This House would allow pharmaceutical companies to advertise directly to consumers

Drug companies like Glaxosmithkline (GSK) and Merck are amongst the most profitable companies in the world. Arguably the drugs they research and produce are among the most important products any company sells. Although the proposition could choose to discuss the advertising of non-prescription drugs, a better debate can be had over prescription drugs (drugs requiring a doctor’s authorization before a pharmacist can dispense them to a patient) because states across the world have taken very different positions on the issue. Only two countries currently allow the practice: the United States and New Zealand. However it has been considered elsewhere, including a proposal by the European Commission in 2001, which suggested limited direct-to-consumer advertising (DTCA), but which was rejected in 2003.

While the EU does not have a regulated system some of the countries have certain exemptions for advertising: In France, DTCA (Direct To Consumer Advertising) of non-prescription medicines is permissible only if purchasers are not reimbursed by the social security system. Moreover, disease awareness campaigns are considered legal only if such campaigns do not refer directly or indirectly to the product or therapeutic class. In Spain, DTCA is allowed only for medicines that treat minor symptoms.[1]

Outside the US, New Zealand, Bangladesh and South Korea allow limited DTC (Direct to Consumer) advertising, while in some other markets limited advertising has been permitted for certain vaccines.  The most attention, however, has been on whether Europe will ever permit DTC — particularly as European regulators have often adapted a number of U.S. regulations for the region.[2]

The U.S. system dates from 1997 legislation and is administered by the Food and Drug Administration (FDA). All adverts, which are predominantly television or print in form, must include a written (and voiced in the case of TV adverts) list of possible side effects and risks, as well as a phrase insisting consumers ask their doctors whether the drug is appropriate for them. They now account for a large proportion of the US advertising market and are blamed by some for the rapid increase in US health costs. Others defend advertising as a helpful tool for matching the right drugs to the patients that need them. Should we allow direct advertisement of the prescription drugs to consumers or should the products be advertised mainly to physicians, as is the practice in Europe?  

 

[1] Pharmaceutical direct-to-consumer advertising in Europe, PF Pharmaceutical Field Online Feature, http://www.pharmafield.co.uk/features/2005/12/Pharmaceutical-direct-to-consumer-advertising-in-Europe, accessed 07/29/2011

[2] Jessop N., Will DTC Advertising appear in Europe ?, published 01/07/2011,  http://pharmtech.findpharma.com/pharmtech/article/articleDetail.jsp?id=702161, accessed 07/29/2011

Title 
Advertisements for prescription drugs are not significantly different from any other advertisement
Point 

Advertising serves an important purpose by informing the public about a specific product. It is also regulated from manipulation, and therefore deserves no special restrictions; these same restrictions and watchdogs would be in place if advertising of drugs were allowed to make sure that no drug is misrepresented. We trust consumers to view adverts with a level of skepticism 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 drug trials (including the ones that fail) online and there are plenty of other sources of information on drugs available. A drug that remains unused is a drug that 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[1].

When the first discussion in the European Parliament was started, regarding the advertisement of pharmaceuticals, the pharmaceutical industry specifically pointed out the anomaly that exists: “Specific laws stood in the way of it communicating with patients over its products, even when others could. Presumably, this meant information was communicated by the media about new medicines. In this regard, the restrictions on the pharma industry contrast with the freedom enjoyed by manufacturers of vitamins and herbal remedies, who routinely advertise products to patients.”[2] This shows that it is unjust to make any differences between the companies.

 

[1] Debate: Should Drug Companies be allowed to advertise prescriptions direct to the public. http://toostep.com/debate/should-drugs-companies-be-allowed-to-advertise-prescription

[2] Jessop N., Will DTC Advertising appear in Europe ?, published 01/07/2011,  http://pharmtech.findpharma.com/pharmtech/article/articleDetail.jsp?id=702161, accessed 07/29/2011

Counterpoint 

Advertising 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 if there were no return on this investment. 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 advertisements, because advertisements were being produced in which the list of side effects was read at too fast a pace to be understood.

