Direct Tv Reviews

A worried-looking woman is pictured walking along a crowded New York sidewalk. The headline reads: "Millions suffer from chronic anxiety. Millions could be helped by Paxil."

This was an advertisement published in the New York Times Magazine lust weeks after the attacks of 11 September, when any reasonable New Yorker might have been expected to feel more anxious and worried than usual. Paxil is an antidepressant available on prescription for those suffering from depression and anxiety. Whether the advert is an example of gratuitous marketing or empowering people remains unclear.

The advertising of prescription medications to consumers, rather than doctors, is legal in just two countries, the US and New Zealand. In 2000, it was estimated that US pharmaceutical companies spent just under $2.5bn ([pounds sterling]1.7bn) on what is known as "direct-to-consumer" advertising. More than half of this, $1.6bn ([pounds sterling]1.1bn), was spent on TV adverts -- the average American is said to watch nine TV advertisements for pharmaceuticals every day.

At present, any advertising of drugs to consumers is banned in the UK. But that might change. The European Commission recently announced plans to relax controls on the marketing of medicines directly to consumers. Consumer groups fear that this is the first step towards allowing the full-blown advertising of drugs to patients.

Opponents argue that such adverts contribute to rising prescription costs by inducing consumer demand, especially for newer, more expensive drugs.

More worrying still, those drugs may be at best unnecessary and at worst inappropriate. Recent research found that patients who requested particular brands of drug after seeing advertisements were nearly nine times more likely to get what they asked for than those who simply sought a doctor's advice. But about half of the doctors later admitted that they might not have prescribed the same drug had the patient not specifically asked for it.

Another accusation levelled by opponents to direct-to-consumer advertising of pharmaceuticals is that it is "disease-mongering", encouraging healthy people to believe that they need medical attention. The heavy marketing of drugs for anxiety, baldness and shyness are cited as examples of this. The growing medicalisation of trivial complaints explains why more than 80 per cent of Americans admit to taking some sort of drug at least once a week.

Such fears have led to a backlash against pharmaceutical advertising in the US and New Zealand. In both countries, large-scale reviews were prompted by concerns about biased information and rising prescription costs. Further restrictions are now being considered, but both countries have stopped short of a total ban.

Proponents argue that pharmaceutical advertising can help improve the public's health by educating people about conditions and treatment options.

If the football coach Dan Reeves grinning out from the pages of Newsweek, with the caption "Taking care of my cholesterol has become an important part of my game plan", makes a 55-year-old man with previously undetected high cholesterol consult his doctor, the advertisement (in this case, for the cholesterol-lowering drug Zocor) has raised awareness, informed and empowered, and possibly saved a life.

If such people are persuaded to consult a doctor, then fewer are likely to end up in hospital needing expensive bypass surgery. So advertising, far from pushing up costs, can save money. Such advertising could even drive down the cost of the drugs themselves. According to a report from the US Institute for Policy Innovation, advertising lowers costs by expanding consumer awareness and increasing sales.

In the US, TV advertising only really took off in 1997, with a change in the regulations. Before that change, the rules required advertisers to include tedious lists of possible complications and side effects -- making short, snappy TV ads out of the question. Adverts still have to make clear that the drug is not suitable for everyone, as well as list a Few major risk factors and refer viewers to sources of more information. But companies can now use more of their expensive TV airtime to concentrate on projecting an image to their target audience.

In Europe, including Britain, the advertising of prescription-only drugs is heavily regulated, permitted only to those who can prescribe, ie, doctors. This forces pharmaceutical companies and their press agents to entice journalists and medics to write favourable words about their products in the national media. Or pharmaceutical giants to fund patient support groups, or run disease awareness campaigns.

Many have pointed out that the ban is nonsense when you can simply log on to the web and read all about the drugs -- who cares that the small print on the pharmaceutical sites reads for "US residents only"?

The accessibility of US drug information is one of the reasons behind the European Commission's decision to relax regulations on "direct-to-patient communications". The Enterprise Commissioner, Erkki Liikanen, argues that there is now a double standard: one for those who speak English and have access to the internet, and another for everyone else.

Last summer, Liikanen and colleagues announced a five-year pilot trial allowing pharmaceutical marketing to European consumers for three medical conditions: asthma, diabetes and HIV. The proposals, which have yet to be agreed by EU member states, would allow pharmaceutical companies to give out information to those who request it. Companies will have to abide by a strict code of conduct and all information will be vetted by the European Medicines Evaluation Agency, Europe's drug-licensing body, before publication.

The move has already met opposition. In Britain, the Consumers' Association feared an influx of biased, inaccurate advertising which would serve only to push the NHS drugs bill "sky high". Even the Association of the British Pharmaceutical Industry, which represents UK pharmaceutical companies, is against the introduction of direct-to--consumer advertising, arguing that it is "unsuitable for the UK healthcare system at this time".

Yet the proposals fall well short of what most would regard as advertising. The only direct communication between pharmaceutical companies and the public is likely to be in the form of highly regulated specialist websites and patient brochures to be handed out if patients ask for them. We are still, however, a long way from seeing Sven-Goran Eriksson advertising cures for baldness on ITV.

Whatever the level of taxes, there will always be limits to what public healthcare systems can afford. It's no good everyone banging the surgery doors down for the latest TV-advertised baldness or shyness medications and then complaining if the NHS cannot afford basic life-saving cancer or heart treatments.

It all comes down to rationing, an issue with which successive UK governments have grappled unsuccessfully. The current approach is for NHS decisions to be based on guidance published by the National Institute for Clinical Excellence (Nice), the body charged with evaluating medicines and medical procedures on the basis of clinical and cost-effectiveness.

In the UK, we need more and better patient information on pharmaceuticals, including details of the comparative merits of different medications, risks and benefits to individual patients, and cost-effectiveness. But it's hard to see how commercials would be able to satisfy this need. Few of us would buy a car on the basis of a TV advertisement alone. We would probably buy a consumer guide or read a" tried and tested" article in a newspaper first. So why not do the same with our health?

If direct-to-patient advertising is ever to be allowed, it would need to be counter-balanced by patient information provided by organisations similar to Nice. Otherwise we risk creating two opposing systems, with advertising fuelled patients on the one side and guideline-following medics on the other. A successful system could operate only where there was a true partnership based on full and frank information -- not one where the patient demands a particular brand of drug, nor one where the doctor guards his professional status by dictating the prescription.

There is a more fundamental question: if such a level of empowerment could beachieved, would pharmaceutical advertising be necessary? And if advertising were still introduced, where might that lead?

Advertising is a sophisticated industry that works by appealing to the irrational side of human nature. When a barrage of health promotion information on the dangers of smoking failed to counter the seductive images of tobacco advertising, the British government opted instead for an advertising ban.

No one suggests that medicines--even if inappropriately prescribed--could ever be as harmful as cigarettes, but it's a cautionary tale worth considering before the advertising genie is let out of the bottle.

COPYRIGHT 2002 New Statesman, Ltd.
COPYRIGHT 2002 Gale Group

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