Healthy Skepticism Library item: 2554

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

Meek C.
2001;
www.rpsgb.org.uk/pdfs/dtcarep.pdf

Abstract:

The Medicines Control Agency justifies the regulation of drug industry advertising in order to protect the public from false and misleading claims: “In order to protect public health it is essential that advertising and promotion of medicines should be subject to effective monitoring and control at all times,’ – Medicines Control Agency, 1999.” The mechanism of control is established through several Acts of Parliament that underpin a complex system of industry self-regulation. According to some, there are very good reasons why governments and regulators should monitor, police and, where necessary, restrict drug marketing. They argue that prescription medicines are part of an intricate system of medical care that should be governed by science and careful human judgement not the profit motive. They add that more consumption of drugs is not necessarily a good thing yet the aim of advertising is to persuade people to do just that. The debate about DTCA has been sparked by changes within the pharmaceutical industry and the development of the patient-consumer. On the one hand it is argued that a ban on DTCA deprives the patient-consumer of a right to know. Those holding this view argue DTCA is inevitable. Those opposing this view say this attempt to fuse industry interests with patient rights is just expediency. Patients should have access to better information but not from pharmaceutical companies they say. They also say DTCA distorts health priorities.
The process of liberalising the laws governing DTCA in Europe began with the European Commission proposal in July this year to reform EU pharmaceutical legislation. This wide-ranging review includes plans to complement the current ban on DTCA in Europe with a pilot system aimed at ensuring the availability of better, clear, reliable information on authorised pharmaceuticals. There are, however, mixed messages coming from the Commission about DTCA. While it has said it wishes to abandon the strict prohibition of advertising, the EU Commissioner has said the moves do not represent the introduction of DTCA. A pilot stage is to be introduced that will allow limited ‘disease awareness’ initiatives for three specific disease groups: diabetes, AIDS and asthma. The ABPI has welcomed this measure as a step in the right direction. Groups opposing DTCA in Europe have strongly opposed the proposal. Only two Western countries permit DTCA New Zealand and the USA. In November 2000 the New Zealand Ministry of Health launched a review of DTCA with four policy options including the option of an outright ban. The review found that patients are going to their doctors as a result of advertising and receiving medications from which they are likely to benefit. However, the review also found that DTCA is raising prescription drug costs. Furthermore, ‘lifestyle’ and other DTC-advertised drugs have the potential to ‘crowd out’ expenditure that would otherwise be spent on treating illness ‘rather than helping people who may not be ill.’ The review also found that the quality and balance of advertisements was
often poor. The review recommended that DTCA regulations should be
tightened. DTCA opponents in the US acknowledge that DTCA will never be banned, but they argue for much tougher regulation. There is some evidence to suggest they are winning influence. There is growing concern about some DTCA tactics such as celebrity endorsements of some drugs. DTCA is also the subject of legal action by those claiming advertising is deliberately deceptive. Recently the industry was warned by influential players who support the concept of DTCA that the advertising needed to be deployed more responsibly. Those who support DTCA argue that it represents good patient education. They say it raises awareness about treatments for specific conditions and does not lead to inappropriate prescribing because the doctor has the last say in what drugs are suitable. It is argued that DTCA ‘merely motivates patients to learn
more.’ Proponents add that DTCA tackles undertreatment because companies have the ability and resources to reach people who may be unaware there is a treatment for the condition they have. They point to conditions such as depression and osteoporosis where it is known undertreatment is a significant problem. Supporters also link the rise of the patient-consumer with the need for DTCA. If consumers were better informed then it would lead to a more balanced dialogue between patients and doctors. Those opposing DTCA argue companies market for profit not education. They say advertising is not educational. Instead they say it is designed to increase sales regardless of need. Opponents say any benefits of DTCA must be balanced against disbenefits and point to cases where DTCA has led directly to inappropriate prescribing. Advertisements have been found to be misleading and lacking balance. They add DTCA can harm the doctor-patient relationship as patients may expect treatments that may not be the best option. Furthermore, they say advertising concentrates on new treatments. These are inevitably more expensive and carry more risks. Several studies have been carried out into the impact of DTCA and public reaction to it. Some of these studies are highly critical of DTCA. One found that many people falsely believe that only completely safe drugs can be advertised and that the advertisements are submitted for prior approval. One Lancet paper concluded that advertisements focused on emotional appeal rather than information about expected benefit. Research into existing websites concluded promotional sites were deliberately confusing as ‘advice sites’ appeared to be camouflaged advertising. On the other hand, broad public surveys appear to
confirm that people like drug advertising and people use them to inform
consultations with doctors. These surveys reveal that large majorities say the advertisements allow people to be more involved in their healthcare and educate people about risks and benefits. Industry uses these broad survey reports as evidence of support for DTCA. However, these public surveys also report that people are sceptical of claims made in DTCA advertisements and that many consider the risks to be understated. There is a growing debate about rising drug costs in the US and many suggest that DTCA is at least partly to blame. Research shows that US spending rose by 84 per cent in the five years from 1993 to 1998. It has been predicted that if DTCA stimulated demand in the UK on the scale seen in the US it would be a recipe for instability as primary care funding would be insufficient without radical NHS reform to introduce more patient co-payment. The increase in drug spending in the US is concentrated in the drug categories most heavily advertised to consumers and there is now little doubt that DTCA is at least partly responsible for these cost increases. These cost rises have raised
concern about the affordability of healthcare in the US. The New Zealand
Ministry of Health and the Pharmaceutical Management Agency have also linked increasing drug costs with DTCA. Importantly, this debate has focused on advertising for ‘lifestyle’ drugs as fears have grown that DTCA can distort health priorities by stimulating demand for
pharmacological treatment for conditions for which there may be better
alternatives such as diet and exercise. Critics also fear that mass media
advertising may encourage companies to concentrate on developing
‘blockbuster’ drugs for prevalent but not life-threatening conditions.

Keywords:
*nonsystematic review United Kingdom European Union New Zealand United States DTCA direct-to-consumer advertising value of promotion consumer behaviour & knowledge consumer drug prices market share ATTITUDES REGARDING PROMOTION: CONSUMERS PATIENTS INFLUENCE OF PROMOTION: CONSUMER DRUG COSTS INFLUENCE OF PROMOTION: MARKET SHARE PROMOTIONAL TECHNIQUES: DIRECT-TO-CONSUMER ADVERTISING VOLUME OF AND EXPENDITURE ON PROMOTION