Power to the Patients
|Power to the Patients
By Peter Pitts
No one would seriously argue that automobile commercials cause traffic accidents. Yet that's exactly the kind of argument often heard in Europe regarding "direct-to-consumer" advertisements for pharmaceuticals.
Many European officials seem convinced that drug ads would be harmful to the benighted masses -- e.g., readers of this newspaper -- who, upon seeing one, would lose their ability to make intelligent purchasing decisions. Yet evidence from other countries suggests that lifting the ban on pharmaceutical advertising could be a boon to public health. The European Parliament, which currently is reviewing its draconian restrictions on other types of direct-to-patient health-care communications, should give serious consideration to overturning its ban on consumer drug advertising.
In the U.S., it has been almost a decade since the Food and Drug Administration dropped most restrictions on direct advertising of prescription drugs, paving the way to television ads for drugs that treat everything from depression to high cholesterol. In both of these cases, and many others, the advertised medications treat diseases that are both underdiagnosed and hugely expensive to national health-care systems when dealt with via acute rather than chronic care.
And while critics continue to parrot the refrain that advertising increases the price of pharmaceuticals and leads to inappropriate prescriptions, they ignore mounting evidence that drug ads can have a positive effect -- and not just on companies' bottom lines.
Studies suggest that direct-to-consumer advertising drives patients to visit their physicians, and the FDA has begun to examine what happens once they're there. A 2002 FDA study found that in cases where a drug ad inspired a patient to visit a doctor, the advertised medicine was prescribed 47% of the time. This in itself suggests a health benefit, as previously undiagnosed ailments were presumably being diagnosed and treated.
The advantages, though, go beyond use of the advertised medicine. The study also found that physicians prescribed a drug of some sort -- including but not limited to the advertised medicines -- in 71% of ad-inspired visits. This suggests that doctors were not unduly prone to prescribe only the drug the patient had heard of. Moreover, in 25% of ad-motivated visits, the doctor referred the patient to a specialist; in 45% of the cases, the doctor suggested a lifestyle change; and 50% of the time, the doctor recommended a diagnostic test. All of these figures indicate that advertisements motivated unhealthy people to see a physician.
Advertising can have a positive impact in other ways too. The FDA study found that 45% of physicians thought that drug ads helped improve patient compliance with doctors' recommendations. The remaining 55% were split between "neutral" and "negative." Is there room for improvement? Absolutely.
It is true, though, that in Europe's state-run medical systems, advertising could force an increase in spending by government health authorities. That's because once patients learn about a new treatment, they may demand it.
This isn't a theoretical prospect: Over the last year in the U.K., two women have waged court battles to get the National Health Service to fund the drug Herceptin as a treatment for their early-stage breast cancer. While Herceptin was not advertised directly to the public, these cases shows how the free flow of information -- in this instance, the women's discovery of new Herceptin studies -- is affecting demand for drugs.
But the prospect of a clamor for new medicines -- ones that could save lives, remember -- is hardly justification for banning ads.
There is evidence that European consumers very much want more health-care information. A recent public-opinion survey by the polling firm Populus asked people in eight EU member states which health-care reforms would most likely increase their quality of care. In every nation, by a large margin, they answered, "giving patients more information about their illness." And while this can be accomplished in ways other than product advertising, it need not preclude it.
The European Public Health Alliance, a network of health-care NGOs, stated in its 2006 agenda that "there is a clear need for better information on prescription medicines for patients." And as Colin Webb, patient advocate representative for the European Commission's Enterprise and Industry Directorate General, pointed out earlier this year, "We are in this ludicrous situation in Europe, where anyone is free to give information, quite legally, about pharmaceutical products -- except the industry which makes them."
Letting drug makers distribute such information themselves would serve that need, while saving state health providers the expense of major publicity campaigns.
European health-care authorities often fret over the distinction between "providing information" and "advertising." Even if one accepts the former but not the latter, there is a great deal of room to ease the rules without going so far as running Viagra ads during the World Cup.
Currently under EU law, it is usually illegal for pharmaceutical companies to offer standard "information-to-patient" programs to users of their drugs. In the United States these programs typically include disease-awareness advertising and online access to the latest studies and recommendations. This access is restricted in Europe, as firms are afraid of sanctions.
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