Meetings & Conferences

Health Action International/European Public Health Alliance

Drug advertising directed to the public in Europe may lead to a spiral of unsustainable health care spending and further encourage unsafe or unnecessary use of medicines, a multinational conference in Brussels heard on 10 January . The conference, arranged to discuss direct-to-consumer advertising of prescription drugs in Europe, attracted more than 100 representatives from patient groups, government agencies, pharmaceutical companies and pharmacists' organisations from around the world. It was organised by Health Action International and the European Public Health Alliance with funding from the Netherlands Ministry of Health, Welfare and Sport. Colin Meek, freelance consultant on business and health service issues, reports

Concerns raised about direct to consumer advertising in Europe

Concern about direct-to-consumer (DTC) advertising of prescription medicines stems from experience in the United States. There, multi-million dollar campaigns for prescription-only medicines are common. It is widely accepted that DTC advertising is at least partly to blame for recent dramatic increases in prescription rates for many new drugs. A study carried out by the US National Institute for Health Care Management linked the 84 per cent increase in prescription drug expenditure in the US in just five years to the growth in spend on DTC advertising. Some pharmaceutical companies are known to be furiously lobbying for legislation to allow DTC advertising in other countries.

Speakers at the meeting queued up to condemn recent European Commission proposals for a five-year trial during which pharmaceutical companies would be able to provide consumers with information about prescribed medicines available for HIV and AIDS, asthma and diabetes.

The Commission has claimed the proposals are based on consultation with patient groups, but none of the patient organisations at the conference said they supported the idea and several said they believed they had been excluded from the consultation process organised so far. The European Aids Treatment Group — which is the only pan-European patient support group for people with HIV — told the conference it had not been asked for its opinion. Health Action International (HAI) has said that the Commission has so far failed to identify one patient group that supports its approach.

Despite repeated assurances that the proposals are designed to improve patient information, many at the conference said the plans will inevitably lead to mass marketing of drugs. Lawyer and director of pharmaceutical affairs and medical technology at the Netherlands Ministry of Health, Welfare and Sport, Leon Wever said that if the Commission wants to improve patient information then legislation is not needed. He said the Commission's decision to propose legislation therefore left him "suspicious" about its real agenda.

Contrary to Commission's claims that the plans will not lead to full-blown DTC advertising for drugs in the three treatment categories, the Commission's explanatory note on the proposed legislation states that the proposal will allow the "public advertising of three classes of medicinal products". Furthermore, a delegate from the Commission at the conference conceded that the measure would allow product-specific advertising.

Turning to the consequences of DTC advertising in Europe, several speakers said that advertising cannot be the answer to the need for better patient information on prescription-only medicines. "If we are going to make informed choices then we need full, balanced, independent information and that, by definition, cannot be provided by advertising," said chief executive of the United Kingdom's Picker Institute Dr Angela Coulter. (The Picker Institute looks at health services through the eyes of the patient.)

Director of Social Audit Charles Medawar described DTC advertising in the US as an "obstacle to honest science and an affront to evidence-based medicine". He said: "I dread the prospect of the kind of medicalisation that turns every runny nose into allergic rhinitis and which will turn forgetfulness into the possibility of Alzheimer's."

Mr Medawar argued that, as development costs rise for the pharmaceutical industry, companies are looking to expand their markets in order to squeeze revenue from blockbuster products.

Other speakers added that experience in the US shows that the drugs most heavily advertised are newly developed medicines. "DTC advertising is pushing very rapid widespread use of new drugs before their risks or benefits are fully understood," said Barbara Mintzes, research co-ordinator for patient information on medicines at the centre for health services and policy research at the University of British Columbia in Vancouver. HAI points out that the controversial diabetes treatment Rezulin (troglitazone) continued to be advertised to the public in the US for over two years after it was banned in the UK. It was eventually removed from the US market in 2000 after it was linked with dozens of fatalities. The US advertisements made no mention of the ban in the UK.

Ms Mintzes cited research published in 2000 that questioned the educational value of consumer-targeted prescription advertisements. The research, published in the Journal of Family Practice, examined information in 320 advertisements for 101 products. It found that only 10 per cent provided information on efficacy, 30 per cent included information about competing treatments and only 25 per cent included information about supportive behaviours, such as a change in diet or physical activity.

If anyone was in favour of the Commission's proposals they did not voice their support at the conference. One of the few speakers to suggest DTC advertising may have advantages for patients was Philip Brown, publisher of SCRIP World Pharmaceutical News. He said that DTC advertising may stimulate patient groups and other agencies to provide well-researched independent information and asked why it was that independent organisations were failing now to provide patients with such information when there was such an obvious demand. He said there were strong arguments for companies to be allowed to fill the vacuum.

The Commission's proposals are likely to meet stiff opposition from at least some member states. The governments in Spain and the Netherlands are known to be opposed. At the conference, representatives from the Netherlands Ministry of Health, Welfare and Sport were strongly critical of the approach taken by the Commission and described legal action it had recently taken against pharmaceutical companies that have broken advertising rules by launching DTC advertising campaigns. Leon Wever argued that any relaxation of laws preventing industry from marketing directly to the public should be balanced with new laws designed to increase public access to information about all aspects of the pharmaceutical industry, especially regarding clinical trial data.