Healthy Skepticism Library item: 20146

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

Mant A
On the (mis)information superhighway
Medical Observer 1999 Nov 12

Full text:

Most of us are accustomed to having patients come in asking about a new treatment they have heard about in the media. This month several GPs emailed me about patients asking if they should try the new Cox-2 inhibitor. A few months ago a similar flurry of activity greeted the advent of the new class of leukotriene receptor antagonists and translated itself into the consultation. It seems that publicity about new advances is priming demand faster and more intensively than ever.

This should not surprise us: health is hot news and it is undeniably everyone’s business. Core business for good prescribing is the doctor-patient relationship and the impact of external forces on it, so we need to work out what is going on and how to be a player in the main game – not just feel caught up in forces beyond our control.

Most pharmaceutical companies have expanded their efforts in social marketing, an integrated approach from which our continuing educational bodies can learn much. Money goes not just into the medical field, sponsorship of opinion leader at medical education meetings and partnerships with with divisional activities, but also into building effective and efficient public relations with the media and relevant patient organisations.

Often media priming seems more intense when there is a problem with reimbursement. Some product names have certainly found their way into the public arena, witness Aricept and Viagra.

This problem of ‘user pays’ has become more intense everywhere but it is not easy for the media to help the public get the issue of subsidy for the Australian pharmaceutical market into perspective. In Australia, safety and efficacy are the responsibility of the Therapeutic Goods Administration on advice from ADEC which recommends marketing approval. In addition, if the company wants to have the drug listed on the PBS (or the RPBS) it has to negotiate a price with the government. For this it must pass a second hurdle of proving cost-effectiveness, and do so on the basis of evidence.

The Australian pharmaceutical market is tiny and has been dominated by the PBS. It is strange for us to think of a private market for drugs and this sits somewhat uncomfortably with our egalitarian public ethic.

This is not the case in the US where the Federal Drug Administration looks only at efficacy and safety. In the US there is no tradition of universal government subsidy for the cost of pharmaceuticals, a tradition that has been with us since 1948.

Publicity about a new drug seems to coincide with or even to precede visits of company representatives and medical meetings covering the latest and the greatest. My GP correspondents observed that public demand is well ahead of those who prepare guidelines to evaluate the evidence and provide advice.

In Australia, the Therapeutic Goods Act and some state legislation make it illegal for anyone to advertise a prescription-only pharmaceuticals to the general public. But this seems only a small brake to enthusiasm, at least for the growing numbers with Internet access or cable television.

The information revolution crosses international boundaries: those with Foxtel can watch advertisements for drugs marketed in the US that cannot be advertised directly in Australia. New pharmaceuticals have web addresses identified by their brand name – there are no access limits to high and low-quality information on a multitude of other sites.

Most of us are a bit rattled with the publicity given to new pharmaceuticals in the mass media. The hope of a new cure, or the hope of avoiding a serious health outcome, fall into the category of good news – and that sells newspapers and gets ratings. The media is also quick with bad news, especially the side effects of medication. A new drug (or class of drug) takes time to find its place: new is not always better, just different.

The media play a major part in feeding the public thirst for information. Of course this can be useful. The well-informed consumer is an asset, not a liability. But by the same token, the misinformed consumer can be a real problem. Valuable consultation time is spent sorting out what the patient has heard or read. Less time is left to get the message across about lifestyle measures such as diet or regular exercise; or achieving an understanding of the value of an adequate dose of paracetamol for the patient with arthritis; or discussing the use of preventers for the patient with chronic asthma.

But the media can help balance progress against the backlash. And we can succeed in getting our own media messages across – by being available with the perspective that only we can supply.