The business of marketing medicine use

MEDICAL MATTERS:Even doctors' choices can be influenced

WHAT’S YOUR favourite TV commercial? For me, it’s the one in which the hero overcomes all sorts of challenges “all because the lady loves Milk Tray”.

But what about the advertising of drugs, not chocolate? When it comes to marketing prescription medicines, New Zealand and the US differ from the rest of the world. They allow direct to consumer (DTC) advertising. By 1999, the average American was exposed to nine prescription drug commercials on TV a day.

A decision by the European Parliament last year to add print media to a European Commission proposal banning the advertising of prescription medicines on TV, radio and the internet suggests we won’t be seeing or reading any such ads in the foreseeable future. Encouraged by MEPs, including Nessa Childers, the legislators’ decision should ensure that only accurate, independent and unbiased health information is made available to patients.

A 2007 study by the University of California, which looked at how 38 television ads for prescription drugs attempted to influence viewers, found that 85 per cent of the ads portrayed taking certain medication as a way for people to regain control of their lives.

The research, published in Annals of Internal Medicine,showed that American television viewers see as many as 16 hours of prescription drug ads each year. Dr Dominic Frosch and his colleagues found that, while most ads made some factual claims, just a quarter described causes, risk factors or disease prevalence. The ads often framed medication use in terms of losing control (58 per cent) and regaining it (85 per cent) over some aspect of life and as engendering social approval (78 per cent). Products were frequently portrayed as a medical breakthrough.

The researchers concluded that ads provide limited information about the causes of a disease or who may be at risk; they show characters who have lost control over their social, emotional or physical lives without the medication; and they minimise the value of health promotion through lifestyle changes.

What about the advertising of drugs to doctors? A paper published today in the Canadian Medical Association Journaladds another dimension to the topic. German and Canadian researchers looked at 11 journals read by German physicians in 2007. They largely compared free journals – those paid for solely by advertising – to journals funded by subscriptions.

The authors found more articles that mentioned the selected drugs in the free publications than in the subscription publications. They also found that nearly all of the articles in the free publications depicted the drugs in a positive light. In two of the free publications, the presence of an advertisement for a drug more than doubled the odds of an article appearing in the issue that made a positive recommendation for its use.

Physicians rely heavily on journals for medical information. Many of these, which rely on advertising for revenue and contain easy-to-read summaries of published research, are sent free to doctors. Others, such as the Lancetand the British Medical Journal, are peer reviewed and are generally accessed by subscription.

Dr Annette Becker of the University of Marburg, Germany, and her co-authors conclude: “Free journals almost exclusively endorse the use of the selected drugs, whereas journals that rely exclusively on subscription fees for their revenue are more likely to recommend against the use of the same drugs . . .

“Physicians need to be aware of these biases when using medical education materials in free medical publications.”

So is there a need to regulate the advertising of drugs to doctors? If covert promotion contributes to the overuse of certain drugs or questionable off-label use, then the answer must be yes. And regulatory bodies must ensure that doctors are not allowed to gather continuing education points by using free journals.