Healthy Skepticism Library item: 20173

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

Mahoney S
Indirect drug promotion: Media an effective way to address patients
Australian Doctor 1998 Aug 1431

Full text:

How often do your patients ask you about a new miracle drug that was discussed on a recent television program?

How often have you been shown a newspaper clipping and asked if you know anything about the treatment it discusses?

Have you noticed these sorts of questions are becoming more common?
If you have, it may be because while advertising of prescription-only drugs to the general public is prohibited by law, indirect promotion is becoming an increasing issue.

It’s on the agenda for discussion at the next Australian Pharmaceutical Advisory Council (APAC) meeting in November 1998.

By raising this issue, the council hopes to generate discussion about direct and indirect advertising among doctors and the public.

“When is indirect advertising a means of giving information to the public, and when is it an impediment to knowledge?” says Professor Lloyd Sansom, APAC chairman.

The Sydney Morning Herald recently published an article labelling doctors as pill pushers, saying that the media has become a powerful tool for the pharmaceutical industry to drive consumer demand and influence prescribing habits.

Indirect promotion of prescription-only drugs is well established, usually occurring in some form of public education provided by pharmaceutical companies.

Even though companies and brands are generally not named, media information about new products, new indications and research results are linked, through timing and often financial support, to conferences, visiting medical experts, awareness days and patient support groups (see page 33).

These all help to increase both consumers’ and doctors’ familiarity with products.

Dr Mary Cohn, the Queensland representative on the AMA council of general practice, says that while the AMA has no official opinion about indirect promotion of drugs, patients can and do put pressure on GPs to prescribe new medications after media reports.

She believes this will become an increasingly important issue. And she says GP drug education needs more emphasis, with CME points being set aside specifically for updating pharmaceutical knowledge.

The Consumer’s Health Forum spokesperson on pharmaceutical issues, Janne Graham, says the “promotion with panache” in the lay media creates demand and puts pressure on prescribers.

And while information given at a press conference may be accurate, it can sometimes be pitched to allow for interpretation by the lay press.

And readers will often take a story generated after a press conference or media release more seriously than something that is clearly an advertisement.

However, this sort of promotion has benefits for consumers in that it stimulates discussion and improved communication between patient and doctor, leading to improved treatment outcomes.

Indirect promotion has also been used with particular benefit in vaccination and anti-smoking campaigns.

Advertisements in the lay press
While indirect promotion to the public seems to be well established in Australia, direct advertising may be on the way of Australia follows the path being taken in the US (see page 34).

There the rules for advertising in the broadcast media were relaxed last August. Any why not, asked an editorial in The Lancet.1

“What is wrong with direct marketing to the patient, especially in this age of accessibility of information to the public and empowerment of the patient?” it said.

As a result of the change in advertising regulations, the US pharmaceutical industry increased its spending on direct-to-public advertising to US$844 million (A$1.39 billion) in 1997. The industry spent more on direct appeals to the public than on advertising in medical journals.

The Lancet editorial said the effect on prescribers would be “interesting to watch”.

“They will be forced to defend their prescribing habits to a greater extent. Will the best-marketed drug win over the drug with the best efficacy, side-effect profile and cost effectiveness?”

It said doctors “should be strong enough to cope with more informed patients, and the patient needs to realise that with empowerment comes the opportunity to take a truly informed part in the prescribing process”.

A report in Australian Prescriber said patients exert a direct influence on prescribing behaviour and this influence on prescribing behaviour and this influence is likely to increase as patients become more informed. 2

It is therefore essential that they receive accurate and balanced information.

The bottom line is that the doctor takes responsibility for the medications that they prescribe.

With patients becoming more informed about pharmaceutical products, the onus is on the doctor to prescribe carefully, and to have the time and knowledge to give a patient a rational and balanced explanation for a prescribing decision.

1. The Lancet 1998: 351; 921
2. Australian Prescriber 1997: 20: S1: 146-49

Spreading the word on the web

The Internet is a rapidly growing medium for pharmaceutical information and advertising.

Patients are increasingly likely to use the Internet to get information on health. And as well as providing information about their products via the net, companies can use it to get feedback from consumers.

An advertisement in the pharmaceutical industry publication Scrip in April this year urged companies to buy the report Pharmaceutical Marketing Strategies on the Internet.

