http://bmj.com/cgi/content/full/326/7402/1302-a

BMJ  2003;326:1302-1303 (14 June)
 

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Collections under which this article appears: Regulation Other communication Confidentiality Patient - other Patients' cultures

Head to head

Should drug companies be allowed to talk directly to patients?

NO

Wendy Garlick, principal policy adviser¹

¹ Consumers' Association, London NW1 43DF wendy.garlick@which.co.uk

Health care in Britain is undergoing a radical shift, with a series of high profile investigations (such as the Bristol Royal Infirmary inquiry report, published in 2001, and the Shipman inquiry, set up in 2002), changes in NHS delivery, and advances in technology. Traditional approaches are increasingly being challenged, and many people are becoming more involved in managing their own health care.

While health professionals must respect the wishes of patients who are content with the traditional "doctor knows best" approach, they cannot ignore the growing number of people keen to become more equal partners in decision making about their own health or that of the relatives or friends they care for. Central to shared decision making is the ability for people to make informed choices. To do this, they must be able to gain access to high quality, balanced, accurate, full, and up to date information as well as have it effectively communicated to them by health professionals and others (such as the media). We are therefore campaigning for a more constructive approach to the provision of information based on patients' individual needs.

The pharmaceutical industry claims to have a direct part to play in educating the public and improving patient information (as set out in the aims of its current "My Medicine" campaign for patient friendly information). On the surface, this may seem attractive. After all, the industry produces the drugs we use. But the Consumers' Association believes that such an approach would only serve to undermine, not strengthen, patient information. The pharmaceutical industry is putting pressure on the European parliament to have the current ban on advertising medicines directly to the public (direct to consumer advertising) lifted. The first vote was held in October 2002, and the proposals—to lift the ban initially as a pilot for three conditions (HIV infection and AIDS, asthma, and diabetes)—met with strong opposition from MEPs (with a 12:1 majority). The vote shows that MEPs share our and others' view that advertising does not equate to education or high quality information.

On the contrary, advertising by its very nature is designed to "sell" a product, and adverts therefore need to talk up the benefits and play down the risks. Another ploy often used to engage the public is celebrity endorsement, such as that of the famous footballer Pele in Pfizer's advertisements for impotence treatments.

The Consumers' Association continues to be guided by the concerns of patients and carers and what they have told us about their information needs. For example, our recent policy report Patient Information: what's the prognosis?¹ is based on the views of patients, and carers and also takes on board those of academics, and representatives from industry and government, all of whom contributed to recommendations designed to improve the quality of patient information. In the report we advocate provision of high quality patient information and propose improvements to reduce the confusing and often conflicting advice confronting patients today. Our recommendations include:

• There should be one central, independent, and impartial source of information on medicines and treatments which is stripped of any commercial or political bias and which the public can rely on to provide or direct them towards accurate and current information. Although several worthy initiatives do exist, what is lacking is an overarching body to ensure consistency and safeguard standards. Information about medicines acquired privately should also be made available
   
• Medicines education should be introduced into the school curriculum within the wider context of health education. We believe this will provide children with a basic respect for and understanding of medicines as well as equip them with the critical skills necessary to appraise health information and become involved in shared decision making with health professionals
   
• Health professionals' communication skills should be strengthened, so that "communication" becomes embedded within training and patients are involved in the design, delivery, and evaluation of such communication training. Effective communication—listening, two way talking, and explanation—is key to developing good relationships between health professionals and patients, and across the health service generally.
   

We also conducted a consumer omnibus survey in June 2002, which showed that only 25% of the public would trust drug companies to provide them with impartial information.² The results of our research underpin our pursuit and promotion of good practice in provision and delivery of health information. This provides strong evidence for the need to retain the current ban on direct to consumer advertising of drugs and to ensure that public health is protected.

People are right to be sceptical about the ability of pharmaceutical companies to be responsible information providers. Reports of the negative impact of direct to consumer advertising in the United States³ and New Zealand⁴ (the only countries where it is currently permitted) strongly supports our view that lifting the ban will be harmful to public health. Reports range from criticism levelled at the many flaws in research supporting direct to consumer advertising (such as Bodenheimer⁵) to examples of profit margins taking precedence over public health. For example, Bayer, the German drug manufacturer of Baycol (Lipobay in Europe), a lipid lowering drug, failed to alert the public to growing evidence of risks associated with its use.⁶ The drug was finally withdrawn in August 2001, but thousands of people developed severe side effects as a result of its use, and at least 100 have died.⁷

In Britain, where prescription drug promotion is permitted only to health professionals, complaints about misleading advertisements have led to some being withdrawn (such as Schering's adverts for its oral contraceptive Yasmin⁸). Such evidence leaves us in no doubt that the pharmaceutical industry cannot, and should not, be trusted as a health information provider to the general public.

It is of particular interest that New Zealand's departments of general practice in the medical schools of Christchurch, Dunedin, Wellington, and Auckland are currently calling for a ban on direct to consumer advertising because of its negative impact on public health. Complaints about it include:

• Misleading claims and a tendency to maximise benefits and minimise risks
   
• The tendency to advertise new drugs (for which there is less known about side effects and which therefore potentially pose a greater risk to public health)
   
• Failure to provide information on alternative treatments or non-treatment
   
• Failure to alert the public when a product has been recalled in another country or where controversy exists over its safety.
   

We believe we should learn from the negative experiences of the United States and New Zealand. It is encouraging to have the support of the UK government and so many MEPs, but we need to be vigilant about the pharmaceutical industry's attempts to jeopardise genuine advances in the provision of high quality patient information and ensure the ban on direct to consumer advertising remains. The priority must be to address what patients and carers need and want. It is also important to remember that patient information is not just about drug advertising.

We envisage that implementing our proposed measures as outlined in this article, and maintaining the ban on direct to consumer advertising, will deliver high standards and quality patient information within 10 years.

For further information visit the Consumers' Association website at www.which.net/campaigns/health or contact Wendy Garlick (tel: 020 770 7258; wendy.garlick@which.co.uk)

Competing interests: None declared.

Listen to the BMJ Round Table Debate: "Doctors as Sherpas"

References

1. Consumers' Association. Patient information: what's the prognosis? London: CA, 2003.
2. Consumers' Association. Drug advertising—what do people think? Survey results, 2002. www.which.net/campaigns/health/dtca/survey.html (accessed 15 May 2003).
3. Gottlieb S. US consumer groups allege misleading drug claims. BMJ 2001;323: 415.[Free Full Text]
4. Toop L, Richards D, Dowell T, Tilyard M, Fraser T, Arroll B. Direct to consumer advertising of prescription drugs in New Zealand: for health or for profit? Report to the minister of health supporting the case for a ban on DTCA. Christchurch: University of Otago, 2003.
5. Bodenheimer T. Two advertisements for TV drug ads. Health Affairs 2003 Feb 26. www.healthaffairs.org/WebExclusives/Bodenheimer_Web_Excl_022603.htm (accessed 30 may 2003).
6. Charatan F. Bayer decides to withdraw cholesterol lowering drug. BMJ 2001;323: 359.[Free Full Text]
7. Meek C. Drug marketing. Health Which? 2003 June.
8. Yasmin advert withdrawn—why and how. Drug Ther Bull 2003;41: 17-8.[Medline]

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