Should drugs ads be legal?: The ban on direct-to-consumer pharmaceutical advertising looks to be coming to an end

Britain has an anomaly when it comes to advertising: we allow tobacco companies the opportunity to promote products that could kill us, but ban ad for drugs that could cure us.

Britain has an anomaly when it comes to advertising: we allow

tobacco companies the opportunity to promote products that could kill

us, but ban ad for drugs that could cure us.



Although over-the-counter goods such as painkillers can be advertised,

prescription drugs - in the UK at least - cannot be promoted direct to

the consumer. But many in the industry think this situation is likely to

change, with the UK heading for a situation more akin to that unfolding

in the US.



At present, only specialist doctors’ journals and magazines are allowed

to carry prescription drugs advertising, which has led to an

unparalleled reading choice for the medical profession, paid for by

pharmaceutical companies with nowhere else to promote their products. A

doctors’ TV channel is now being planned. Called the Medical Channel, it

will be broadcast on Sky and is able to exist as a result of the limited

areas in which drugs companies can spend their ad budget.



In the UK, the pharmaceutical industry spends about pounds 50m a year on

prescription drugs advertising, compared with pounds 262m on

over-the-counter medicines, out of a sales and marketing spend of pounds

3bn a year.



But in the US, the situation is different. Drugs companies have been

able to advertise all their products since August 1997 when the Food and

Drug Administration relaxed regulations. They now spend about dollars

2bn (pounds 1.2bn) a year. Famous campaigns include the former

Republican presidential candidate Bob Dole promoting the anti-impotence

treatment Viagra. At the same time, there has been an 11% rise in US

drugs sales, to dollars 100bn (pounds 60bn).



Because of this freedom to advertise direct to consumers (DTC), US

pharmaceutical adspend is in the same league as that of major consumer

brands. A recent calculation touted around the pharmaceutical industry

was that once Glaxo Wellcome and SmithKline Beecham merge, the resulting

company will have the third-highest global adspend after Coca-Cola and

Anheuser Busch, the brewer of Budweiser.





Freedom of the net



The view in the UK now is not whether DTC advertising will be allowed in

the UK, but when. This thought process has been massively accelerated by

the internet. Healthcare has now overtaken pornography as the most

popular net sector. Companies in the US are placing ads and information

on the net and consumers and patients here are able to pick them up. To

get access, all they have to do is tick a box online stating that they

are a US citizen.



UK journals and magazines previously limited to an audience of doctors,

too, are going online, where they can be accessed by all.



Last year, the Medicines Controls Agency, which polices drugs

advertising, announced that journals such as The Lancet and the British

Medical Journal can retain their ads online. This ruling is particularly

significant, because it means that for the first time ads for prescribed

drugs are already reaching a wider audience.



Buoyed with confidence by this ruling, pharmaceutical companies are

blurring the boundaries even further.



Novartis, the Swiss giant, paid for an awareness-raising TV ad about a

fungal nail infection in 1998. The ad mentioned no product, simply

highlighting the condition, but it is little surprise to discover that

Novartis makes Lamisil, a leading treatment. Critics saw this campaign

as a first major step toward DTC advertising.



Last year Pharmacia & Upjohn paid for a pounds 1m campaign orchestrated

by Saatchi &Saatchi about incontinence. Again, no product was mentioned,

but the company hoped patients would be more willing to discuss the

problem with their GP, who in turn might well prescribe Detrusitol, the

market-leading drug made by, of course, Pharmacia & Upjohn.



Insiders say the ad was, in retrospect, too controversial. But the

industry is sure DTC advertising will arrive here. Managers at Glaxo

Wellcome think it will take five years, Roche believes it will be four,

Pfizer says two. Meanwhile, they hope to persuade the government to set

up a group of industry members, doctors, politicians and patients to

discuss how drug information should be disseminated.



But the Association of the British Pharmaceutical Industry (ABPI), which

represents 80 companies in the UK, is more reluctant than individual

members to say DTC is inevitable.





Differing healthcare set-ups



Richard Ley, ABPI spokesman, says: ’It’s a tendency for the media, and

society in general, to look to the US and say it must come over here. It

doesn’t necessarily work like that. In the UK, we have a very different

healthcare set-up and I think to look at advertising in the US and say

it must be here in six months is wrong. No one can tell if we are going

to see similar spends over here. As an industry, we are not pressing for

that.