It told prospective purchasers that “no other system allows a company to capture the thoughts, views and opinions of such a broad area of consumer, professional and industry opinion”.

“Company executives can access healthcare news groups and self-help sites. Indeed, such sites can be instigated by industry to bring awareness of conditions and their treatment”.

Discussing the possibility of direct-to-consumer advertising in Europe, a recent article in the industry publication Inpharma said unregulated drug information was becoming increasing available to the public through areas like the Internet.

And because of this, pressure from patients and the pharmaceutical industry for responsible direct advertising would rise significantly.

The WHO passed a resolution in May 1997 highlighting its concern at the advertising, promotion and uncontrolled sale of medical products through electronic communication. Such promotion could not replace the medical oversight and pharmaceutical counselling fundamental to ensuring safe and appropriate use of drugs.

Ways to boost public awareness
Methods used to promote public awareness of medical conditions and possible treatments that are allowed within the Australian Pharmaceutical Manufacturers Association code of conduct include:

1. Offers to provide information about an illness
Media advertisements are placed about a medical condition or a set of symptoms, prompting people to visit their doctor to discuss the problem.

A toll-free telephone number or postal address might be offered, and further information can then be sent to the person who has requested it.

Although products and company names cannot be identified in the advertisement, the company may be identified in any material that is requested by the reader.

Another technique sometimes used is for advertisements in the lay media to have the same artwork and colours as those in the medical press.

This increases the chance that the doctor will recognise the product if the patient brings the leaflet or advertisement with them to the consultation.

2. Media releases
Companies can issue media releases to allow the media to inform the general public about research issues as a community service.

These may be timed to coincide with a conference or a disease awareness day. Such media reports influence doctors as well as the general public.

General media releases must not contain information about specific products but can give information about specific products but can give information about medical conditions.

3. Media releases for new products
The Australian Pharmaceutical Manufacturers Association code of conduct allows the announcement of a new product or major indication to the lay media if the product has been registered for use in Australia, and if the medical profession has been supplied with the appropriate information.

The written release must be confined to the Australian approved name, approved indications and therapeutic class.

No reference to the launch date and no promotional claims can be made. The code also says no other promotional media releases are permitted, although it is acceptable to respond to a public issue.

4. Awareness days
Awareness days, or weeks, for specific diseases are often supported by pharmaceutical companies.

5. Patient groups
Patient groups may be supported by pharmaceutical companies. Patients can become good public advocates for drugs.

6. Clinical trials
The excitement and enthusiasm that may be generated among patients who are participating in a clinical trial of a product may result in these consumers becoming a powerful lobby group for the approval of the product.

Advertising direct to the consumer
Direct-to-consumer (DTC) advertising is permitted in the US.
Printed advertisements must include a brief summary of prescribing information. This usually appears as the fine print, and is not as extensive as full prescribing information. 1

On radio and television in the US this brief summary may be replaced by the text of the approved package label, together with references to other sources of information about the drug.

These may be toll-free telephone numbers, world-wide web sites, print advertising, and physicians and pharmacists.

One of the arguments in favour of DTC advertising is that it empowers people and helps them to take part in the decision-making process when drugs are being prescribed.

An editorial in The Lancet said restricting the public’s access to information perpetuates “the paternalism of the medical profession – knowledge remains as power”. 2

It also said product information would need simplifying before the public could understand it.

There are concerns about DTC advertising – such as whether the consumption of new and expensive brands will be increased over older and cheaper products.

On the positive side, people who may not otherwise have consulted a doctor may come to ask about new medicines, providing an opportunity for preventive health care.

Advertising is aimed at selling a product, although advertisements may convey information.

A report in Australian Prescriber said prescribers underestimate the influence of advertising, promotional material and interaction with industry representatives on their prescribing behaviour.3

“GPs are inexperienced in applying the critical appraisal process and as a result tend to apply subjectively and emotionalism to the evaluation process. Equally, pharmaceutical companies use subjectively and emotionalism in describing the features and benefits of their products”.

It may be harder for the public to objectively evaluate promotional material.

1. American Journal of Health-System Pharmacists 1998; 55: 594-97.
2. Lancet 1998; 351: 921
3. Australian Prescriber 1997; 20:S1:146-49