Direct advertising an uneasy pill to swallow

By WARREN GAMBLE

Oversized trousers burning on the clothesline, an exploding armchair - the obesity-fighting drug Xenical hit New Zealand television screens with a brand-awareness bang.

Xenical's is one of the highest-profile of a wave of prescription drug ad campaigns in New Zealand over the past five years.

Down at Auckland's Viaduct Basin, the signs of new America's Cup sponsor Cialis, an erectile dysfunction drug rivalling Viagra, are everywhere, even on sails.

The Women's Health Action Trust claims such signs are breaching advertising codes, but says a lengthy complaints procedure means they will be long gone before a decision is reached.

The emergence of the ads, known in the industry as direct-to-consumer advertising, has had an incendiary affect on doctors concerned at their impact on consumers and themselves. A range of health groups, public health academics and the Government drug purchasing agency Pharmac have added their voices, saying the DTC ads are often misleading and create a "pill for every ill" mentality.

On the other hand, the pharmaceutical industry has made the case for a patient's freedom of choice and some doctors have welcomed patients discussing previously sensitive subjects, such as erectile dysfunction.

The battle has rumbled on over the past few years after health officials allowed the industry to self-regulate prescription drug advertising.

New Zealand and the United States are the only countries where prescription medicines are advertised directly to consumers. That is because legislation does not specifically ban the practice, as in Europe.

This month a group of senior academic doctors from New Zealand's medical schools fired the latest shot, calling for the Government to impose such a ban and set up an independent consumer health information service.

The group's spokesman, Professor Les Toop, from the Christchurch School of Medicine, says the advertisements are putting an increasing strain on doctor-patient relationships.

Of the 1600 GPs who replied to the group's survey, 90 per cent said they had consultations generated by advertising, and 68 per cent felt consultations were often unnecessary. More than 40 per cent said they had either started patients on advertised drugs or switched drugs at their patients' request even though they felt such drugs offered little new benefit.

The survey has been criticised as flawed by the pharmaceutical industry because it was sent with a letter outlining the group's ban proposal.

Toop says the survey confirms that already hard-pressed GPs are wasting valuable time educating patients on why they are unsuitable candidates for advertised drugs.

The most common complaints were of patient confusion and anxiety generated by misleading advertisements and requests for inappropriate medicines, particularly obesity drugs. There was anecdotal evidence that some patients became angry if they were refused an advertised drug and went elsewhere to get it.

Toop says the ads have been guilty of playing on emotions, overemphasising the product's effectiveness, minimising its risks and side effects, rarely mentioning costs and almost never alternatives.

Other recent surveys, however, contradict the findings of the doctor group.

A Massey University study released this month, using a random sample of several hundred GPs, pharmacists and practice nurses, found most believe DTC ads have benefits.

Senior marketing lecturer Dr Lynne Eagle, who co-authored the study with psychology professor Kerry Chamberlain, says there was a three-way split in doctors' opinions. "One group is violently opposed philosophically, another group is ambivalent and a third group think it is positive," she says.

Eagle says overall the medical professionals reported only limited pressure from patients to prescribe an advertised drug. "It is a myth that doctors feel pressured by patients armed with printouts from the internet and demands for the latest drug shown on TV."

However, the study also found strong concern that direct ads did not give enough information on the risks and negative effects of drugs.

That is a concern shared by consumers, according to yet another study, carried out by Palmerston North-based Massey marketing professor Janet Hoek.

A survey of 630 randomly selected consumers last year showed brand recognition of drugs such as Xenical, Viagra and asthma drug Flixotide was extremely high, at around 80 per cent.

But fewer than a quarter could recall any information about the risks or side effects, and most strongly agreed that the ads should carry that balance.

Hoek says about 10 per cent of those surveyed said they had got the advertised product prescribed by their doctor.

Overall, 70 per cent opposed an advertising ban and only 10 per cent were for it.

Hoek, who helped to develop the independent pre-vetting system now mandatory for all prescription drug ads, believes there should be attempts to get a better balance of benefits and risks before any decision to ban the ads.

The pharmaceutical industry body, the Researched Medicines Industry Association, says direct ads are part of a trend of patients becoming better educated about their health.

Board member Mark Crotty, general manager of the New Zealand arm of Viagra-maker Pfizer, says the growth of advertising here coincided with Pharmac's reduced funding of new drugs. "Obviously if a pain-relief drug is funded in Australia and not funded here, the only way to tell consumers about it is through advertising."

He says most breaches of advertising and medical codes involve non-prescription drug advertising.

Doctors and pharmacists are the checks to prevent drugs being prescribed inappropriately, and he does not believe there is enough evidence to say doctors are under pressure from patients to prescribe.

Crotty says better patient education can make doctors sharper as "they have to stay up with new therapies and be a bit more on the ball".

Sandra Coney, from the Women's Health Action Trust, says the companies are simply out to stimulate demand for their products, many of which are lifestyle drugs. "All it does is encourage people to go for a pill rather than exploring other options."

In the middle of the debate is the New Zealand Medical Association, which represents about half the country's doctors.

Chairman Dr John Adams says the association will gauge members' opinions through its committee structure in the coming months.

He says the report from Toop has compelling arguments. Adams believes advertising does put extra pressure on doctors to prescribe requested medications. "The problem is, that process conflicts with the largely unbiased nature of the relationship between patient and doctor and the recommended treatment."

Ideally, the doctor would resist such pressure, but in reality it could be difficult to do so.

The Minister of Health, Annette King, who has previously expressed misgivings about direct advertising of prescription drugs, will have the final decision. It is understood she has made it clear that if a ban is to be considered, it must have the support of the medical profession.