The Pharmaceutical Journal Vol 267 No 7156 p45-46
July 14, 2001

Should pharmaceutical companies be able to advertise directly to patients?

The Consumers’ Association believes that members of the public should have access to information that allows them to make informed choices about the drug treatment of disease. So, why is it against direct-to-consumer advertising? Frances Thompson finds out

Consumers’ Association recommendations

• The existing ban on advertising to the public should not be lifted
• A full assessment of the impact of direct-to-consumer (DTC) advertising should be made before more leeway is allowed
• A levy on companies should be set up to support the provision to patients of independent, comprehensive information about medicines, inclu-ding non-drug treatments and comparisons with other medicines
• A review should be conducted of how the interests of companies and other bodies, including that of the Department of Health, will be protected if DTC advertising is allowed

Advertising prescription-only medicines to members of the public is not currently permitted in the United Kingdom or in Europe. However, with the publication of a Consumers’ Association (CA) policy report on the topic and the imminent arrival of a European Union (EU) proposal to relax the rules for advertising drugs, debate on the subject is gathering momentum.

“Over the past 18 to 24 months, there has been a chipping away of the rulings about not advertising. For example, companies try to raise awareness of certain diseases by advertising during Coronation Street,” said Clara MacKay, the CA’s principal policy adviser, at the launch of the report “Promotion of prescription drugs: public health or private profit?”. The CA believes that the National Health Service drugs bill could “go sky-high” if advertising and marketing of medicines were to be allowed in mainstream media.

However, Richard Ley, head of public affairs at the Association of the British Pharmaceutical Industry, affirmed that the ABPI has never sought to “indulge in advertising campaigns in the American style”. Pharmaceutical companies in the UK were interested in providing more and better information to patients. Patients want this because they want to be better informed about the medicines that they are taking, he said. “The fact that the companies that have done the research into a drug are the only people that cannot provide information about it, is an anomaly.”

In its report, the CA says that it has been given little information about how the EU established that the advertising suggested in its proposals would be appropriate. “Although the EU says that it has consulted patient groups as well as the industry, none of the ones that we contacted had been approached,” said Ms MacKay.

DTC advertising in the US

The Consumers’ Association report includes an assessment of the impact that direct-to-consumer (DTC) advertising has had on the health systems of other countries. For example, it says that DTC advertising began in the United States in the 1980s but only took off in 1997. In 1999, US pharmaceutical companies spent nearly $14bn on advertising. The CA says that $1.8bn of this was spent on DTC advertising and that the top spenders were now allocating most of their advertising spend to consumer rather than to professional promotion. In addition, it says that the drugs bill in the US increased by 84 per cent over the period 1993 to 1998. The CA attributes this rise largely to DTC advertising and says that the 10 most heavily advertised products accounted for half of the rise.

It is less clear what effect advertising has had on the use of generic drugs.

Quality of information

The CA report concludes that, in terms of providing information to patients, DTC advertising tends to highlight the benefits of treatment rather than the risks. In addition, there is often no reference to non-drug treatment of disorders or to data that compare the product with other available treatments. In terms of its educational value to patients, the quality of the information given in the advertising is “highly variable”.

Of 28 US advertisements looked at by the CA, only half were accurate and gave adequate information about side effects. Ms MacKay commented: “The best advertised drugs are the ones that sell, not the best drugs. Sometimes this conflicts with guidelines, especially in promoting the use of antibiotics.” The report adds that, although advertising is undoubtedly linked to an increase in prescribing, there is no evidence that it improves outcomes or makes prescribing more rational.

With regard to information already available to patients on the internet, Ms MacKay said that it often contains “promotion dressed up as education”. In some cases, it is difficult to tell whether the site is run by a patient support group or by a company. She added: “Members of the public should not be stopped from reading information on the internet but poor or promotional material can be countered by the provision of websites containing good, independent data.”

Ms MacKay said that the system of reimbursement that operated in the NHS was not compatible with the concept of DTC advertising. In the US, prescription costs were covered by insurance, so neither the state nor patients were particularly interested in the price of drugs. In the UK, the state was extremely concerned about drug costs and the Government would probably not wish to support a move that would increase the drugs bill. However, companies were not just pushing for a relaxation in advertising rules but also for a change in the UK reimbursement system and this would make DTC advertising easier.

Mr Ley commented that if DTC advertising were to go ahead, the ABPI would want to see rules or a code of practice put in place to govern companies wishing to advertise in this way. However, Ms MacKay said that the CA was concerned that the code of practice might be developed and regulated by the pharmaceutical industry. This was “not good enough”; it had to be independent.

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Frances Thompson is on the staff of The Pharmaceutical Journal