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.[1]

[1] FDA: Direct-to-Consumer Advertising of Prescription Drugs:Looking Back, Looking Forward, published October 2005,  www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/ucm095993.ppt, accessed 08/07/2011 

Title 
Patients will be better informed than under the status quo
Point 

Advertising prescription drugs enables patients to learn, and to request innovation faster in order to benefit from the new drugs that health personnel still have not gotten used to.

Advertising increases consumer awareness of drugs, which makes consumers 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 under current rules is used to 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 her list of patients.[1]

56% of AMA general practitioners believed that direct-to-consumer advertising had prompted some of their patients to seek treatment for a condition which would have otherwise been neglected.[2] 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.

Further on, in 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 because 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 authorized for use, but the process was much faster in the US where Roche could run advertisements alerting consumers to the potential benefits of Herceptin, and thereby immediately giving patients access to a similar level of information as their doctors and allowing them to push for its authorization.

 

[1] Patient View – for improving patient care, Information on prescription medicines: the views of EU-based patient groups, http://www.patient-view.com/projects4.htm, accessed 08/07/2011

[2] Lyles A., Direct Marketing of Pharmaceuticals to Consumers, Annual Review of Public Health, published May 2002,  http://www.annualreviews.org/doi/full/10.1146/annurev.publhealth.23.100901.140537, accessed 08/08/2011

Counterpoint 

Many ads don't include enough information on how well drugs work. For example, Lunesta is advertised by a moth floating through a bedroom window, above a peacefully sleeping person. Actually, Lunesta helps patients sleep 15 minutes faster after six months of treatment and gives 37 minutes more sleep per night. The Majority of ads are based on emotional appeals, but few include causes of the condition, risk factors, or important lifestyle changes. In a study of 38 pharmaceutical advertisements researchers found that 82 percent made a factual claim and 86 percent made rational arguments for product use. Only 26 percent described condition causes, risk factors, or prevalence.[1] Thus not giving the patients balanced information that would make them aware, that taking one of the pills is not a magic solution to their problem.

Actually, according to a study conducted in the US and New Zealand, patients requested prescriptions in 12% of surveyed visits. Of these requests, 42% were for products advertised to consumers and consumers could not recall more than 4 different products of medicine.[2]

This proves that the decisions made by the patients are not more informed and mainly only pressure to the advertised drugs. 

[1] Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising. Ann Fam Med. 2007 January; 5(1): 6–13.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783924/

[2] Mintzes B. and co-workers, Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey, BMJ 2002,  http://www.bmj.com/content/324/7332/278.full.pdf, accessed 08/01/2011

Title 
Advertising will enable patients to get better treatment earlier in their illnesses
Point 

Advertisements—especially those that identify symptoms—can lead to a healthier citizenry, as consumers become aware of their diseases earlier, and can thus find the drug that targets their problem at an earlier stage. Many drugs can prevent or reduce the likelihood of a patient requiring surgery (for instance anti-cholesterol drugs can reduce the buildup 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.

Also 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.

Counterpoint 

This leads to patients requesting drugs they do not need and in many cases are even harmful to them.

The prescription drugs are very different from freely available drugs. They often treat serious diseases, and so advertising those should target mainly people that are very ill and especially vulnerable. On the other hand, with direct-to-consumer advertising, many people who do not have a serious disease become convinced that they need the prescription drug, because the advertisements scare them.

Because of such advertisement, in the U.S. there was a rapid widespread exposure to dangerous drugs before risks were fully recognized, as with troglitazone (Rezulin) for diabetes and cisapride (Propulsid) for nighttime heartburn. Causing people to become more ill instead of healthier, because this leads to a higher “self-diagnosing”. [1]

[1] Health Information Action, Direct-to-Consumer Prescription Drug Advertising The European Commission’s Proposals for Legislative Change, September 2011, http://www.haiweb.org/campaign/DTCA/BMintzes_en.pdf, accessed 08/07/2011

Title 
Adverts generate profit. Profit funds research into improved drugs
Point 

We 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 small percentage of the drugs that are researched ever make it to the market.[1] The more profitable the industry, the more new drugs it can afford to research and develop and thus the more patients who can receive appropriate treatment. 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.

