That "drug companies should be able to advertise their prescription products to the public" was the subject for debate at a breakfast discussion session held at the King's Fund in London on October 20
Direct-to-consumer (DTC) advertising of prescription products by pharmaceutical companies could help to overcome a number of problems affecting the National Health Service at present, Ms MARGOT JAMES (chief executive, Shire Hall Group) said, opening the debate. In particular, there was a large degree of local variation in the treatments offered through the NHS and there was a huge waste of money stemming from patients' non-compliance with prescribed medicines.
She said that many patients did not know that there were treatments available which could help them get over the symptoms which they suffered. Many patients with long-term medical conditions were stuck on polypharmacy regimes of older medicines because they believed that their problems were caused by the disease they had, whereas, in fact, it was the drugs they were taking which were at fault. Properly balance advertisements would help these patients by raising their awareness of the treatments available.
There was also an argument about equity of access to treatments. Poorer people were known to have restricted access to health care. In addition, they got more of their information about new health treatments from television and tabloid newspapers, which had a more sensationalist approach, rather than the more balance approach of information in broadsheet newspapers or the internet. These people were more likely to see, and learn from, television advertisements.
DTC advertising could also help improve patient compliance, both through patient education and loyalty programmes and through reminding people of their medicines when the advertisements appeared.
Ms James said that the most important point was that any such advertising should be subject to strict and effective regulation. There was no justification for advertisements which distorted or raised unfounded hopes. It was time for the debate to move on from whether such advertising should be allowed to how it could be controlled.
Opposing the motion, Professor JOE COLLIER (professor of medicines policy, St George's hospital, London and editor, Drug and Therapeutics Bulletin) said that pharmaceutical companies existed to sell medicines. They were extraordinarily powerful organisations with friends in high places.
Dissecting the motion, he said that the purpose of promotion was to increase sales, even when done indirectly. The advertising of prescription only medicines to the public was currently illegal under both United Kingdom and European law on the grounds of safety and the interests of the wider community. The public was a diverse and vulnerable group, including people who were desperate for "cures".
Professor Collier said that he was not alone in opposing the advertising of prescription medicines to the public: it was also opposed by many groups which were lobbying for greater access to information for the public, including the Consumers Association, the Drug and Therapeutics Bulletin, Social Audit, and the American Public Citizen magazine. All of them were worried about the experience of DTC advertising in the United States.
Advertising would distort the market place. There would be lots of advertising for newer, expensive, treatments and little for older or non-drug therapies. It was distracting for health care professionals, since it led to inappropriate requests and time-consuming arguments. The advertisements would appeal directly to individuals, ignoring concerns about affects on the wider community in health or financial terms.
"The UK would be a sadder and more troubled place with DTC," Professor Collier concluded.
Mr CHARLES MEDAWAR (director, Social Audit) said he believed that the country had reached a watershed on the provision of medicines. It was about to undertake something which would have profound effects but which had not been examined in detail.
The real danger of DTC advertising was that it would create a contagion of ill health by talking about hidden illnesses. A "health for me" approach would destroy the "health for all" ethos of the NHS.
Dr ELIZABETH NELSON (chairman, South West London community NHS trust) said that in every other market in existence the consumer was king. She had heard a lot of condescension in the debate so far. The public wanted this information. They considered advertisements to be one of the sources of information which they learnt from. Many of the concerns expressed had been raised in the past in relation to over-the-counter medicines and toiletries.
Dr PHILIP BROWN (publisher, PJB Publications) said pharmaceutical companies did not particularly want DTC advertising, but were under pressure to introduce it in order to maximise the gains from their research and development investment in the shortest time. They were concerned about the costs involved if they got into a spending war against rival companies. This could then have an adverse effect on prices.
Advertising was a business activity not an educational one, he said.
Dr TREVOR JONES (director general, Association of the British Pharmaceutical Industry) agreed that advertising was a commercial activity, but he pointed out that advances in new medicines came from the industry's investment.
"We have kept patients in the dark for a century on a presumption of weakness and incompetence on their part." Dr Jones said.
Mrs CLAIRE RAYNOR (president, Patients Association) felt that it was unlikely that anyone would develop incontinence after seeing an advertisement about it.
Dr LAURENCE BUCKMAN (general practitioners committee, British Medical Association) said that his experience of DTC advertising in the US was of "dire knocking copy, distorted and full of caveats". As a GP he did not see himself as a supplier of consumer products to consumers, but as someone who looked after people with problems. His nightmare was patients with sheaves of information downloaded from the internet about "magic crystals" who said that "if it is on the internet it must be true". He did not want patients relying on information from a single source.
Dr IAN BANKS (mens' health forum, BMA) said that advertising increasing demand was a myth: it had not happened with Viagra (sildenafil). However, he would have more sympathy with the concerns about increased demand if the Government did not spend less on health care than any other developed nation.
Summing up, Professor Collier said that his biggest concern was patients becoming reliant on information from a single biased source - pharmaceutical companies with products to sell.
Ms James noted that the US Food and Drug Administration had called for empirical evidence of problems caused by DTC advertising - none had been forthcoming.
In a final vote, the audience (a mixture of representatives of health care organisations and patient groups) gave17 votes for the motion, 25 against, with six abstentions; a result essentially unchanged from before the debate began.