Healthy Skepticism Library item: 20139

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

Jeffries M
The mark of Zorro
Pharmaceutical Marketing 2000 May;

Abstract:

The ABPI is fighting for DTC communication, but first it must overcome some prejudices.

Full text:

Direct to patient (DTP) drug communication by pharma companies has become a prime objective has become a prime objective for the Association of the British Pharmaceutical Industry (ABPI). This long mooted idea for patients to learn about the medicines they are prescribed – and others they are not – has patiently awaited its crossing from the US. Now the ABPI has announced that it is launching the final stages of its campaign before it tackles the Government and the EU head on.

It is the spearhead of a carefully thought-out campaign. The ABPI battle plan is to deploy ground troops in the form of patient support groups, sympathetic medical opinion and healthcare professionals known as “stakeholders” – which will lead the debate on the informed patient issue. This will have the effect of weakening political, ideological and professional defences.

Then the ABPI will follow through with high-level precision strikes on specific regulatory enclaves in both Whitehall and Brussels. The news was launched to members of the Pharmaceutical Marketing Society at a meeting held at Innovex in Marlow.

The ABPI argument is inescapably rational. Patient demand for information is the fastest growth sector in health today. Yet it has become evident that current restrictions preventing the industry from informing patients about medicines often work against their interests. Regulatory controls prevent the UK pharma industry from disseminating authoritative information about is drugs on the internet beyond the newly launched Electronic Medicines Compendium.

Yet any other organisation – medically enlightened or not – can say what it likes about any company’s products. Some sites give conflicting information. The scope for inaccuracy and potentially dangerous advice is obvious.

The ABPI says that, in any case, internet users denied information in the UK can simply access an international pharma site for drug information. And since more than a quarter of the medicines used in the NHS are supplied by US companies where DTP advertising is a growth industry, patients are exposed to the more hard-nosed ‘sell’ than would be adopted here.

No doubt they would receive reliable information on drugs direct from US pharma sites. Even so, this information may be on an unrepresentative range of products. In the UK and the EU the restrictions on pharma companies need to be eased, declares the ABPI.

Professor Trevor Jones of the ABPI told the marketers: “Patients have a right to know about the treatment they are receiving. But I think patients in this country are largely kept in the dark about what medicines are available. We are not allowed to inform them adequately”.

But controls were lifted it is unlikely that the US-style DTP advertising would be operated here straight away. Indeed, Professor Jones said that he did not feel the American approach was right for the UK. Last year the US pharma industry spent $1.5 billion on DTP advertising – nearly double the 1997 figure of $844 million. This year the figure will be even higher.

By 1998 in the US there were three main ways that US companies could advertise to patients:

*Brand name reminder advertisements which did not mention indications

*Disease awareness advertisements which mention therapeutic class but not brand names

*Ads that provide both brand names and indications, but these have to give a balanced summary and cover risk factors

Final guidance for broadcast advertisements was given by the FDA last year. In contrast, the ABPI’s direct-to-patient approach would be a “responsible and factually based” communication about drugs and illnesses, said Dr Jones. It would be designed to complement information already provided by healthcare workers.

He said patients wanted to know what drugs were available, how effective they were and learn about their side-effects. The industry was the most authoritative source for that information. “Yet we have this mark of Zorro on our foreheads”, he said, because as “industry” they were regarded with suspicion.

The APBI was now approaching the issue by enlisting patient support groups as part of the Informed Patient Initiative campaign. Patient organisations, with their own clinical advisers, were already starting to fight their cause for access to drug information. “Patient groups offer us a big opportunity to provide them with authoritative information for them to use objectively in a way that benefits their members”, he said.

The ABPI believes that the current restrictions at both the UK and EU level should be reviewed in the light of technological advances and the increasing demand from patients to understand more about their medicines.

The first phase of aligning the industry with the Informed Patient Initiative campaign started in 1998 and was now largely completed, said Professor Jones. In the last year they had been studying the regulations regarding promotion in varying European countries and meeting with doctors, nurses and other carers.

Focus meetings with patient groups appear to have surprised the ABPI by their open-minded attitude to the idea. It has been expecting much more mistrust of industry’s motives, which earlier research had thrown up. Among nurses – who spend more time with patients – the response was even better, with more support for informed patients than among doctors.

Phase two of the campaign is now involved in seeking alliances with patient groups, the BMA, Royal Colleges, media and others. A recent publication by the ABPI, The Expert Patient, is part of a softening-up assault to be mounted through there interested parties and opinion leaders by stimulating public debate.

One of the report’s key points is that patients-doctors and patient-pharmaceutical industry groupings can form effective partnerships with mutual benefits even though they have different aims.

The ABPI will also carry out research with patients and prescribers and use pharma companies as sources for public relation information on informed patients issues.

Persuading hard-pressed GPs that debating the relative advantages of drug A over drug B with a patient who has been downloading internet information by the ream is a Good Thing, is another matter.

An NOP survey on whether doctors would like to have informed patients showed that a third said “No” and a further third answered “Don’t know”.

The BMA and others have told the ABPI that doctors are not seeking to prevent patients having more information. They are worried about the effect it will have on the day-to-day running of busy surgeries.

Professor Jones, however, responds that if that means a routine brief consultation and a repeat prescription becomes a more meaningful exchange of information – albeit taking a little longer – this might change the doctor’s prescribing to the patient’s advantage.

As for other public reactions, I suspect that the Patients’ Association, which is not the heavy-hitter its title suggests, will nervously agree to DTP information from the industry. A number of patient groups representing conditions such as Parkinson’s disease and epilepsy and those who fall foul of post-code prescribing will undoubtedly welcome it.

But (surprise, surprise) the real shoot-out will be with the Government and politicians in the European Union. Though at least one health minister has said recently that the Government fully backs patients’ right to making informed choices about their treatment, DTP information will undoubtedly raise the ‘Zorro Factor’.

“The industry is seeking to communicate direct to patients to sell more drugs”, they will claim. And, it has to be said, that is a likely outcome.

The industry’s response to such charges, according to the ABPI, should be: “The patient has the right to know about the range of treatments available, how to use them and to participate in the choice”. And, anyway, it is the doctor in the end who prescribes the drugs – not the patient. As for DTP information substantially increasing public spend on drugs, improved use of medicine will improve health outcomes and often reduce further expenditure by cutting referrals to specialists, hospital treatment and social services.

But – if all goes according to the ABPI plans – stakeholders (a substantial proportion of patients, doctors, nurses, other health professionals (and The Lancet) will be vocally supporting the pharma industry for the patient’s right to know. If one or two weak links in the ABPI’s argument can be plugged then maybe, just maybe, the political spinners about drug industry’s motives and profits will be out-spun.