New Zealand is one of only two developed countries, along with the US, that permits direct-to-consumer advertising of prescription medicines, and it needs to stop, writes Dr David Menkes. 

It’s been a long time coming: a new Consumer report makes it clear that most New Zealanders want to see a ban on the direct-to-consumer advertising (DTCA) of prescription medicines.

The release of the Consumer report is timely, as it coincides with the government’s review of submissions on a draft Therapeutic Products Bill which will determine whether such advertising will be allowed and, if so, under what conditions.

DTCA has been a contentious issue in New Zealand, one of only two developed countries (the other being the US) that permit such advertising. How did we find ourselves in this position? It may be reassuring to some that New Zealand has never passed a law allowing DTCA; rather, our outdated and soon to be replaced legislation (the Medicines Act 1981) failed to anticipate and thus made no provision for the regulation of DTCA as it emerged and developed during the following three decades.

What’s the problem with DTCA? For many years, doctors have been concerned that DTCA presents a biased, overly optimistic picture of advertised medicines and prompts patients to request treatments they don’t need. Advertised products are usually new, branded medicines with a premium price tag; for these reasons, DTCA has also been linked to increases in pharmaceutical expenditure.

Another problem with the advertising of newer medicines is that their range of side effects may not be fully appreciated when first marketed; indeed a number of intensively advertised drugs (such as the painkiller Vioxx) have later been withdrawn from the market when they were later understood to produce serious side effects, for example elevated rates of heart attacks and even death.

There is evidence, too, that DTCA is commonly misinterpreted as trusted public health information, and differentially affects “at risk” communities and those with unhealthy lifestyles that might be better managed with diet or exercise.

There is little doubt that DTCA affects the doctor-patient relationship; consultations are often coloured (and prolonged) by doctors’ need to interpret and respond to patient requests. In light of this, and the risks outlined above, it is unsurprising that a variety of professional bodies including the New Zealand Medical Association, the Royal NZ College of General Practitioners and others have all issued strong statements against DTCA.

The previous National government refused to consider banning DTCA, as one might expect from their usual reluctance to interfere with the “free market”. Notably, however, one National MP has publicly stated his opposition to DTCA. Dr Shane Reti’s views may have something to do with the fact that he is also a general practitioner.

So, who’s in favour of DTCA? As one might expect, drug companies are keen to market their products and are consistent supporters of DTCA here and overseas. A distinction needs to be made, however, regarding what is being advertised; in the case of over-the-counter medicines and other health products, such marketing is a normal and expected function of a company seeking to sell their goods. On the other hand, DTCA refers to the marketing of prescription medicines directly to consumers.

Herein lies the rub: those responding to the ad need a doctor or other prescriber to essentially validate their consumer choices. These ads are easy to recognise, as they typically end with the memorable phrase “Ask your doctor if Expensol (or other branded medication) is right for you”. Involving the doctor-patient relationship in the marketing of drugs is a cardinal feature of DTCA, providing the basis for both professional and comedic critiques.

Supporters of DTCA have claimed that it provides useful information and empowers individual choice; both clinicians and patients describe examples of how ads can prompt appropriate, sometimes lifesaving, visits to the doctor. Partly for this reason, professional bodies and others lobbying for the elimination of DTCA have proposed a health information strategy to fill the “gap” left by DTCA. Such an agency could both promote health literacy and provide unbiased and accessible health information to the public, including pharmaceutical and other treatment options.

While government support for such a strategy will be necessary, freedom from political and commercial influence is also important. New Zealand consumers clearly want access to reliable health information, and it is also notable how keen they are to protect the doctor-patient relationship from external influences such as industry sponsorship and DTCA.

The government’s draft Therapeutic Products Bill specifically considers how DTCA should be regulated. To assess the viability of different approaches, we reviewed the effectiveness of three distinct regulatory models that had been tested in the US: government regulation, industry self-regulation, and a mixture of the two. Recent studies demonstrate that DTCA in the US continues to be misleading and contains minimal if any educational value, despite the best efforts of the government’s watchdog, the FDA.

Other regulatory models prove to be equally unsuccessful. Taken together with New Zealand and international evidence that regulation has consistently failed to prevent inappropriate promotion and overuse of prescription drugs, these findings suggest that DTCA is more likely to cause harm than benefit and should be banned.