Drugs have become increasingly expensive and advertisement helps to cover those costs. From 1980 and 2004, from about $6 billion (in 2005 dollars) to $39 billion. There has been a real growth rate of about 8 percent a year, on average.

By comparison, drug firms’ gross margins—sales revenue minus costs and income taxes—have been increasing more slowly, by about 4 percent annually.[2]

So, with more personalized medicine and greater costs in drug development, the industry needs a greater source of revenue in order to research therapeutics further.  Advertising would provide this revenue.

[1] Hollis A., Me-too drugs: is there a problem ?, University of Calgary, published December 2004,  http://www.who.int/intellectualproperty/topics/ip/Me-tooDrugs_Hollis1.pdf, accessed 08/08/2011

[2] Congres of United States, Research and Development in the Pharmaceutical Industry, October 2006,  http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf, accessed 08/01/2011

Counterpoint 

Actually prescription drugs are generally sold expensively worldwide, especially in North America and receive enormous profits, regardless of the advertising. Companies actually have enormous budgets dedicated to advertising, in countries where it is legal. They are required to spend this money because they have to compete with other companies that are advertising their products, but if there were no advertising, they could spend the money on more research.

The pharmaceutical industry has been the most profitable industry in America for each of the past 10 years and, in 2001, was a five-and-one-half time more profitable than the average for Fortune 500 companies[1]. Moreover, in Canada, the sale of a typical patented branded drug would bring about a profit margin of almost 70%[2].

 “U.S. Pharmaceutical Launches: Marketing Spend and Structure" reveals that the average blockbuster brand in the United States allots 49% of its budget to fulfill advertising needs.  This hefty allotment is attributed to the fact that most blockbuster brands target a mass-market audience that requires large-scale advertising.[3]

Advertising 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 particularly the case as it has become increasingly difficult to find a ‘blockbuster’ drug (because increasingly, new drugs are minor adjustments to existing ones). Significant changes to the way drugs are researched are needed for scientific advancements, but such changes are expensive and carry high risks of failure. It is of much lower risk is to the manufacturer to relicense existing drugs for new markets and new consumers, thereby allowing them to re-brand the drug[4].

So they do not use the money mainly for research for new therapeutics, but spend nearly half of it on advertisements to maximize their profit even more.

 

[1] CIBC World Markets (2003) 2003 Investors' Guide to The Canadian Drugstore Industry, published 2003,  http://www.envoycapital.com/includes/docs/drugstore_industry.pdf, accessed 07/30/2011

[2] Families USA (2002) Profiting from Pain: Where Prescription Drug Dollars Go,  http://www.familiesusa.org/assets/pdfs/PPreport89a5.pdf, accessed 07/30/2011

[3] PR Newsmedia – United Business Media, Pharmaceutical Advertising: United States vs. Europe, published 12/22/2010,  http://www.prnewswire.com/news-releases/pharmaceutical-advertising-united-states-vs-europe-55640307.html, accessed 07/29/2011

[4] Turning ideas into products- a pharmaceurtical paradigm shift. http://www.paconsulting.com/our-thinking/turning-ideas-into-products-a-pharmaceutical-paradigm-shift/

Title 
Creating a mentality of illness
Point 

Advertising 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 advertisements for Paxil in the New York Times, claiming the drug would solve chronic anxiety. These advertisements came at a time when the events of 9/11—rather than a medical condition—were probably to blame for New Yorkers’ stress. The FDA declared in a 1999 study that fewer than one in four new drugs has 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. By allowing the prescription drugs to be advertised we are making more people believe they are ill and need pills for them, rather than explaining to them that their back pain and high blood pressure are problems caused by their lifestyle choices.[1]

 

