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Debate:Pharmaceuticals, advertising of
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[  ][  ][  ][  ][  ]Should drugs companies be allowed to advertise prescription drugs direct to the public? |
This article is based on a Debatabase entry written by Jonathan Bailey. Because this document can be modified by any registered user of this site, its contents should be cited with care.
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[ ][  ][  ][  ][  ]Argument #1 | |
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[  ][ ]YesAdvertisements for prescription drugs are not very different from those for anything else. We trust consumers to view adverts with a level of scepticism and we know that they form only one part of the research that goes into, say, buying a car. Drug companies have become more open in recent years, for instance GSK now publishes the results of all their drugs trials (including the ones that fail) online, and there are plenty of other sources of information on drugs available. A drug which remains unused is a drug which is helping nobody; adverts are simply a reasonable way for drug companies to help consumers find out about their products within a safe and highly regulated environment. |
[ ][ ]NoAdvertising does not attempt to tell the truth, but to give a biased view of a product. Companies spend millions of dollars a year on advertising and would not do so unless there was a return. While purchasing a particular brand of cola on the basis of an advert might not be disastrous for the consumer, using an inappropriate drug could be. Drugs companies have also shown their willingness to abuse their advertising rights. For instance the FDA has recently had to insist that the possible side effects of drugs must be listed as an integral part of TV adverts because adverts were being produced in which the list of side effects was read at too fast a pace to be understood by a different voice seemingly unconnected to the rest of the advert. It is thus understandable that in a survey soon after the 1997 regulations on direct to consumer advertising, 80% of American Medical Association (AMA) General Practitioners (GPs) thought it was not a good idea and undermined their role. |
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[ ][ ][ ][ ][ ][  ]Argument #2 | |
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[ ][ ]YesAdvertising increases consumer awareness of drugs which makes them more likely to take appropriate medication. The drugs market is complex and so advertising can help explain the differences between treatments, for example between contraceptive pills intended to reduce period pain, period flow and those simply to prevent pregnancy. Advertising can also inform patients of new drugs which may be appropriate for conditions which they suffer from (such as recent asthma drugs which reduce the frequency of attacks) but which their doctor might overlook or not have the time to crosscheck against their list of patients. 56% of AMA GPs believed that direct to consumer advertising had prompted some of their patients to seek treatment for a condition which would have otherwise been neglected. If a patient has taken the time to actively consider a particular drug and then visits their doctor, whether they are prescribed it or not, they are building up a positive relationship with their doctor and are more likely to continue to take an active interest in their health. |
[ ][ ]NoIf a patient sees a drug which is inappropriate for them and asks their doctor for it, if their doctor does not prescribe it they may ignore them and seek a second or third opinion. In private health care systems it is likely that economic pressure will result in a doctor eventually agreeing to the patient’s demand. In nationalised health services ‘pester power’ has resulted in doctors giving in to patients in the past rather than arguing with them (for instance the massive over-prescribing of antibiotics by British GPs for viral infections against which they are ineffective). If the doctor prescribes another drug (perhaps a cheaper generic version) even if it is chemically identical to the branded and advertised drug, the reverse-placebo effect may result in the drug being less effective than it should be because the patient believes it is a weaker treatment. They may also be less willing to complete the course or visit that doctor again thereby undermining the doctor-patient relationship. Prescription medicines are fundamentally complex and dangerous things, which is why they require a prescription by a qualified doctor. It is not helpful to have a patient who lacks the decade of medical training a GP has self-diagnosing on the basis of an advert. |
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[ ][ ][ ][ ][ ][ ]Argument #3 | |
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[ ][ ]YesAlthough drugs are expensive to research and develop, they are usually very cheap to produce and tend to sell for a few dollars. Many drugs can prevent or reduce the likelihood of a patient requiring surgery (for instance anti-cholesterol drugs can reduce the build up of atheroma in blood vessels, which cause cardiovascular heart disease and strokes, thus reducing the likelihood of a heart bypass being required and improving any post-stroke rehabilitation). This not only saves money but is also better for patients. Surgery involves the risk of complications as well as taking time both directly and in post-operation rehabilitation. Many degenerative conditions can be best treated by early intervention; if patients are aware of the drugs that are available at an early stage they are more likely to take them, thereby increasing their standard of living and reducing their long-term cost to state or private health cover providers. |
