
\1\ There are no capital costs or operating and maintenance costs associated with this collection of

    Dated: December 18, 2008.
Jeffrey Shuren,
Associate Commissioner for Policy and Planning.
[FR Doc. E8-31057 Filed 12-29-08; 8:45 am]