Healthy Skepticism Library item: 20125

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: Electronic Source

Advertising Prescription Drugs
Which Online 2001

Full text:

Advertising prescription drugs to the public could happen in the UK. We’re not convinced it’s a good idea.

Advertising prescription drugs to the public is illegal in the UK and across the EU. But pressure from the pharmaceutical industry to change the situation is growing. Along with this pressure comes increasing concern that such advertising would cause more harm than good.

The arguments for and against advertising are complex. They touch on issues of access to information about drugs, the role of advertising in health, and regulation of the internet,

To give just a flavour of the debate, here we report on the results of Consumers’ Association (CA) research into the effects of direct to consumer advertising (DTCA) in the US – its impact on the US drugs bill and on public health. We also consider the potential implications for the NHS.

Whats to come?
Leaf through almost any magazine, or watch TV in the US, and you’ll see evidence of the billions being spent on advertising prescription drugs to the public. You may even see celebrities promoting drugs – in some cases, for conditions that they don’t even have.

Some ads (see the ad for Prilosec) offer financial inducements of around $5 to $20. You take the money-off coupon to your doctor and, if you get a prescription, you then take it to a pharmacy to claim your discount.

In addition, most companies are using patient sites on the internet to raise awareness of illnesses, the drugs they produce, and of the companies themselves – see ‘The Internet’.

DTCA really took off in 1997, when the US Food and Drug Administration relaxed TV advertising rules. The latest figures from the US National Institute for Health Care Management show that spending by pharmaceutical companies on DTCA rose by over 38 percent in the last year to $1.8 billion, and is projected to rise even further. In fact, drug companies are now spending more on courting patient interest than on advertising to doctors.

For and against
One of the key arguments put forward by those who support the introduction of prescription drug advertising is that it will help raise awareness of health problems and put patients on a more equal footing with doctors.

However, we’re concerned about such advertising for a number of reasons. For instance, it will only focus on those conditions where drug companies have products to sell. Also, we don’t believe that DTCA will give patients full and accurate information about the pros and cons of taking prescription drug treatments – by discussing other treatment approaches, more effective drugs, or less costly generic drugs, for instance.

CA has long campaigned for access to better information about medicines, but advertising can’t fill this void.

The UK Picture
In the UK, advertising of over-the-counter drugs to consumers is permitted, but not of prescription drugs. This includes a ban on any activity that could be considered as indirect promotion. Government and industry guidelines says that information on prescription medicines must be factual, non-promotional and that companies shouldn’t do anything to ‘encourage the general public to ask their GP to prescribe the product’.

Pushing the limits
Recently, drug companies in the UK have started to challenge the current restrictions. For instance, last year Pharmacia & Upjohn used a prime time TV ad to raise awareness of urinary incontinence – see TV first for drug company, Health Which?, October 1999. This coincided with the company’s launch of a prescription treatment for the condition.

Another example is of two websites, produced by drug companies, which encouraged sufferers of multiple sclerosis to campaign for access to prescription drug beta-interferon. Both were shut down following complaints from a patient group concerned that the sites were designed to look like they were run by independent patient groups, and that they focused on just one treatment.

Our Analysis
We analysed the available research into the effects of DTCA in the US and found that it can lead to increased numbers of patients visiting their doctors. This can be a good thing if conditions are undertreated.

For example, patient visits to US doctors for osteoporsis nearly doubled in the year following a major advertising campaign. In addition, the US public’s response to an early advertising campaign for nicotine patches in 1992 saw demand for this treatment quickly exceed supply.

However, our analysis also found that DTCA hasn’t always supported public health objectives. For instance, a recent advertising campaign promoting the use of antibiotics clashed with public health concerns about overprescribing of antibiotics.

And a study published in The Journal of the American Medical Association in 1997 found that ‘pharmaceutical promotional practices’ led to an increase in inappropriate treatment of high blood pressure with calcium antagonists and ACE inhibitor drugs – in direct contradiction to national guidelines.

It’s clear that drug companies will only ever want to raise awareness about diseases for which they have products to sell. We found that the increase in sales of prescription in the US has been concentrated within a narrow band of illnesses. And four categories of drugs – anti-ulcer drugs, antihistamines, antidepressants, and cholestrol-reducing agents – account for a particularly big chunk.

The drugs bill can be expected to rise from year to year, but spending in the US went up by a massive 84 percent between 1993 and 1998. Analysts attribute most of this to a rise in the use of newer, more costly, drugs heavily advertised to the public.

So how would the NHS fare? The direct relationship between rising drug costs and advertising is indisputable. And, although it’s difficult to make exact predictions, it’s likely the industry would push for the introduction of a co-payment scheme, where you would pay more towards the cost of drugs than at present.

The internet
We’ve looked at 40 US consumer websites for prescription drugs. Overall, we aren’t convinced that they can provide balanced or complete information, or that they actually help consumers make better decisions about medicines.

Our verdict
On balance there is more evidence to show that DTCA is harmful than it’s helpful. We’re especially concerned that, in the US, most advertising is for a small number of ‘profitable’ illnesses. Ultimately, DTCA has one motive – to increase sales of a drug, even if better options are available. Also there’s no question that DTCA would massively increase the NHS drugs bill.

Patients need access to better information about prescription drugs. But the information patients need to make informed decisions won’t be provided through advertising. Unfortunately, the Freedom of Information Bill, currently going through Parliament, will do little to improve access to information about medicines.