[1] Health Information Action, Direct-to-Consumer Prescription Drug Advertising The European Commission’s Proposals for Legislative Change, September 2011, http://www.haiweb.org/campaign/DTCA/BMintzes_en.pdf, accessed 08/07/2011

Title 
Advertising puts pressure on doctors to prescribe inappropriate drugs to their patients
Point 

If a patient sees a drug that is inappropriate for him, and asks their doctor for it, if his doctor does not prescribe it, then he may ignore his doctor 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 nationalized health services ‘pester power’ has resulted in doctors giving in to patients in the past rather than arguing with them (seen, for example, in the massive over-prescribing of antibiotics by British general practitioners 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. The patient may also be less willing to complete the prescription, or to visit that doctor again, thereby undermining the doctor-patient relationship.[1]

Prescription medicines are fundamentally complex and dangerous, 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.

 

[1] FDA: Direct-to-Consumer Advertising of Prescription Drugs:Looking Back, Looking Forward, published October 2005,  www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/ucm095993.ppt, accessed 08/07/2011

Counterpoint 

The majority of products that are advertised treat currently under-treated conditions. Drugs dealing with diseases such as depression, diabetes, and high cholesterol are some of the most frequently advertised. These advertisements can help inform viewers about their conditions, and prompt visits to physicians, who can help treat the problem early on. 

Additionally, informed citizens are good for society, as physicians do not always recommend necessary or helpful drugs. In the status quo, patients do not visit their doctors often enough to be diagnosed. Only approximately half the patients in America get beta blockers after a heart attack. Clearly, an advertisement for beta blockers would be informational, rather than harmful.

Title 
The costs and effects of advertising will place an additional burden on the healthcare system
Point 

Allowing advertising places an additional burden on the health care system.

As a result of advertising, if it were allowed, many patients would request the more expensive brand drugs and so place an additional burden on the public health care system. The offered generic drugs have the same effect; they are simply cheaper because they do not spend several millions on advertising.

Drug costs 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 been 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 that manufacturers can demand for a snappily named product. In private health care systems, this drives up insurance premiums, thereby pricing large numbers of people out of health care coverage (44 million Americans have no coverage, 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 levels of coverage (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[1].

Actually estimates in the United Kingdom state that, by buying generic drugs, the public health care system could save more than £300m a year. General practioners could make more use of cheaper, non-brand versions of the drugs, without harming care. An example of the NHS overpricing drugs: one treatment for gastric problems, Omeprazole, can be bought from wholesalers for between £2.50 and £3.40, yet the NHS pays £10.85 every time it is prescribed. To make the matter worse, doctors often over-prescribe; at least £100m could be saved if they were more careful in this matter.[2]

Therefore, because it would create a substantial financial burden to the current public health care system, allowing advertising would be a bad idea.

 

[1] Heath Care in the United States. http://en.wikipedia.org/wiki/Health_care_in_the_United_States

[2] BBC News, Drug profiteering claims denied, published 03/14/2004,  http://news.bbc.co.uk/2/hi/uk_news/scotland/3511102.stm, accessed 07/30/2011

Counterpoint 

According to a financial study conducted by the Villanova School of Business explained that there is no significant burden to the health care system due to direct-to-consumer advertising. The study, conducted in the years 2001 – 2005 in the United States, shows that there is no significant relationship between advertising and price sensitivity. The comparison with other countries shows, the prices of pharmaceuticals and the price for health care (for drugs) have not risen in the United States.

Through advertising, after the introductory phase of a drug, the health system is not burdened more. Simply put people are just able to choose between drugs, in a comparable price range easier and therefore do not cost additional money to the state.[1]

So a greater financial burden is no excuse from prohibiting companies to advertise products.

 [1] Villanova University, DOES DTC ADVERTISING RAISE PRICE? THE IMPACT OF

PHARMACEUTICAL ADVERTISING ON CONSUMERS’ PRICE SENSITIVITY, published 2005 http://www.brandweeknrx.com/files/dtc_drug_advertising_and_drug_prices_study.pdf, accessed 08/07/2011

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