Healthy Skepticism Library item: 20128

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

Panckhurst P
Inside the drug wars
AdMedia 2000 July
http://www.archivesearch.co.nz/?webid=adm&articleid=2983

Full text:

Making more effort to provide “balance” within direct-to-consumer (DTC) pharmaceutical advertising on television looks likely to be crucial for advertisers and pharmaceutical companies if they want to avoid a DTC clampdown.

News coverage such as last month’s Listener cover story, “Pill Pushers” – a piece that, incidentally, failed even to acknowledge key arguments in favour of DTC – shows plenty of heat left in the debate on the pros and cons of DTC.

However, while magazines and newspapers are burning up column inches on the broad topic of DTC, and DTC as bogeyman, a more useful focus might be on one specific issue: the need to achieve balance within DTC ads on television.

When AdMedia spoke last month to Peter Pratt, of the Ministry of Health’s Medsafe division – someone who’s had a key role in watching over the DTC field – he cited balance as “still an issue”.

This is “balance” in the sense of drawing enough attention to such things as risk factors and possible side-effects, something that’s much more of an issue, and more difficult to achieve, for television ads than for their print cousins.

A look across to the only other developed country that allows DTC advertising of prescription medicines, the United States, illustrates a very different approach to the balance issue. Let’s use Xenical as our example.

Here in New Zealand, the Xenical “I’d Like” commercial – the making of which was AdMedia’s cover story in March – shows a series of fantasy scenes and ends with the following messages:

• A graphic saying, “Lose weight, gain life. Xenical.”

• A voiceover: “The average New Zealander is increasing in body weight by a gram a day. Xenical is now scientifically proven to be twice as effective as diet alone. Call 0800 49 36 42 or talk to your doctor or pharmacist. Because Xenical works.”

• A graphic saying: “Xenical (orlistat 120mg) is a prescription medicine used for the treatment of significant obesity and its risk factors. 0800 49 36 42. A charge applies. Use strictly as directed and if there are side effects see your doctor or pharmacist. Roche Products (New Zealand) Ltd, Auckland.”

Now contrast that with what’s been happening in the US, where ad industry bible Advertising Age says US Food & Drug Administration requirements that branded DTC ads should include “fair balance” information mean Xenical is now a drug notorious for its side-effects.

A DTC spot that ran on national television warned Xenical could cause “gas or oil with discharge” and “increased bowel movements – an urgent need to have them and an inability to control them”.

Eventually, according to Ad Age, Roche switched to unbranded ads on obesity to avoid mentioning the possible side effects of the drug. Sales of the product haven’t taken off in the way the drug company had hoped.

In New Zealand, tv ads for Viagra are seen within the ad and pharmaceutical industries as being at the “more balanced” end of the spectrum, while something like “I’d like” for Xenical must be right at the other end.

You could argue that any ad that directs viewers to an 0800 number or website information services for fuller information is part of a package that is “balanced” in the overall sense.

However, that argument has never cut it with, for example, the Consumers Institute, which has said in the past that such information services “hardly compensate” if advertisers are irresponsibile in their primary advertising.

Likewise, Medsafe’s Pratt is clear that “balance” is required within each individual advertisement.

Someone with an interest in DTC, Robert Munro, the general manager of agency McCann Healthcare, says: “Because this is a new ballgame, people are finding their way in terms of what is acceptable for ‘balance’… I don’t think anyone disagrees at all with the need for getting in the right amount of information.”

What about critics who say some DTC ads on tv here have been unbalanced?

“It’s up to them to forward those complaints. Put their money where their mouth is. They can be helpful – help the industry – by lodging complaints and helping to improve the material.”

He points out that the US situation is not ideal. Onerous requirements for balance mean that ads are destroyed as pieces of communication. As well as that, says Munro, the FDA’s got a reputation for being erratic in what it demands for “balancing” information.

Four other developments in the DTC field:

One: Drug companies in New Zealand, in the shape of the Researched Medicines Industry Association, last month played one of the strongest cards they’ve got, releasing a 34-page document, “DTC Advertising Can Enhance Public Health”. A key argument here, one that didn’t get a look-in in the Listener cover story, is that, in some cases, DTC advertising means people who were never previously diagnosed, or were not getting proper treatment, finally get the medical help they need. For example, the RMI document quotes research from Glaxo Wellcome as suggesting the tv campaign for asthma drug Flixotide reached a population of asthma sufferers who weren’t getting the health information they needed through traditional channels.

Two: The Ministry of Health operation Medsafe last month released details of a study it carried out between November and early February that showed about 30% of DTC prescription medicine advertising failed to meet the Medsafe advertising guidelines. This led to Peter Pratt being quoted in The Dominion as saying “self-regulation on its own doesn’t work, it needs someone with a big stick”. However, when AdMedia asked him about that, he said the story was not accurate, and his view of the level of compliance – which was up dramatically on the previous survey, in 1998 – was “more positive than the spin that the Dom wanted to put on it”. More improvements are needed but things are heading in the right direction, he says.

Three: The DTC debate began to look increasingly confused, with critics lacing their arguments with references to drugs that are not, in fact, marketed direct to consumer. A New Zealand Herald piece on the dangers associated with some contraceptive pills raised the issue of DTC advertising, even though those pills aren’t marketed DTC. Likewise, a letter to the editor published in the Herald, from a member of Auckland University’s psychology department, John Read, drew Prozac into the debate, but, likewise, the anti-depressant is not a DTC drug.

Four: On a different tack, in the United States, questions are being asked about the apparent contradiction between requirements for balance in DTC tv ads but the lack of restrictions on editorial coverage that’s driven by public relations firms. The issue is increasingly relevant as drug companies sign up celebrities to tout the benefits of drugs. Beverly Hills 90210 star Jennie Garth, for example, is promoting the migraine drug Imitrex. (You could argue the programme’s audience would have been more deserving, but let’s not go there.)

According to a report in the Financial Times last month: “Drug companies are employing celebrities in the same way Nike or Pepsi might feature the latest sports or pop star to push their product. Last year, one drugs company even put an advert in Variety, the entertainment trade magazine, saying that it was searching for a celebrity who was using its heart drug, to star in a DTC advertising campaign.”

It’s an odd situation if pharmaceutical companies who are forced to highlight potential side effects in their ads, can side-step that by getting celebs to put out the message via magazine puff pieces and human interest stories. However, as one healthcare agency head said in the FT piece, while there were “certainly more opportunities for third parties to talk about drugs more liberally in interviews than in adverts”, pharmaceutical firms knew “that if you push too hard or take short-cuts it can be counter-productive. They are trying to be as cautious, yet as aggressive as possible, in their marketing. It is a fine line.” Sounds a lot like the sort of thing you might hear said in this country.