Selling drugs to consumers

British Medical Journal, Oct 30, 1999 by Annabel Ferriman

Time was when fat people were counselled to eat less and shy people were advised to get out more. Now, if they are living in the United States, such people are exhorted to take pills. Hoffman-La Roche is spending $75m (47m [pounds sterling]) persuading Americans to take its slimming pill Xenical (orlistat), and SmithKline Beecham is spending $30m promoting its antishyness pill, Paxil (paroxerine).

In Britain, however, consumers are protected from, or deprived of (depending on your point of view), such blandishments. Both products are prescription only medicines, and the pharmaceutical industry is not allowed to promote them direct to the general public.

But how long will this last? The British drugs industry sees changing the law as its most pressing task. It is promoting discussion of the issue throughout the media. You can hardly open a newspaper today without seeing another article on the subject And last week, the King's Fund, an independent think tank, held a debate on the issue entitled: "Drug companies should be able to advertise their prescription products to the public."

Margot James, chief executive of Shire Hall Group, a public relations company whose clients include several large drug companies, outlined the arguments in favour of the motion. She claimed that many poor people with chronic conditions were unaware of the fact that effective treatments existed. She cited the example of incontinence. Until recently, many women suffered in silence, not knowing that treatment was available. A television public awareness campaign shown, among other rimes, during breaks in Granada Television's Coronation Street had changed all that and had transformed peoples' lives, she said.

"Most communication to the public about health comes from the editorial columns in newspapers and magazines" Ms James said. "This increases the inequality in out society because people from lower socio-economic groups get their information from television and the tabloids. It is in the quality press that you see the best information. People who read the tabloids are more likely to be at the end of a sensational health scare than receive useful information."

Other speakers suggested that there was a conspiracy of silence, whereby neither the medical profession nor the government told patients about new drugs because doctors wanted to keep their individual prescribing budgets down and the government wanted to keep a lid on the country's drugs bill. Dr Paul Hooper, UK general manager of the drug company Eisai, pointed out that, with the advent of the National Institute for Clinical Excellence (NICE), it was likely that certain new drugs would not be available on the NHS.

The industry had some powerful allies in the shape of Claire Rayner, president of the Patients Association, Dr Ian Banks, chairman of the Men's Health Forum, and several chairmen of NHS trusts. Ms James also pointed out that when the US Food and Drugs Administration recently asked for data showing that direct to consumer advertising had harmed public health no one provided any.

But how well do these arguments stand up? Joe Collier, professor of medicines policy, at St George's Hospital Medical School, and editor of the Drug and Therapeutics Bulletin, does not think that they stand up at all. More information for patients is good, but biased information is not the same as unbiased information, he says. In many ways, biased information is worse than no information at all because it thoroughly confuses people.

"A company is there to look after its shareholders and keep its profits up. There is no point in advertising unless you are going to increase the use of your products. Advertising is about increasing sales." He said that most of his time at the Drugs and Therapeutics Bulletin was spent trying to unravel the distortions put about by doctors, who had been "bought" by the drugs industry, and by patients groups, which had also been "bought" by the industry. "Very rarely, if ever, do you get advertising that is not distorted. If you abolished advertising to doctors, it would improve prescribing" he claimed.

Claire Rayner accused Professor Collier of "hating" the drugs industry. He denied it. "The industry has done some wonderful things. What I don't like is when it distorts the truth" he explained. "If you allow drug companies to advertise to patients, they are going to distort the truth. They will promote their own product as if it is the only product. It might well be a new product, it may well be more expensive than existing products, it may not work as well as older products," he said. The drug companies would enlist members of the public as "foot soldiers" in their campaigns to increase sales by persuading them to go and ask their doctors for their drugs. "They are cheaper than sales representatives," he added.

He also pointed out that he was not alone in opposing direct to consumer advertising: "Most of the organisations which have campaigned for better information for patients over the years are also opposed to it." He cited, as examples, the Consumers' Association, Social Audit, the International Society of Drug Bulletins, Health Action International, and the Public Citizen in the United States.