In Australia, both consumers and health professionals have expressed a need for independent information about treatments, including pharmaceutical treatments. Does advertising meet this need or do consumers need protection from misleading claims?
Direct advertising to American consumers increased in the late 1980s and early 1990s. In 1996, the pharmaceutical industry in the U.S.A. spent more on printed advertisements for prescription-only products aimed at consumers than it did on printed advertisements aimed at health professionals. Why did the pharmaceutical industry change its focus to direct advertising of prescription medicines to consumers?
Between 1987 and 1992 there was a rapid growth in direct advertising. Research by a marketing firm found that, in 1987, 18% of consumers in the U.S.A. asked their doctor about specific drugs; by 1992, 54% of consumers were asking about specific drugs.1 Research also shows there is a major imbalance in the resources available to produce commercial promotional information on drugs compared to the resources available for independent information.
In Australia, promotion of prescription medicines (S4) to the general public is not permitted. Should this be changed?
According to the recent book `Too much medicine'2, advertising contributes to raising expectations about the benefits of drug treatments and influences both doctors' behaviour and patient expectations. While direct advertising for prescription medicines to consumers is not permitted in Australia, the pharmaceutical industry uses a range of other effective marketing strategies. One example is the tendency to define the common problems experienced at different stages of life as a disease requiring drug treatment. The community's increased awareness of depression and less serious conditions such as mild anxiety has made people more open to considering drug treatment when non-drug options such as counselling or leading a more balanced lifestyle may be just as effective.2
Despite the ban on direct to consumer advertising in Australia, the marketing of prescription medicines to health professionals together with increased community awareness of chronic conditions has been a factor contributing to the growth in use of prescription medicines. New drugs listed on the Pharmaceutical Benefits Scheme, such as proton pump inhibitors, while effective for those with severe problems are not appropriate for those with mild or temporary conditions. The use of these drugs for people with mild conditions may actually be a barrier to better health through a change of diet and lifestyle.
`During the last 5 years, the annual number of prescriptions written by doctors under the Pharmaceutical Benefits Scheme increased from 100 million to 124 million. New heavily promoted and highly expensive drugs account for much of this growth.'2 Australians are paying a heavy price for the increase in prescriptions with the cost going from $1.5 billion in 1991-92 to almost $2.5 billion in 1996-97.
There is considerable debate in Europe and Canada about the issue of direct advertising to consumers. In the U.S.A., direct advertising to consumers is defended as part of an effort to empower people with information. The Canadian reaction is not to support direct advertising to consumers. The key question is does advertising lead to improved health outcomes? A prerequisite for any improvement in treatment and health outcomes is accurate information.1 Does pharmaceutical advertising provide us with this accurate information?
Canadian research on non-prescription drug advertising for consumers found that 24% of advertisements for over-the-counter drugs contained `minor errors' such as stating there were no adverse effects, and 39% had major errors such as unapproved claims or misrepresentation. The research on prescription drug advertising to doctors also found that the advertising aimed at doctors was biased in favour of the benefits of the medicine. `The information on risks and benefits was skewed towards a misleadingly positive representation of the product and a lack of attention to warning both health professionals and consumers about potential risks.'1
In Australia, there is a specific code (the Therapeutic Goods Advertising Code)3, which is part of the Therapeutic Goods Regulations, that regulates how and where non-prescription and complementary medicines are advertised as well as allowable claims. This Code has the advantage of ensuring that advertising is responsible and serves to provide accurate information to potential consumers. The Code is upheld by government, industry and consumers, and has specific legislative underpinnings to ensure compliance. In relation to prescription medicines, the Code of Conduct of the Australian Pharmaceutical Manufacturers Association governs standards for appropriate marketing to health professionals (see page 78).4
For over-the-counter products, the Proprietary Medicines Association of Australia Code of Practice operates to ensure that standards are established for responsible advertising and information to consumers.5
Pharmaceutical company advertising is not independent information. Consumers are still poorly catered for in relation to independent information about medicines. Objective information about prescription medicines is an important part of the broader empowerment process for consumers. There is evidence to show that the more efforts are made to empower people in the health system, the more this has a positive influence on their health status. Consumer medicines information (CMI) is a positive example of the industry, consumers and health professionals working together to provide accurate information to consumers about prescribed medicines. Although the industry is required to provide CMI, consumers do not always know that they are entitled to receive CMI with a prescription medicine. Consumers are reliant on their doctor or pharmacist to provide the CMI when the prescription is dispensed or to look for it in the packaging.
Australian Prescriber*, the Australian Medicines Handbook and Therapeutic Guidelines are aimed at assisting prescribers to make informed decisions when prescribing, based on the evidence available about drug treatments. The National Prescribing Service (NPS) is a recent national initiative which will also provide independent information and education, primarily to prescribers, about prescription medicines. However, more effort is still required to promote independent information to consumers about their medicines. It would be remiss of those responsible for public health policy in Australia if the pharmaceutical industry was the main provider of information to the public about prescription medicines.
* This electronic version of Australian Prescriber now contains some comments for consumers, click here.
Acknowledgement
The author wishes to thank Mr Derek Weir, Consumers' Health Forum representative on the Therapeutic Goods Advertising Code Council, for his advice and assistance.
