Healthy Skepticism Library item: 7088

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: news

Cresswell A.
Commercial brakes
The Australian 2006 Dec 16
http://www.theaustralian.news.com.au/story/0,20867,20933833-23289,00.html

Abstract:

DAYTIME television seems an unlikely battleground for the war that has
erupted over the ethics of doctors’ promotional activities – or any
other war, for that matter.

But the interludes during the lurid US talk shows and badly lit soap
operas are apparently peppered with examples of the advertisements that
have some members of the medical profession, consumer groups and even
the federal government reaching for the cough syrup. Although the
concerns have been bubbling away for months, they were dragged into the
open this week by Adrian Pokorny, a medical student at the University of
Newcastle, who wrote a letter to the Medical Journal of Australia
suggesting TV endorsements were ethically dubious and “poor for the
public image of doctors” (2006;185:673-4).

Since his letter was reported in The Australian on Monday, Pokorny says
he has “only heard agreeing voices”, mainly from other students –
blunting suggestions these concerns come from out-of-touch fuddy-duddies.

“A few doctors have given my position their support as well,” Pokorny
told Weekend Health. “This has confirmed my belief that people have been
noticing these ads and thinking about these issues, in both the wider
and medical communities.”

These ads are not just an issue for doctors – pharmacists are at it too,
and in both cases it’s because the longstanding ban on health
professionals making commercial endorsements was relaxed in August last
year. But it’s advertisements by doctors that are springing up the most,
and among doctors that the concerns are being voiced.

“I think the best time to find these ads on TV is in the mid to late
afternoon, such as during The Bold and the Beautiful on Channel 10,”
Pokorny explains.

In one widely screened ad for Children’s Panadol, Brisbane GP Dianne
Wruck is pictured at her surgery, at home and at a mothers’ group with
her own young baby. Her voiceover tells viewers that “nothing works
faster or is more effective” for children’s pain and fever, but many
mothers were “in the dark” about the best treatments.

Most doctors who have appeared in these advertisements – including Wruck
and Sydney GP Kerryn Phelps – have defended their involvement.

Wruck says appearing in the ad was “certainly not a decision I made
lightly”. “The real issue for me is whether I stand by my decision to
publicly endorse Children’s Panadol, and I do,” she says. “Everyone
needs to weigh up their own decisions (on endorsement offers) . . . I
can say that I can’t easily imagine myself endorsing something other
than Children’s Panadol.”

Phelps, a former president of the Australian Medical Association (AMA),
says a blanket ban on endorsements is “inappropriate in 2006”. She says
patients no longer want to have to see a doctor for every cough and
sniffle. Also, she says policymakers should not view patients as dummies
who will swallow any health message given to them. “People will still go
to a doctor or pharmacist to ask if it’s appropriate for them,” Phelps says.

Within specific guidelines – such as the existing requirements that
advertisements disclose that a doctor has been paid, that the doctor has
experience with the product and their favourable opinion is genuinely
held – Phelps says there’s nothing wrong with such advertising.

But there is now strong pressure on the Therapeutic Goods Advertising
Code Council (TGACC), which watered down the binding code last year to
allow professional endorsements, to reverse the changes.

The council comprises representatives from the Therapeutic Goods
Administration (TGA) and 12 other organisations, such as the Pharmacy
Guild of Australia, the Consumers’ Health Forum, the Australian Self
Medication Industry and the Advertising Federation of Australia. A
spokeswoman for the TGA, whose chief medical adviser Dr Rohan Hammett
currently holds the rotating chair of the TGACC, said the rules were
watered down because “it was felt that consumers could benefit by
recommendations by health care professionals – not only doctors, but
dentists, for example, recommending a product”.

The relaxation applies only to non-prescription medicines and medical
devices. The endorser must certify that the opinion is genuine and the
ad must disclose whether the doctor, dentist or other professional has
been paid – although there is no requirement to say how much. The
spokeswoman said the TGACC had “not been provided with any evidence” to
support the AMA’s claim that endorsements threatened to upset the
public’s trust in doctors.

The TGACC was meeting this week and was understood to be discussing a
request to reintroduce the ban, a measure supported by TGACC members
such as the Consumers’ Health Forum and fellow consumer group Choice.

Although not directly represented on the TGACC, the federal Government
is also thought to support some toughening of the rules. Parliamentary
Secretary for Health Christopher Pyne is understood to be very concerned
about last year’s changes to the code, and feels there is a good case
for it to be reversed.

“I welcome the fact that doctors are now going to have a debate about
it,” Mr Pyne told Weekend Health. “I do think that doctors, like
pharmacists, are in a position in the public eye where much of what they
say, consumers are prepared to believe. And so doctors need to be very
cautious about trading on that trust.”

The AMA last month changed its own code of ethics, which had previously
hitched itself to the provisions of the TGACC’s code, to make clear the
AMA’s opposition to doctors making commercial endorsements. The
association has since written to the TGACC, urging it to reverse last
year’s changes.

“A doctor who publicly advertises a therapeutic good . . . is
effectively giving that particular product greater credibility in the
eyes of patients, and therein lies the danger,” wrote Dr Kate
Stockhausen, senior policy adviser in the AMA’s public health and ethics
department, in a recent edition of the AMA’s in-house news magazine
Australian Medicine.

“The AMA recommends all doctors who are considering publicly advertising
therapeutic goods to think twice – is it really worth it?”

The AMA’s code is advisory only, and does not bind any doctor, whether
they are AMA members or not. But there are plenty of doctors who think
the AMA’s tougher line is the right one.

Tony Hobbs, a GP in Cootamundra in rural NSW, is chairman of the
Australian General Practice Network – the umbrella body for the 120-odd
“divisions”, or local groupings, of GPs nationwide. Hobbs agrees with
Pokorny that there’s a “potential conflict of interest involved” when
doctors plug products, and it doesn’t matter if the product is
well-known and relatively low-risk.

“We have a certain degree of trust in the community to act at all times
in the best interests of patients, and again you have to think that’s
being compromised by this line of work,” Hobbs says.

He doesn’t think it gets doctors off the hook to point out their
endorsements are for popular over-the-counter medications, such as
Nurofen (ibuprofen) or Panadol (paracetamol), which are generally
regarded as very safe when used according to the directions.

“If I’m getting paid to promote it, that’s a conflict of interest
immediately,” he says. “I think the bottom line is that the TGACC really
needs to be doing something about it.”

However, Phelps thinks the fuss is a replay of a controversy running 20
years ago, when doctors frowned on colleagues who carved out any sort of
media profile, because they were suspected of advertising their own
services.

Phelps says the fact doctors appear personally in endorsements is the
best safeguard that the information is trustworthy, since she says no
doctor would willingly risk their professional reputation by endorsing a
dubious product. But more widely, she says the focus on doctors
endorsing products on TV ignores the fact that commercial imperatives
operate throughout health care – such as when pharmacists recommend
patients in their shop buy one product over another, or orthopaedic
surgeons suggest a particular prosthesis or artificial joint.

“It’s an absolute nonsense to say it’s an ethical problem (for GPs to
endorse products on TV) when it’s not an ethical problem for
pharmacists,” she says.

“If the rules were to be changed (back), there would have to be some
demonstrated harm to the public from the status quo.

“And I don’t think anybody will be able to demonstrate that.”

Keywords:
Opinion leaders Ads DTCA techniques government agencies ethical guidelines policy restrictions reform doctors pharmacists information sources associations students opinions