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Living in a free world - should we advertise prescription drugs?

New drugs have revolutionised medicine and are becoming more easily available. So why are the only people not allowed to supply information on a particular medication - or the disease it treats - the drug manufacturers themselves?

Under UK law, pharmaceutical companies cannot provide any additional information about their prescription products. The patient only receives the leaflet that accompanies the medication. The drug companies say this legislation is illogical, unnecessary and ultimately fails to benefit people who really need the drug.

Where will it all end?

Up until mid-October, the European Commission was inclined to agree. It proposed a pilot scheme to relax rules on promoting drugs, allowing pharmaceutical companies to supply information about the treatment of three conditions: AIDS, diabetes and asthma.

However, on a first reading in the European Parliament, MEPs voted against the proposal. The ministers said the scheme would give drug companies a foot in the door to promote products in newspapers, magazines and on television - as is already the case in the US and New Zealand.

Pharmaceutical companies cannot be trusted to provide impartial advice and so any information on new drugs should only come through an independent source, they argued. The Consumers' Association agreed wholeheartedly; the Association of the British Pharmaceutical Industry (ABPI), unsurprisingly, did not.

However, patients' groups and medical associations want further discussion and are arguing about how new drugs should be brought to people's attention.

People power

At the heart of the issue is the question of the extent to which individuals can be expected to make their own decisions when it comes to medication.

Spokesman for the ABPI Richard Ley says times have changed and the law needs to change too. "The days of going to a doctor and being given a prescription that you just take three times a day - you may not even know what was wrong with you - are long gone."

Instead, he says, people are learning about their own health and which drugs are out there to help. "They want to know more about a condition, but the people who actually produce drugs to tackle it are not allowed to tell them."

He says patients would benefit from more information about the condition itself, the possible side effects and how a medication interacts with other drugs.

Brand power

But pharmaceutical companies' motives are never going to be purely humanitarian, as the Consumers' Association is keen to point out. "Any changes to the law allowing the pharmaceutical industry to directly market drugs to the public would not better inform patients on disease treatment, but would merely increase drug brand awareness, fuelling fears of a hypochondriac society," it said in a statement.

The group says the drug bill in the US increased by 84 per cent between 1993 and 1998 because people simply started taking more prescription drugs. Only four types of drug contributed to 30 per cent of this increase. And of the 10 most heavily advertised drugs, seven fell into one of these four groups.

Companies also favour promoting drugs that they still have under patent, instead of older and cheaper alternatives. That drug companies in the US now spend more on advertising existing products than they do researching new drugs is proof to many that relaxing the rules would be detrimental.

At the patient's request

But Richard Ley denies that changing the law would lead to drug commercialisation. "We cannot ever sell direct to the patient, they always have to go through a doctor. We're not talking about advertising, we're talking about providing information."

Again though, a study in the British Medical Journal in February 2002 found that doctors in the US and Canada were more likely to prescribe a particular medicine if it was requested by a patient. It concluded, "Concerns about opening up the regulatory environment... seem well justified."

But neither side meets the approval of chief executive of the Patients' Association, Mike Stone. "We are asking for an open debate and to stop treating patients maternally," he says. "So long as the information given is good, we have no problem. Patients are grown-up now and they're not stupid either."

A centralised approach

Mike is against a US-style approach to drugs, but points out that Europe's laws are already falling behind. "You go to a GP or specialist to get the product but you can easily go to a US website to get the information," he points out.

Instead, he sees a national information bureau that monitors all drug information (the drugs industry is largely self-regulated) and which includes lay people, as the way forward.

That future lies in the balance while the EU Council of Ministers reviews amendments made by the European Parliament. Spokesman Ton Huyssoon says there have been quite a lot of changes to the directive. The Council of Ministers will issue a "common position" next month or possibly early next year, he says, but it is "difficult to predict" what it will decide.

But even if the council accepts the amendment and abandons the pilot scheme, something is going to have to give. Patients are becomingly increasingly aware of what drugs are available and are hungry for information. The main challenge is therefore going to be satisfying this desire, while maintaining a safe, ethical health service.

Further information:

The Consumers' Association
Association of the British Pharmaceutical Industry
Patients' Association

Link to this story on Discovery Health

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