Govt should move now to ban drug advertising

If the Government is serious about supporting PHARMAC’s mission of getting best value for money in pharmaceuticals, it should take steps now to ban direct marketing to consumers, writes the University of Auckland's David Menkes and La Trobe University's Dr Deborah Gleeson

New Zealand and the US are the only two industrialised countries which still allow drug companies to advertise directly to consumers. Pressure has been growing for New Zealand to follow the global trend and ban the practice, but unless the Government acts very soon, any change of policy could be prevented by the rebranded Comprehensive and Progressive Trans-Pacific Partnership (CPTPP).

The issue of Direct-To-Consumer Advertising (DTCA) of prescription drugs is particularly relevant right now. The Government is currently revising the Medicines Act so this would be a perfect opportunity to regulate the practice or, better still, phase it out altogether. However, if the CPTPP is signed and ratified in its current form, its Investor-State Dispute Settlement (ISDS) mechanism would enable companies to sue the NZ Government if new legislation was seen to harm company profits – for example, by restricting DTCA.

The reason most countries have banned this type of advertising is because of the harmful effect it has on rational prescribing, pharmaceutical expenditure and health outcomes. The practice prompts people to see their doctor and ask for advertised drugs by name. Doctors find these requests distracting. They are forced to choose between complying by writing a prescription, or taking time to explain why an advertised product may not be appropriate.

The practice inflates prescription costs by creating demand for particular, usually patented, products and shifting demand away from cheaper alternatives. It has been associated with distorted drug information, unnecessary prescriptions and reductions in the overall quality of prescribing. Furthermore, recently licensed drugs are often promoted via DTCA, and there have been occasions where serious side effects have emerged following commercial release and the product subsequently withdrawn.

Efforts to ban DTCA in New Zealand have attracted widespread support from doctors, their representative bodies, and consumer groups. Unsurprisingly, the pharmaceutical industry wants DTCA to continue, and argues that the practice helps to empower patients and support informed choice.

Many health professionals regard this argument with scepticism, particularly in light of the fact that DTCA is an important promotional tool, and the industry spends nearly twice as much on marketing as on research and development.

More recently, concerns have been expressed about how, even in countries that have banned DTCA, pharmaceutical companies circumvent restrictions by promoting ‘disease awareness’ while avoiding specific mention of their products. Similarly, direct-to-consumer marketing of medical testing has developed into a highly profitable variation on the theme of exploiting the public’s health anxieties and often unsophisticated understanding of risk. These developments indicate the industry’s creativity in identifying and exploiting weaknesses in DTCA regulation and suggest that continued vigilance is needed even when restrictions or bans are in place.

The first trade agreement to specifically mention DTCA was the Australia-US Free Trade Agreement (AUSFTA), which came into force back in 2005. The US, which hosts the headquarters for many of the world’s transnational pharmaceutical companies, wanted to add a clause that would legalise DTCA via the internet. However, through clever wording that referenced domestic laws, regulations and procedures, Australia was able to extend and maintain its ban across all advertising media.

However, a subsequent trade agreement between the US and South Korea had omitted this crucial reference, raising a large question mark over the effectiveness of that country’s DTCA ban.

If the Government is serious about supporting PHARMAC’s mission of getting best value for money in pharmaceuticals, it should take steps now to ban DTCA, in accord with previous Labour Government policy, and make good on its support for improved and independent consumer health information. There are thus a variety of reasons – political, fiscal and clinical – to set these legislative wheels in motion, and to do so before CPTPP ratification.

-Associate Professor David Menkes is from the School of Medicine at the University of Auckland and Dr Deborah Gleeson is from the School of Psychology and Public Health at La Trobe University, Melbourne.

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