Healthy Skepticism Library item: 4473

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: news

Efrat Z.
Under the influence
Australian Doctor Weekly 2004 Jun 16

Full text:

There ’ s a fine line between some disease awareness campaigns and direct-to-consumer advertising. Zilla Efrat reports.

BRISBANE man Lee Porter spoke openly on Channel Nine’s A Cur rent Affair about the impact his erection problems had on his marriage. Those television viewers interested in his plight were shown the answer to his problem, as Mr Porter picked up a packet of tablets and pulled back his bed sheets with his wife.

Only television viewers who also saw Media Watch are likely to have learned that drug companies paid the Porters to appear on A Current Affair.

GlaxoSmithKline and Bayer (the former company promotes Levitra in Australia for the latter) also paid actor Gary Sweet to speak about erectile dysfunction, though as Media Watch revealed, he “was not always careful to watch his tongue”.

During an interview on Adelaide’s Radio 5DN, Mr Sweet mentioned Levitra by name.

“There’s a new product called Levitra out at the moment and that is very effective and … there’s a number of treatments and they do work very quickly, very effectively, I’m assured by most GPs.”

While Mr Sweet’s mention of the drug name may have been accidental, this type of promotion is not new and has been likened to the ‘cash for comment’ scandal that has embroiled leading radio announcers in recent times.

It is this type of campaign that is drawing criticism and sparking debate over the line between disease awareness campaigns aimed at educating the public and illegal direct-to-consumer advertising.

The latest is another arm of the Levitra campaign –“roll in the hay”.

You probably first noticed the GP version in medical publications such as this one.

The latest is a television commercial with the same concept and branding. It shows a contented-looking middle-aged man with hay on his clothes and a jacket swung over his shoulder, as well as colours and images that are key to Levitra’s branding – a flame and the colours purple, white and orange – plus a mention of the availability of a Performance Pack.

The campaign appears to break new ground by targeting both consumers and GPs with the same strong branding.

But it doesn’t break the law by mentioning the presription drug by name, so what’s the problem?

According to Professor Rob Donovan, who has extensive commercial experience in marketing and advertising and is co-director of the health promotion evaluation unit in the department of public health at the University of WA, the campaign is not in the spirit of legislation prohibiting direct-to-consumer advertising of prescription drugs.

“If it was in the spirit, the drug companies would not have the logo and the same images [in ads for doctors and consumers],” he says.

“It’s a two-pronged attack. The drug company surreptitiously gets its branding out to consumers, and consumers do have a say in brand choice. It’s pushing at the edges of what is allowable.”

Dr Robin Napier, chairwoman of the AMA Therapeutic Committee, believes drug companies have found a loophole they can exploit by duplicating their branding in educational campaigns.

“It is pushing the boundaries although it isn’t breaking the rules because they haven’t named the product,”she says.

So if the product isn’t named, how are these ads intended to work? Brett Van Heekeren, lecturer in advertising at Charles Sturt University, explains the theory.

The Levitra campaign, he says, is what’s known in the industry as 360º advertising because it surrounds the targets with communication to increase its effectiveness and uses the same elements in both trade and consumer campaigns.

“The brand properties are warehoused in the consumer’s mind. That’s where brands live. Not on the shelves. And consumers are much more likely to engage with a brand that they recognise.

“Advertisers try and get their peripheral images stored in consumers’ minds so that when they see it later, they will recognise it, and it will feel like a friend they have known all their life. When consumers go to the GP, the GP is the influencer and it’s important that the brand images are also in the GP’s mind so that the GP is likely to recommend that brand.”

This branding is then reinforced by the Performance Pack once it is passed on to consumers, Mr Van Heekeren says. The patient is then more likely to say, “That’s my brand”or “I know this brand”.

Professor Donovan believes the Performance Pack, which is described in advertisements to GPs as an “information kit” and which does not contain medication, also works as an incentive for patients to ask for that drug.

“By calling it a Performance Pack, the advertisers are implying that something in there will help consumers with their performance. It works as a show bag. It would certainly act as an incentive [for patients to ask for drugs] because consumers believe they will get something when they go in and ask for it.”

The Therapeutic Goods Administration, which administers the ban on direct-to-consumer advertising, says it has referred Levitra’s “roll in the hay”campaign to pharmaceutical industry body Medicines Australia’s Conduct of ConductCommittee.

While unable to confirm receipt of such a complaint, Medicines Australia director of strategic relations, Mr Steve Haynes, says of the tactics used in the campaign: “Either it breaks the law or it doesn’t. If it does, then it will be dealt with by the TGA and Medicines Australia’s code.”

GlaxoSmithKine corporate affairs manager Ms Nikki Capp did not return Australian Doctor’s calls, but her PA referred queries to Mr Haynes.

In an opinion piece written for Australian Doctor Mr Haynes says while recent campaigns about men’s health, featuring television personalities, “may have got some critics offside”, disease awareness campaigns play a valuable role in encouraging people to visit their doctor for assessment and treatment.

“Men are much more reticent than women to discuss their health problems, particularly if they involve sexual performance.

“The outcome of disease awareness programs is to encourage patients to visit their doctor for assessment and treatment. Isn’t this preventative health care for consumers at its best?”

While the drug name Levitra is not mentioned in advertisements to consumers, it is referred to on the “roll in the hay” web site, which says: “Click here if you have been prescribed Levitra (vardenafil) or have received a starter pack from your doctor.”

Dr Peter Mansfield, SA GP and director of Healthy Skepticism, lodged a successful complaint with Medicines Australia in March in regard to a similar web site reference that appeared as part of Eli Lilly’s erectile dysfunction campaign.

Eli Lilly, which manufactures Cialis, was found to have breached the code of conduct and was instructed to remove references to prescription drugs from the site (see box, page 25).

Dr Mansfield says web site references are likely to boost the number of patients who are familiar with the drug and are likely to ask for it by name.

“This will make them more likely to request or mention it by name to their doctor or to accept it if their doctor mentions it first,” he said in his complaint to Medicines Australia.

“Doctors like to please patients and may believe that there is no major medical difference between the drugs in this class. Consequently, patients’ requests, reminders or acceptance will be enough to tip the balance on at least some occasions so as to make doctors more likely than otherwise to prescribe Cialis rather than an alternative therapy.”

Ms Hilda Bastian, consumer advocate and managing editor of Informed Health Online, agrees. While drug companies can pay fines up to $200,000 for breaching the Medicines Australia Code of Conduct (last financial year companies were fined between $7500 and $50,000) this is small fry when compared with the company’s overall advertising budget. “Even if you are going to pay a fine, I can see why you would [break the code], if you are going to make a profit,”she says.

Professor David Henry, professor of clinical pharmacology at the University of Newcastle and a former chairman of the Pharmaceutical Benefits Advisory Committee, says the “roll in the hay” web site is a clear example of “disease mongering”.

He says the site sells the idea of having a medical problem to people who don’t think they are sick.

The web site has a self-test section of five questions, including, “Do you have difficulty getting an erection?” and “Have you had problems staying hard enough to have sex?”. If the user submits “sometimes” just once to one of the questions, the site states: “If you answered ‘Yes’ or ‘Sometimes’ to any of these questions you may want to discuss with your doctor why this is happening.”

According to Dr Mansfield, the bottom line is whether patients are harmed or not.

“They are harmed directly if given an inferior drug, or indirectly when expensive drugs divert funding away from more cost-effective therapies,”he says.

“When doctors are booked up because of an advert, patients with serious illness cannot get early appointments.

This distorts the diseases that we see away from those that are most important towards those that happen to be most profitable for drug companies at the time.”