Healthy Skepticism Library item: 7140

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Publication type: news

Creswell A.
Commercial brakes : The drug advertising regulator is under pressure to reimpose a ban on TV endorsements by doctors.
The Australian Newspaper 2006 Dec 16
http://www.theaustralian.news.com.au/story/0,20867,20933833-23289,00.html

Full text:

Commercial brakes

* The drug advertising regulator is under pressure to reimpose a ban on TV endorsements by doctors. Health editor Adam Cresswell reports * December 16, 2006

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.”