Healthy Skepticism Library item: 20127

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: Magazine

Parnell K
Conflict on direct drug promotion
Australian Doctor 2000 Aug 1127

Full text:

In the US, it’s not unusual to see a television ad for hamburgers followed immediately by an ad for diet pills. Yet the irony seems lost on the public, who continue to inch their way into the records books with their rapidly expanding girths.

Direct to consumer (DTC) advertising is a growing trend in the US, with spending at more than a billion US dollars annually and predicted to reach $US7.5 billion in 2005.

In Australia, promotion of prescription medicines to the public is not permitted, although the legislation is under review.

However, it could be argued that this promotion already occurs in the guise of community service campaigns, such as the recent ads about flu and obesity.

These ads, known as symptom advertising or issues awareness campaigns, describe a medical condition, convey the message that appropriate medication may be available but stop short of mentioning a drug name. They are sponsored by the pharmaceutical industry and often coincide with the marketing to doctors.

The review of the drugs, poisons and controlled substances legislation may result in a relaxation of advertising restrictions, allowing direct advertising to the public of prescription drugs. At the time of going to press, the review was yet to hand down its findings. This issue is also being debated in Europe, the UK and Canada.

Proponents of DTC advertising say advertising prescription drugs improves knowledge about health because many people with chronic conditions are unaware effective treatments exist. It’s also been suggested that direct advertising may reduce health care costs by increasing competition between drugs and encouraging people to seek earlier treatment, which may avoid later high costs for hospitalisation or surgery.

There’s also a view by some proponents that direct advertising would equalise the doctor-patient relationship, giving the public access to information previously only available to GPs.

On the other hand, opponents including the Consumers Health Forum say drug company motives are commercial rather than altruistic, and that changes will create an imbalance in the quantity of independent versus promotional consumer information.

They emphasise the difference between independent, unbiased information detailing side effects, alternative drugs and treatments, and one-sided information, which they say can be worse than no information.

According to an outspoken UK expert in medicines policy, Professor Joe Collier, “a company is there to look after its shareholders and keep its profits up… Advertising is about increasing sales”.

While acknowledging benefits of the pharmaceutical industry, Professor Collier says that if allowed to advertise directly to consumers, the drug companies would enlist members of the public act as foot soldiers in their campaign to increase sales by persuading them to ask their doctors for specific drugs.

“They are cheaper than sales representatives”, he says.

Yet objective and impartial evidence about the effects of DTC advertising on health seems conspicuous by its absence. Instead, most research seems to have focused on doctors’ and patients’ responses to advertising, rather than on health outcomes.

One US study found 42% of family doctors acquiesced to patients’ specific prescription requests for drugs advertised in the lay media, even when the drug in question was not the doctor’s first choice.

Another study surveyed patients’ anticipated reactions to being denied a prescription for a drug they’d seen in the media.

It found 46% would be disappointed, while one-quarter said they would resort to persuasion and try to obtain the drug from another practitioner. Fifteen percent said they would consider terminating their relationship with the doctor.

The chair of the Australian review, Rhonda Galbally, says there are at least some areas where direct advertising may be in everybody’s interest, such as childhood vaccination.

The review’s anticipated recommendations will be a space to watch, because any changes to the DTC ban will affect us all.