[ ][ ]NoDrug costs are spiralling upwards and are increasing at a faster rate in the United States than anywhere else in the world (roughly by 25% year on year since the mid-1990s). This growth has mainly driven by patients demanding advertised drugs (they accounted for half the 2002-2003 increase, for instance). Advertised drugs are always more expensive than generic rivals because of the branding and advertising costs, as well as the increased price the manufacturers can demand for a snappily named product. In private health care systems this means that insurance premiums increase, thereby pricing large numbers of people out of health cover (44 million Americans have no cover despite the United States spending more per capita on health care than any other country). Alternatively, it forces many people to select insurance packages with lower cover (the solution introduced in 2005 by the Bush administration). The EU has estimated that its member states with public healthcare systems would be crippled if they spent as much on drugs as the United States. |
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[ ][ ][ ][ ][ ][ ]Argument #4 | |
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[ ][ ]YesWe should not attack drugs companies for making profits from their products, nor for encouraging patients to use them. Each new drug costs an average of $500m to produce and very few drugs that are researched ever make it to the market. The more profitable the industry, the more new drugs it can afford to research and develop and thus the more patients who can be treated appropriately. Many of the complex cures being developed for diseases like cancer, HIV/AIDs, SARS and Avian ‘Flu will take decades to research; in the meantime drug companies require funding streams from other drugs to continue research. |
[ ][ ]NoAdvertising reduces the incentive for research into new drugs as companies have found the returns on investment in advertising are better than those on research and development. This is particular the case as it has become increasingly difficult to find a ‘blockbuster’ drug as new drugs are increasingly simply minor adjustments to existing ones. Significant step changes to the way drugs are researched are needed for scientific advance but such changes are expensive and carry high risks of failure. Much lower risk is for a manufacturer to relicense existing drugs for new markets and new consumers, thereby allowing them to re-brand the drug. Total spending on DTCA in the US has increased from $700m in 1997 to more than $4bn in 2004 as its effectiveness became apparent to the drug companies. Arguably this rush to promote the wider use of existing drugs was one of the reasons for Merck’s decision to push Vioxx as a solution to a wide range of acute pain conditions; a decision which they reversed in 2004 after a series of studies revealed the drug caused a significant increase in the risk of heart attacks, something which Merck is accused by some of already having known. |
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[ ][ ][ ][ ][ ]Argument #5 | |
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[ ][ ]YesIn states where there is no direct to consumer advertising but there is advertising to doctors, patients are disadvantaged because it is in the interest for private medical insurance firms or national health services to keep information about expensive new drugs from patients. In the UK it was on ground of cost that the Primary Care Trusts (PCTs) refused to allow the prescription of Herceptin, a drug which US studies have shown reduces the damage done by breast cancer. Ultimately pressure from Roche, the drug’s manufacturer and from patients resulted in the drug being authorised for use, but the process was much faster in the US where Roche could run adverts alerting consumers to the potential benefits of Herceptin thereby immediately giving patients access to a similar level of information as their doctors and allowing them to push for its authorisation. |
[ ][ ]NoAdvertising to patients promotes a ‘pill for every ill’ mentality as the drug industry seeks to ‘create’ new markets for its drugs by convincing patients that a pill can solve their problems. This leads both to greater hypochondria and to self-diagnosis of normal conditions as medical ones. For instance in October 2001 GSK ran adverts for Paxil in the New York Times claiming the drug would solve chronic anxiety, when the events of 9/11 rather than a medical condition were probably to blame for New Yorkers being stressed. The FDA declared in a 1999 study that fewer than one in four new drugs have any therapeutic value and the medical community now accepts that prevention through lifestyle choices is often the best way to tackle disease (for instance rather than seeking a weight loss or diabetes wonder-pill, childhood obesity should be tackled through exercise and healthy eating). Pill-popping seems easier and so is more attractive to many patients but in practice it is worse for the long term health of society. |
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