Direct drug ads due for review

By Dita De Boni

The new Government's wide-ranging scrutiny of broadcast communications is unlikely to stop at well-paid news presenters and subliminal children's advertising.

The fledgling Direct-To-Consumer (DTC) advertising industry, worth around $10 million in New Zealand and growing, comes up for review by Health Minister Annette King this year.

Used to promote mostly nonsubsidised or partially subsidised "lifestyle drugs" for problems such as weight, impotence and hair loss, DTC advertising has been persistently called uninformative and irresponsible since its debut here three years ago.

But advertisers and drug companies say a voluntary advisory system set up last July (the Therapeutic Advertising Advisory Service, or TAAS) has gone a long way to fulfil the advertisers' brief of "social responsibility" under the Advertising Standards Authority (ASA) Code for Therapeutic Advertising.

TAAS, administered by the Association of New Zealand Advertisers (ANZA), is funded on a user-pays basis by advertisers wanting to forestall criticism that could lead to long hauls through the Advertising Complaints Board.

TAAS contracts the services of an adviser who liaises with the ASA, the Ministry of Health and other industry groups to ensure ads comply with the Medicines Act 1981, Medicines Regulations Act 1984 and the various codes governing DTC advertising.

For the year to last October, 23 complaints went to the Complaints Board. Thirteen concerned the advertising of "complementary medicines" such as herbal remedies, and five involved prescription medicines.

From TAAS's inception to last month, 90 advertising campaigns have been run by the body's adviser, one-third for prescription drugs.

ANZA's Jeremy Irwin says most therapeutic advertisers now consult TAAS about their campaigns. He believes New Zealand has a "well-run, self-regulated system" for ensuring that DTC ads provide all the information consumers need.

"The first ads for Xenical prompted a look at the therapeutic code, and it was agreed the information presented needed to be strengthened.

"After that, we set up the advisory service, and now Roche [makers of Xenical] use the advisory service, as do the other agencies, and they accept the views and opinions of the adviser."

The trickle of DTC that turned into a torrent started with an advertisement for Merck's Proscar, a prescription medicine for prostate problems. First published in 1997, it asked men: "Has your torrent turned into a trickle?"

ASA executive director Glen Wiggs says the next major media campaign in the same vein - the infamous Xenical commercials - caused a storm of debate because people were not convinced the product could deliver.

"You also had doctors against [it] because they thought bulimic young girls would just keep going from doctor to doctor until one of them prescribed it.

"But our response is: shoot the doctor. If the doctor is unethical, it's got nothing to do with the advertising."

However, unethical colleagues was not the only problem doctors found with the new method of targeting consumers.

Although 91 per cent of doctors polled last year said they were comfortable with saying "no" to patients requesting inappropriate drugs, most still thought DTC created unnatural demand.

That view is upheld by the Government drug-buying agency, Pharmac, which says it can see problems where DTC advertising is a "wonder drug for the industry itself, because of its ability to affect patient demand - and, in turn, patient behaviour."

As well as financial concerns over the demand created by DTC, Pharmac has publicly stated opposition to the TAAS system of self-regulation, saying it is "inappropriate for the industry body to act as judge and jury when it is a direct beneficiary of DTC advertising."

It is easy to see why advertisers wish to retain the right to self-regulate. In the United States, where DTC advertising has been legal since 1985, it accounted for almost $US2 billion in 1999 out of total wholesale drug revenues of more than $US81 billion.

Claritin, an antihistamine hayfever medication from Schering-Plough, is the top-moving prescription drug in the US and accounts for around $US267 million of DTC advertising annually - more than Coca-Cola.

CWFS McCann, which was set up in 1991 as the New Zealand arm of McCann Erickson's healthcare advertising network, bills around $6 million a year to clients such as AstraZeneca (Asthma turbuhalers), Reckitt & Colman (indigestion drug Gavison) and Pharmacia & Upjohn (impotence drug Caverject).

General manager Robert Munro says that although most of the agency's work is still aimed at the medical community, "in terms of turnover, the ratio is tipping because for every dollar you spend talking to a doctor, you spend $10 talking to consumers."

He says doctors benefit from patients knowing more about healthcare options.

"What's happened in the past two years is an acceptance that the world has changed and people have been surfing the web, dialling up information about their diseases.

"Then they've come to talk to the doctor after surfing, and I think the upside for doctors is that sometimes they are engaging in a more informed debate."

He says products are well tested in the health sector before mass media exposure.

"Drug companies launch a product, sell it in for a good couple of months to the health sector, and then, once they've used it for a while and are comfortable with it, then the drug company launches a consumer campaign."

Mr Munro says one example of the benefits of DTC advertising involved the promotion of a herpes helpline on behalf of Wellcome (now Glaxo Wellcome) some years ago, where smalltown consumers - too embarrassed to approach their local GP for remedies - could call an 0800 number and, if necessary, be referred by specially hired counsellors to out-of-town doctors.

Around 7000 calls were received by the helpline while it was running.

The ASA's Mr Wiggs says the Proscar campaign resulted in a deluge of normally reluctant male patients to doctors, resulting in "scores finding out they had prostate cancer."

Research Medicines Industry general manager Terrence Ashoff chips in with the case of asthma medication Flixotide, marketed first in July 1998, which resulted in over 24,000 calls to Glaxo Wellcome - overwhelmingly from "Pacific Islanders, Maori, single-parent families and beneficiaries."

"These figures strongly suggest that the Flixotide TV advertising campaign ... may help stem the ongoing tragedy of poorly controlled asthmatics from low socioeconomic backgrounds, particularly children, ending up in hospital winter after winter."

Ironically, a discordant note about New Zealand's DTC advertising comes from McCann Erickson Healthcare Worldwide chief Joe Torre, who says this country needs to provide more balance in DTC campaigns.

"In my opinion, in the US there is a greater emphasis on a fair balance of information such as side-effects and contra-indications, although the quality of the creative [here] is excellent."

New Zealand is the only country outside the US to allow DTC prescription advertising, although Canadian and Australian authorities are reviewing their advertising codes.

But Mr Wiggs says the flow of information to consumers is higher now than ever.

Despite the fact that supplementary information can now be supplied via 0800 numbers or websites, he says the fact that the media are demanding ads be vetted by TAAS also makes responsible advertising the foremost concern for most drug companies.

"We can't stop someone standing in Queen St and handing out pamphlets on this wonder drug or that, but the industry's self-regulation, which is not prescriptive but allows advertisers to take responsibility themselves, is a wonderful service to everyone," says Mr Wiggs.

"Not a day goes by that we aren't advising an advertiser on a campaign, and I can't see why the Government wouldn't be comfortable with that."