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Healthy Skepticism Library item: 20171

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

Mansfield P
Debate: drug advertising: No
Australian Doctor 1999 Oct 864

Full text:

GPs around the world object to direct-to-consumer (DTC) promotion of prescription drugs.

For most drugs there is a range of opinions on how often they should be used. For example, some assert that all postmenopausal women should take HRT, while others assert the opposite. For many drugs the truth is more likely to be nearer the middle of the range than at either extreme.

Drug companies are locked in a grave battle for survival. The deaths of many companies have been disguised as mergers. More companies are about to fall. Staff of many companies face a desperate struggle to increase sales quickly or lose their well-paid jobs. In that context, they have little choice but to promote positions near the extreme case for maximum use of more expensive drugs.

Consequently, it is no surprise that all the major studies of the quality of information provided by drug companies have found that much of it is unreliable. For example, one study found that 44% of advertisements in major US medical journals, if relied upon, would lead to improper drug use.

Doctors are intelligent enough to decode promotion. With adequate training, we are also smart enough to pilot a space shuttle. Of the two tasks, decoding promotion is more difficult because it requires advanced understanding not only of the realities of general practice but also of pharmacology, epidemiology, statistics, logic, psychology, sociology, economics, communication studies and many sub-disciplines of the applied science of marketing.

Many of our patients have fewer skills for decoding promotion than we have. Promotion does not fool all of the people all of the time. It fools the more vulnerable.

The aim of promotion is not to educate but to persuade. Promotion uses conscious and subconscious appeals to the head and to the heart which have been developed over thousands of years since they were discussed by the ancient Greeks.

Promotion is a sophisticated applied science. Advertisers were using controlled trials involving as many as 25,000 subjects back in the 1920s. Promotion is better resourced and more sophisticated than modern medicine.

DTC promotion uses sophisticated methods to get patients to jump to a decision to demand a specific drug without hearing the other side of the story.

In New Zealand and the US, DTC promotion is allowed with little restriction. Spending on DTC promotion in the US in 1998 exceeded $US 1.2 billion ($A1.86 billion). Companies would not spend that much money if it didn’t work. It increases prescribing of expensive drugs. Surveys of doctors in both countries have found that the majority of them are opposed to DTC promotion.

In February, I spoke with many New Zealand GPs while on tour to launch Health Scepticism, a newsletter for GPs about misleading drug promotion. Many New Zealand GPs expressed distress about interference with the doctor-patient relationship from DTC promotion. Patients who demand inappropriate drugs can be difficult to cope with, let alone help.

Time is wasted which should be used making the right diagnosis before selecting the most appropriate therapy. DTC promotion diverts attention and resources away from many important conditions that are not sources of big profits for drug companies often towards conditions where drug provide less benefit for money. DTC promotion contributes to “disease mongering” (eg, worrying healthy introverts into thinking that their uncomfortable but natural shyness is a pathological social phobia requiring expensive drugs).

Consumer organisation are keen on increased access to information, but they oppose DTC promotion. They understand that it harms their constituents because it is so difficult to distinguish the needle of reliable information that they need from the haystack of unreliable promotion. Consumers do not need the haystack to be made any larger.

The total funds for health in Australia are relatively stable over time. Expenditure on drugs has been soaring at up to 17% per year. This experts pressure for cuts to funding for hospitals and for GPs. DTC promotion exacerbates that problem by increasing demand for more expensive drugs and reduces the funds available for independent information.

As long as drug companies are paid according to sales, regardless of the impact on health outcomes, DTC promotion is harmful to taxpayers, doctors and, most importantly, our patients, The thinly disguised DTC promotion currently occurring in Australia should be prohibited urgently.

Evidence to back up the statements in this article is available at or on request.


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