’I don’t think it’s appropriate for the UK or our type of market. In

America, it’s private healthcare, by and large,’ he says. ’If a patient

sees an ad, he says to the doctor ’I want this’. Here, health is

provided by the state, and having a patient banging down the door

demanding a drug is not an appropriate scenario.



’If you came back in five years’ time, possibly things will have

changed, but not now. What we are interested in is information for

patients,’ he adds.



The ABPI says the web has accelerated companies’ desire to be able to

put out information without fear of being hauled before a disciplinary

body. The ABPI itself has a Code of Practice Authority, which

investigates about 140 complaints a year. But its spokesman says that

what the industry wants is informed patients, rather than people being

bombarded by advertising.



’We find it ironic that if you type the name of a well-known drug such

as Viagra into a search engine on the internet, you will come up with

hundreds, possibly thousands of sites,’ he says. ’Some will be very

good, others shocking and full of misinformation. But the one company

which is not allowed to put anything more than the most basic technical

information is the manufacturer. That doesn’t seem to us to be

reasonable or just, or indeed in the patients’ interest.



’What we would like to do as an industry is to sit down with the

government, healthcare professionals and, very importantly, patients, to

say that the rules have clearly been overtaken by technology, and by the

demands for patient information which didn’t exist 20 years ago. We need

dialogue, not a loosening of the rules to allow multi-million pound

advertising campaigns.’



Vic Ackermann, managing director of Roche, recently described DTC

advertising as ’the hot topic’. He thinks that within four years, DTC

will be allowed in the UK, and that three years later, companies in

Europe will be spending dollars 2bn (pounds 1.2bn) on it.



Roche spends dollars 100m (pounds 60m) promoting the anti-obesity drug

Zenical in the US, and its UK marketing team is studying the methods

with a view to emulating them when the time comes. ’We are preparing for

when it becomes a reality here,’ says Ackermann. ’Like the big banks,

there’s a customer-oriented trend, and we do not see that going

away.’



Other companies, although keen on increased patient information, seem

reluctant to embrace advertising as keenly as their cousins across the

Atlantic, and feel the American system has gone too far. One industry

source claims the market is just not big enough in the UK to justify

spending the amount major ad campaigns cost.





Regulating DTC ads



Glaxo Wellcome, the UK manufacturer, says it is far too early for any

practical changes to be put in place in its marketing departments to

prepare for advertising. But when it does prepare, according to

spokesman Philip Thomson, it will take account of the US experience.



’There is a train of thought in the US that the advertising needs to be

regulated, because it goes too far with its claims. If it does happen

here, we need to learn from the US.’



Thomson believes that DTC advertising will be here in five years, but

adds that at present, Glaxo spends only ’hundreds of thousands’ on

advertising in the trade press, with creative by McCann-Erickson.



’We think there’s a certain amount of inevitability about it,’ he

says.



’The internet is the prime generator. You cannot split marketing down

into regions anymore, because it’s too globalised. You can see from our

merger with SmithKline Beecham the growth of the global approach. That

filters right down to marketing. I think you will also see a spread in

US marketing techniques.



’We don’t want to push DTC, but we do want to be at the forefront, so we

are researching and taking a close interest in legislation and the

current thinking at European and local level,’ he adds. ’It was probably

inconceivable 30 or 40 years ago to think of a disease-awareness

campaign, and plenty of pharmaceutical companies do those now.’



Markets which would particularly benefit from advertising are expected

to be irritable bowel syndrome, asthma, and migraine treatments. ’There

are millions of people who suffer from migraine, but very few go to

their doctors to get a prescription,’ says Thomson. ’Typically you will

find it’s not the diseases which are classified as serious, but those

which patients might put up with and have not realised there are better,

or indeed any, treatments available.’



The companies have powerful supporters on their side, including groups

such as the Multiple Sclerosis Society, and professional bodies such as

the Royal College of Nursing. They believe patients have a right to more

information and feel that Pharmacia’s incontinence campaign was an

effective way of broaching a subject with a social stigma.



However, others are horrified by the prospect, describing DTC as a

’hypochondriac’s charter’. GPs are already inundated with patients

bringing print-outs from the internet and demanding certain

treatments.



Dr George Rae, chairman of the British Medical Association’s prescribing

committee, says: ’I’m all for patients getting information from leaflets

or the internet, but advertising is encouraging people to go to their

doctors and ask for certain drugs. It’s not helpful to the consultation

process. The doctor-patient relationship is a partnership, but when it

comes to prescribing, it has to be the doctor who makes the choice and

talks through the options with the patient, so they can decide

together.’



