Healthy Skepticism Library item: 20129

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Medawar C
Pushing ethical pharmaceuticals direct to public
The Lancet 1998 Mar 28; 351:(9107):921
http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2805%2960594-6/fulltext

Abstract:

“Pravachol helps prevent first heart attacks”. Readers of medical journals might guess that this quote comes from an advertisement in such a journal. US physicians are better placed to recognise the source (The New Yorker); the headline quote is an example of the direct-to-public advertising of prescription-only medicines that is allowed in the USA.
That advert covered two pages of colour with a following page in black and white of closely packed type listing contraindications, warnings, and other information, which is unlikely to be read except by the most dedicated. The detail there is hardly written for the general reader anyway (HMG-CoA, AST, and ALT are not spelt out, although CPK is; AUC and Cmax make an appearance, as do 3-α-hydroxy metabolites and p values). The typeface is small but is just readable. The same cannot be said for an advert in The Boston Globe with the bottom line of “Ask your doctor about BuSpar”. The product information there is fuzzily printed in grey type on ordinary newsprint paper.
Last August, the US Food and Drug Administration relaxed the rules about prescription-drug advertising to the public on US television and radio, which are now allowed to carry even skimpier information about risks and adverse events than that in printed adverts. Advertising on these broadcast media is much more expensive than in print outlets, and since the rules were relaxed, the drug industry has spent considerably more on direct-to-public advertising: US$844 million in 1997, compared with about US$500 million in 1996. A milestone is that the industry spent more on direct appeals to the public than it spent on advertising in medical journals.
But in the triad of drug industry, prescriber, and patient, who exactly is the customer? Philip Brown, the publisher of Scrip, is clear that it is the physician: “I do not believe that it is the role of the pharmaceutical company to create patient pressure for particular branded products. That is a dangerous road” (Scrip Magazine, July/August, 1997). That view seeks to perpetuate the paternalism of the medical profession—knowledge remains as power. What is wrong with direct marketing to the patient, especially in this age of accessibility of information to the public and empowerment of the patient?
The inquisitive patient in the past was always able to search in local general libraries for information about drugs from pharmacopoeias and the like. Now, information is readily available, for free, from easily accessible sources, such as patients’ information and support groups. A trawl of the Internet will yield mountains of information about drug treatments. Therein lies the rub for the ethical pharmaceutical industry. Anyone can put anything about therapy for a disease on the Internet, but the drug industry cannot.
The time is right for an extension of direct-to-public advertising for prescription-only medicines from the USA to other countries, at least on a trial basis. The drug industry already knows what makes for an acceptable standard. Some members of the industry fly at the edge of this envelope, but regulatory authorities are well able to reign in transgressors. Advertising in lay media, as the figures above show, is not cheap, and someone has to pay. Whether private or public insurance foots a nation’s drugs bill, in the end it is always the public who pays. So drug-pricing authorities will need to keep a tight audit on any unexpected increases.
The effect on prescribers will be interesting to watch. They will be forced to defend their prescribing habits to a greater extent, but empowerment of patients has already started doctors in that direction. Will the best-marketed drug win over the drug with the best efficacy, side-effect profile, and cost-effectiveness? The question already applies to direct-to-prescriber advertising, and changes in prescribing trends can be monitored. The product information needs seriously simplifying before the public can understand it.
It is time to take a mature view about marketing ethical pharmaceuticals direct to the public. Physicians should be strong enough to cope with more informed patients, and the patient needs to realise that with empowerment comes the opportunity to take a truly informed part in the prescribing process.