TCS Daily

What the Doctor Orders

By Laurence Frost - October 25, 2002 12:00 AM

The European Parliament's vote to maintain a ban on advertising prescription drugs was a victory for consumer groups. But was it a victory for consumers?

The doctor really does know best. If you believe the European Parliament, that is, whose members (MEPs) have just voted overwhelmingly to maintain restrictions preventing ordinary Europeans from getting information on medicines straight from their manufacturers.

The Strasbourg assembly voted 494-42 to reject a trial scheme allowing drug firms to give out information on their treatments for three conditions - asthma, diabetes and HIV/AIDS - as an exception to the European Union's blanket ban on advertising prescription drugs.

The tightly-circumscribed information campaigns would have been conducted not through TV, newspapers, magazines or other mainstream media, but on more discreet company websites and leaflets - and only when requested explicitly by the individual.

But the debate before the vote revealed the extent of MEPs' fears over the proposal, most stemming from the notion that a green light for the five-year pilot would lead to an irreversible flood of US-style 'direct-to-consumer advertising' in the mainstream media.
"If we open the door to direct advertising it's a slippery slope down the American road where pink pills on TV ads offer a miracle solution to everything from baldness to chronic fatigue," Scottish Socialist Catherine Stihler told fellow MEPs.

"We don't want consumers, sitting on their couches, bombarded with a hard sell from big drug companies in the break between Crossroads and Coronation Street."

A second reading by MEPs and national ministers could, in theory, produce some form of compromise in coming months. But given the crushing size of the parliament's October 23 vote - reinforcing a more modest 2-1 rejection by its environment committee - the whole idea looks dead in the water.

Unveiled last year by EU Industry Commissioner Erkki Liikanen, the proposal drew immediate flak from doctors, understandably keen to preserve their current near-monopoly on drug knowledge, and - more puzzlingly - from consumer groups better known for championing the public's right to information.

Europe's doctors appear to be living in fear of a new generation of know-it-all hypochondriacs, already poking their spotty heads around surgery doors thanks to the increased availability of medical information on the Internet. Rather than presenting a set of symptoms for evaluation, even the docile English patient often arrives demanding a particular drug by name.

"It's very difficult for a doctor to deny people the things they have identified and feel they need, even when you know there's a better choice," says Professor Mike Pringle, chairman of Britain's Royal College of General Practitioners.

Amid the hype surrounding Prozac and Viagra, European doctors had their first experience of handling waves of determined patients who had already made their own diagnostic and prescription decisions, and wanted nothing more from their doctor than a signature.

Both medicines offer model examples of the new marketing strategy adopted by drug firms to side-step the EU ban on direct advertising by feeding often-quirky stories about their products to a news media increasingly keen on 'soft' consumer and lifestyle issues.

When the product happens to be an impotence-busting wonderpill, the task is obviously much easier. Pringle says the frenzy of media attention surrounding Viagra led to "almost irresistible demands" for prescriptions from sufferers who might have benefited more from other treatments.

That view is supported by Britain's Consumer Association, which recently published a study showing that 75% of drug advertisements in the US and New Zealand include no information on alternative treatments or how the medicines work, while only 10% mention the success rate or duration of treatment.

But pharma firms insist there is no comparison to be made between the altruistic information campaigns they planned to unleash under the EU initiative - recently described by Roche CEO Franz Humer as "patient empowerment" - and the kind of commercial messages quoted by its opponents.

"That's not what we want and that's not what's being proposed," says Brian Ager, director general of the European Federation of Pharmaceutical Industries and Associations (EFPIA). "But if you or I went down with diabetes tomorrow we'd want to go onto the Internet and get all the information available."

None of this washes with the Consumer Association's John Cox, who says any move to let pharma companies give out information on their drugs would increase the competitive pressure on them "almost to create ailments, in order to promote their pills".

He cites the controversy surrounding allegations that GlaxoSmithKline exploited Americans' alarm and bewilderment in the wake of the 9-11 attacks - not exactly a glaringly irrational response - with advertisements suggesting anyone experiencing sleeplessness or anxiety should consider taking its antidepressant Paxil.

But EU governments have other reasons to fear the consequences of letting the public hear the pharmaceutical industry's whispers.

Across Europe, pricing negotiations between state health providers and pharma companies routinely delay the availability of a new medicine for up to three years.

This is, so far, a little-known fact among the potential beneficiaries of new treatments, life-saving or otherwise - but with pharma companies freed to trumpet their own accomplishments, all that would change overnight. Under the spotlight of public attention, governments' already-strained health budgets would tend to increase as they became increasingly reluctant to hold out for the 'right price'.

As the Consumer Association report acknowledges, drug advertising increases spending on new, branded medicines, even when there are cheaper alternatives that are as effective or better.

Concern for government budgets is not, however, what prompted EU consumer organization BEUC to lobby the Liikanen proposal to death - nor was it assumed the pilot would inevitably lead to full-blown advertising, according to the group's spokeswoman Caroline Hayat.

"Patients do need more information on drugs, but not from industry,' says Hayat. "I can't see a drug firm saying, 'If you're prone to these side effects you should try another product from another company.'

"It's really not the medium we're worried about, it's the message."



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