Others are concerned that the NHS just couldn’t cope with the financial

implications of patients’ demand for expensive drugs. Soaring drugs

sales are not a government concern in the US, where the bulk of

healthcare is paid for by private insurance.



In Europe though, an advertising-led boom in sales would have to be met

by public expenditure. The government has already set up the National

Institute for Clinical Excellence (NICE), which many see as a charter

for rationing. Tony Blair is expected to be extremely reluctant to

encourage advertising of new drugs which would fuel demand. If a patient

does not know about the latest, more expensive treatments, the rationale

goes, then they cannot ask for it.





Private resources



The expense issue is a real problem. Although NICE recently rejected the

NHS introduction of Relenza, the anti-flu treatment, on the grounds that

there was insufficient evidence to prove its efficacy, many saw it as a

covert decision to protect the NHS from having to provide a

resource-draining treatment for free.



Pharmaceutical companies are well aware of this issue, and Merck Sharp

and Dohme has asked that its latest high profile ’lifestyle’ drug, an

anti-baldness pill called Propecia, be available only privately.



Frank Dobson, the former health secretary, made it clear that he was

opposed to DTC, saying it would happen ’over my dead body’. But there

seems to have been a change in direction at the Department of Health

since Alan Milburn took over. As well as UK law, a European directive

bans DTC, so the UK would have to wait for the EU before it changes the

status quo.



But a working group is being set up to gain an EU consensus on the

subject.



’There have been quite a lot of developments with patient information,

patient groups and internet sites,’ says one official. ’I’m not

presuming the working group would definitely lead to DTC, but there is a

move in that direction.’



Like the government’s attempts to ban tobacco ads, a relaxation of the

Medicines Act may be a controversial and drawn-out process. But in a

couple of years, if the House of Lords sides with the government and the

billboards are stripped bare of cigarette promotions, you can be sure

the drugs companies will be queuing up to fill them.



TOP 20 PRESCRIPTION PRODUCTS IN UK


Product       Company                       Sales       Market

                                         pounds m      share %

Losec         AstraZeneca                   249.3         4.53

Zocor         Merck Sharp & Dohme           129.9         2.36

Istin         Pfizer                        108.1         1.96

Prozac        Eli Lilly                     107.3         1.95

Zoton         Wyeth                         104.9         1.90

Seroxat       SmithKline Beecham             87.4         1.59

Serevent      Glaxo Wellcome                 84.9         1.54

Innovace      Merck Sharp & Dohme            83.6         1.52

Pulmicort     AstraZeneca                    81.2         1.48

Ranitidine    generic                        80.5         1.46

Becotide      Glaxo Wellcome                 78.6         1.43

Flixotide     Glaxo Wellcome                 77.5         1.41

Zestril       AstraZeneca                    69.7         1.27

Ventolin      Glaxo Wellcome                 60.0         1.09

Adalat        Bayer                          58.2         1.06

Zantac        Glaxo Wellcome                 54.1         1.00

Lustral       Pfizer                         49.9         0.91

Voltarol      Novartis                       49.1         0.90

Imigran       Glaxo Wellcome                 43.3         0.79

Becloforte    Glaxo Wellcome                 41.0         0.73

SOURCE: IMS





AWARENESS-RAISING



In 1997, Glaxo Wellcome launched a direct-to-consumer campaign in the US

on TV, radio and in print to highlight treatment for a condition many

found it difficult to broach - genital herpes. Glaxo makes the

anti-viral drug Valtrex, the lesser-known alternative to Zovirax.



The campaign encouraged patients to talk to their doctors about

treatment options. It addressed the psychological components of the

condition, offering hope to those finding it difficult to manage the

disease.



Since the campaign was launched, Glaxo has had 800,000 calls from

patients wanting information about the disease. Some 11% had not seen a

doctor about the condition for two years, but 86% now planned to see

one.



In a subsequent survey by Market Measures Incorporated, 49% of those who

had called the toll-free number on the ad had seen their doctor within

three months. Some 76% said they felt the ad provided a valuable service

in educating the public.



In 1996, Valtrex had a prescription share of 12%. Following this

campaign, Valtrex was the fastest-growing brand in 1997. Its market

share for July 1999 was 31%. MMI reported that in 1998, awareness of

Valtrex had risen from 18% to 58% among those with the disease.



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