Healthy Skepticism Library item: 1653

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

Corbey D
Patient doesn’t benefit from direct-to-consumer advertising
Opinion page NRC Handelsblad 2002 Jan 17

Full text:

In Europe pharmaceutical companies are prohibited from advertising medicines directly to patients. That is a good thing as advertising pushes medicine costs upward, says Dorette Corbey.

From now on, the pharmaceutical manufacturers want to reach patients directly with advertisements for their medicines. Until now this type of direct-to-consumer advertising has been forbidden in Europe, but there are proposals to change that: patients no longer need protection and certainly no patronising. Consumers and patients want information and have become more able and expert, acccording to the industry. Advertising campaigns, in addition, can contribute to more knowledge about illnesses and symptoms.

This all sounds too good to be true. There are a number of arguments to be made against advertising of prescription medicines. Consumers or patients are still far from all being experts. Someone who is sick or who has poor health is vulnerable and more receptive to promotional claims that promise better health. The border between offering information and problematic sales pitches is very thin. In order to sell a medicine, a person has to believe they have a sickness or a health problem.

In the US, where direct-to-consumer advertising is allowed, advertising campaigns for a great part are targeted at medicines against so-called “social diseases” such as baldness, impotence, anxiety, shyness and clammy hands. These are general complaints affecting many people but which have little to do with public health. Advertising campaigns also play upon feelings of anxiety (Is it just forgetfulness or is it Alzheimer’s?)

A healthy skepticism is needed against these dangerous campaigns. Medicalisation is often unhealthy and advertising is not needed to provide more information. And importantly, patients do not decide themselves which medicines they will use, but rather,their doctor does. But advertising seems to work in the US.

Patients that go to the doctor after seeing an advertisement and ask for a prescription often have success: in 80% of the cases the doctor writes a prescription for the requested drug. During the past few years, the sales figures of the 50 most promoted medicines in the US have doubled. The question is if all of these patients actually benefit from these medicines.

Advertising is not only dangerous, it also pushes costs upwards. More money spent on marketing leads to higher prices. Medicines are already expensive due to high research costs. The path to bring a drug to the market is long: after the development of a potential substance many tests must be done to prove its effectiveness and safety. These factors don’t pan out all of the time, thus many potential medicines never reach the market.

According to the industry, the development costs per medicine average US$ 500 million, including all of the dead ends and failures and problems. The estimates made by non-profit organisations are noticeably lower, but development costs must be re-couped. Therefore patent protection exists and government support is necessary for that. In each country negotiations on setting prices are done with the government. If the patent protection is over after 20 years, copies of drug can be brought onto the market, but the prices can still remain high.

The pharmaceutical market is a billion dollar market. Thanks to protective constructions, high incomes are the reality as well as high development costs. In this way in 1998 pharmaceutical firm Bayer earned almost one and a half billion Euros on ciproxin, an antibiotic used against serious intestinal problems, tuberculosis and anthrax. The manufacturer of Prozac earns yearly almost two billion dollars on this popular drug against depression.

Compared to other sectors, the pharmaceutical industry enjoys extremely high profits. At the end of the 1990’s the profit margin in the pharmacuetical giants was approximately 20%. This is a bitter pill for society because despite high-profit figures and protective rules, innovation is declining. From the perspective of public health the biggest problem is that the pharmaceutical industry targets profit-making illnesses and complaints.

Tropical diseases and rare illnesses from which millions of people die are considered unattractive and therefore little investment is made in them. Of the 1,400 new medicines brought onto the market since 1970, only 13 are targeted at tropical diseases.

Annual reports suggest that many pharmaceutical firms have clearly higher budgets for marketing than for research. The drug industry must compete on the basis of innovation and the development of new medicines, but in the last few years it has sailed ahead on the higher sales of existing products. More advertising is then a logical step. The pharmaceutical industry cannot be blamed for wanting to make a profit. But the manner in which it makes that profit has direct consequences for public health.

The most important objection to allowing advertising is that it is a step in the wrong direction. Direct-to-consumer advertising will strengthen the position of profit-making illnesses and will try to reach a broad and buying public. Instead of allowing advertising, the EU should take a much more active stand in the pharmaceutical sector. The European Union should create funds to play an active role in development projects that currently cannot be financed.

A European pricing policy must be established with a medicine index so that costs per country can be compared. In any case, prices must be transparent. The development costs of a new product should be weighed during the determination of the price, and the price must be consistent with its therapeutic value.

The European governments can agree to higher prices if, in exchange, they get guarantees that “unprofitable” diseases will get a place on the research agenda.