Healthy Skepticism Library item: 20154

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

Young S
Prescription-only medication should be advertised in the media: No
Medical Observer 2000 Aug 431

Full text:

On the surface of it, allowing mass-media advertising of prescription medicines would seem a reasonable idea – a continuation of our move toward patient-centred practice.

Patients are already keen to access health information through the Internet. Advertising drugs in the general media could be seen to be a natural extension of this patient access to information, so they can come to doctors’ surgeries better informed about drug options.

A deeper look at the issues suggests a need for caution.

Drug manufacturers are publicly listed companies whose primary responsibility is to their shareholders. They are in the business of selling products.

There’s no question that many of these goods improve quality of life, but this fact shouldn’t blind us to the underlying aim of the game: profit.

Prescription drugs are referred to as “ethics” on the Australian Pharmaceutical Industry website. Under this title, they appear in tables showing the “Best Sales Prospects” and “Top 10 Value Growth Categories”.

Doctors already have experience of how drugs are advertised. Most could probably name an ad that had been withdrawn for overstepping the mark. And now manufacturers have begun finessing evidence-based medicine to win our approval. Concept ads often quote studies that favour their product but wait until the fine print to reveal the article, year of publication and other qualifiers. Conflict-of-interest declarations are usually omitted.

In the current context, these ads are reasonable. The Therapeutic Goods Advertising Code allows advertising to health professionals because doctors are trained and experienced in evaluating evidence by researching primary sources and seeking independent opinions. Most patients aren’t. Rather than being empowered by drug advertising, patients are at risk of being manipulated. And the potential consequence is not just increased sales for particular brands, but the selling of concepts that aren’t necessarily good for health.

Promotion of the idea that drugs are the best – possibly only – solution to health problems is one risk; another is the medicalisation of normal life. I can see headlines on the full-page spreads already: “Tired?”, “Depressed?”, “Anxious?”.

The World Health Organisation’s Ethical Criteria For Medicinal Drug Promotion 1988 (which the Therapeutic Goods Advertising Code endorses) states: “Advertising should not cause fear or distress”. Given the complex nature of prescription medications (the very reason they are available only on prescription), avoiding fear or distress in advertising seems an unlikely outcome.

The US is one of a minority of countries that allow the general advertising of prescription medications. There, the public body permits some strange behaviour in the name of rights of the individual – for example, the right to carry a weapon, drive without a seatbelt or install an unfenced swimming pool.

Despite initial opposition from minority groups, Australians generally don’t regard such legislative interventions as infringements on our freedom. Rather, we seem them as sensible public-health measures.

We also differ from Americans in our attitudes to health and medicine. For whatever reason, we lack the unerring faith the US public has in technology and drug intervention for curing ills. I finally cancelled my subscription to AudioDigest tapes because US doctor after US doctor expressed the view that patients don’t want lifestyle advice, just drugs.

Australian doctors don’t see treatment in such drug-only terms and nor do our patients…yet.

When individuals need health advice about prescription medication, it should come from an impartial source who has an eye to the evidence and a comprehensive and continuous approach to health maintenance – in other words, a GP.