Is prescription drug advertising empowerment?
Empowerment as a theme perhaps relates most obviously
to patients. Clara McKay, principal policy adviser for health to the Consumers’
Association, explained how at first sight it seemed odd that the Consumers’
Association was against the idea of direct-to-consumer advertising of
prescription products. Its whole history has been concerned with providing
more information to the public, she said. A recent European Union proposal
has recommended that advertising of prescription medicines direct to the
public be permitted for drugs used in diabetes, AIDS/HIV and respiratory
drugs. “This is probably a move towards a complete relaxation of the present
laws,” she said.
Ms McKay explained that the Consumers’ Association
has looked into this issue in some detail. She elaborated that the expectation
was that direct-to-consumer advertising (DTC) would fill an information
gap and maybe empower patients, increasing their access to treatments,
the detection of disease and the rational prescribing of medicines. However,
this optimism is not supported by experience in the United States where
the pharmaceutical industry spent $1.8 bn on DTC in 1999, an increase
of 40 per cent over 1998.
The problems with DTC are many. Drug companies tend
to focus on a limited range of products and conditions, so only a narrow
section of the information gap is addressed. Half the 84 per cent increase
in spending on drugs in the US between 1993 and 1998 was accounted for
by only ten therapeutic conditions. “Drug companies want to focus on new
branded products and not cheap well-established generic ones,” she said.
Advertisements are designed to sell and boost industry profits, so they
tend to overplay a prescription drug’s benefits and underplay the negative
aspects. No data comparing the advertised drug with alternatives is ever
given, and the overall educational value, as opposed to promotional value,
is highly variable. The presentation of material in a misleading way or
the omission of vital data is common in the US.
There are several examples of campaigns that have
gone against current clinical recommendations. For example, one antibiotic
campaign has resulted in increased antibiotic resistance.
Advertising does increase the number of GP consultations
about advertised drugs and the extent of their prescribing, but there
is no evidence for better prescribing outcomes. There is even the risk
that patients will push GPs to prescribe advertised drugs, even when they
are not appropriate, which could be harmful, she said. “In short, the
best advertised drugs sell, and not the best drugs,” she said. For the
National Health Service this would mean an increased drugs bill but with
no increased health benefits.
Ms McKay warned that the EU and the United Kingdom
must do more to provide assessments of the impact of DTC on patients,
public health and the NHS before any more leeway is allowed. The present
ban should not be lifted until this has been done.
Ms McKay stressed that there is a real need to give
patients more information on medicines but that this needs a deliberate
and formal plan for implementation. “A ban on DTC does not keep patients
in the dark,” she said “but the information gap must be filled or drug
companies will step in somehow”. Information must be part of health care
provision, but there is a potential role for independent groups that do
not have an agenda to take this on. Drug companies and health care professionals
have their own agendas, with the latter held in lower regard by patients
these days. This makes patients less likely to trust professionals. She
reminded delegates of UKMI’s reputation for impartiality in asking “What
will be the role of MI?”.
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