E-drug: Opinion of DTCA published in Sydney Morning Herald
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An introduction to my concerns about Direct to Consumer prescription
drug promotion was published in the Opinion page of the Sydney
Morning Herald this morning (Monday 3 July). The text is below.
http://www.smh.com.au/news/0007/03/features/features05.html
Regards,
Peter
Dr Peter Mansfield
PO Box 172 Daw Pk SA 5041 Australia
ph/fax +61 8 8374 2245
peter.mansfield@flinders.edu.au
www.camtech.net.au/malam
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Sickening sales pitch of the drug marketeers
Allowing drug companies to hawk their wares direct to the public is a
major health risk, argues Peter Mansfield.
Will drug advertising harm you? Around the world, multinational drug
companies are lobbying governments to weaken the regulations on
direct-to-consumer advertising of prescription-only drugs (DTCA).
Previously drug companies in Australia were allowed to aim their
advertising only at doctors. But they have recently started advertising
prescription drugs direct to the public, using a loophole in the law that
allows them to highlight the disease as long as they don't name the
drug.
For example, there has been television advertising of a new
weight-loss drug for obesity. The drug companies want to be able to
name the drug so that people will be able to demand it from their
doctors by name. As a doctor, I fear that this practice would be a
major threat to health.
The drug companies want Australia to be as permissive as the United
States and New Zealand, which have the weakest laws in the Western
world because the possibility of DTCA was never considered when
their legislation was written.
In the US, spending on DTCA soared by 40 per cent to $US1.8 billion
last year because the companies have discovered that such
advertising produces massive growth in sales of drugs. The costs
have been passed on to the customers, without them knowing.
In Australia the cost of the Pharmaceutical Benefits Scheme is already
growing out of control. DTCA is a further threat to the hip pocket of
every taxpayer, especially those with health problems.
To make good decisions about the use of medicines people need
balanced, reliable information about the probabilities of benefit and
harm from all the alternatives. Drug companies claim that DTCA
provides the information that people need. However, many studies
have shown that people gain little information from drug
advertisements.
There are no incentives for companies to provide clear warnings about
adverse effects, let alone to inform the public about the advantages of
cheaper drugs or non-drug therapies.
Advertising does not educate, it persuades. Advertising uses
conscious and subconscious appeals to the head and to the heart
which have been developed over thousands of years since rhetoric
was invented by the ancient Greeks. The science behind advertising is
better-funded and more advanced than medical science.
DTCA uses sophisticated emotional manipulation to get patients to
decide to demand a drug without hearing the other side of the story.
Studies of doctors show that the more we rely on drug company
promotion, the more mistakes we make. Some patients are more able
than their doctors to view this manipulation with scepticism, but many
are not. Promotion may not fool all of the people all of the time, but it
does fool the more vulnerable.
Drug companies claim that doctors will protect people from
prescription drugs that are harmful. However, people can bypass
doctors and get drugs from friends, family and the Internet.
The adverse consequences are not felt only by patients, but also by
doctors. Many New Zealand doctors have told me about their distress
at having to cope with patients who demand inappropriate drugs.
Studies show many doctors cave in to pressure from patients despite
knowing that what they are asking for is not in their best interests.
This happens because most doctors want to please people.
We doctors already have a high death rate because our work is so
stressful. More DTCA would make things even worse.
The drug companies know that DTCA is likely to be banned in New
Zealand soon because the country's Health Minister, Annette King, is
no fool. Consequently, there has been some desperate lobbying in
Wellington in recent weeks.
In June, the association for foreign drug companies, the Researched
Medicines Industry in New Zealand, used the advertising of the virility
drug Viagra as an example of the benefits of DTCA.
Many men have occasional "equipment failure" that would come good
with reassurance. By contrast, current ads directed at consumers to
promote Viagra in New Zealand seek to frighten men into thinking that
if they don't use the drug their wives will leave them. This is not
supported by the research on why relationships succeed or fail. Viagra
does benefit many, but can also kill. The advertisement does not
provide the clear warnings that are needed to prevent deaths.
If the use of fear to promote Viagra is the best evidence in favour of
DTCA that the drug companies can come up with, then we would be
better off getting information from less biased sources.
The reason that drug companies can't be trusted to provide reliable
information about their products is not because they are bad. The
problem is that the system rewards drug companies for increasing
sales, regardless of the impact on health.
Consequently, company staff have little choice but to do what works
to increase sales or to lose their well-paid jobs. One method used to
promote this mentality is "groupthink", where staff reinforce each
others' false beliefs that their drugs really are superior and under-used.
We need to find ways to pay drug companies more for doing the right
thing than for doing the wrong thing. For example, they can be
required to sign capped annual contracts which reward them for
selling only so much of their product - no more, no less.
That will not be easy but it is a possibility for the future. Meanwhile,
the regulations on DTCA should be strengthened.
Dr Peter Mansfield is an Adelaide GP and director of the Medical
Lobby for
Appropriate Marketing (MaLAM).
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