30 Jun 2023

Calls to end advertising of prescription medicines

From Nine To Noon, 9:25 am on 30 June 2023
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Photo: RNZ /Dom Thomas

Doctors are calling for a ban on direct to consumer advertising for prescription medicines, a move they say would reduce over-diagnosis, over-treatment and treatment related harm.

New Zealand and the United States are the only two developed countries that allow unrestricted advertising of branded prescription medication, they say.

A new Therapeutic Products Bill is being introduced to replace the country's outdated Medicines Act, and is being viewed as the perfect opportunity to create specific regulations on the industry.

Auckland University Associate Professor of psychological medicine David Menkes told Nine to Noon the Council of Medical Colleges represents all 17 different medical entities in New Zealand, and is opposed DTCA (direct to consumer advertising).

But Medicines New Zealand chief executive Doctor Graeme Jarvis said the industry was well regulated, and there were already a set of rules and regulations that applied to DTCA in New Zealand, that were working well.

Menkes said direct to consumer advertising of prescription medicines comes in a variety of forms, for all sorts of different types of medicines, including inhalers, medicines to help sleep or to reduce depression.

But advertising tended to overstate benefits, downplay harms and cause consumers to push their doctors for medicines they do not need, he said.

"The reason why these medicines are prescription-only is because they're judged to have significant risks of harm if used inappropriately. So there's a barrier in place," Menkes said.

"Allowing this policy to continue is both going to compromise safe prescribing - certainly [it] threatens the doctor-patient relationship, and it also increases costs to the health budget."

Menkes said advertising was not a good way to share health information with patients.

"We do agree with Medicines New Zealand, that the provision of medicines information is a good thing, and also having informed consumers is a good thing - so when people go to the doctor, having some awareness of their condition and the treatment options is an excellent way to start that discussion with the doctor.

"However, DTCA allows information to reach consumers that is almost inevitably unbalanced in favour of the purported benefits of the medicine, it tends to downplay the possible harms ... a number of studies now quite convincingly [show it leads] to unnecessary prescription. So people think they need a medicine, and whether or not they do, they will ask for it from the doctor - and this creates a big stress on the doctor patient relationship, because doctor's inevitably find themselves needing to discuss why a medication might not be appropriate, might be more likely to cause harm than benefit."

Menkes said the stakes were high when it came to DTCA.

Sales and advertising of the anti-inflammatory drug Vioxx was a good case in point, he said. The drug was found to increase the risk of heart attacks, leading to a class action and a large payout by the drug's manufacturer, in the US. It had been widely advertised advertised, but was [https://journal.nzma.org.nz/journal-articles/time-for-new-zealand-to-ban-direct-to-consumer-advertising-of-prescription-medicines withdrawn from sale worldwide] in 2004.

Senior woman taking vitamins with water. (Photo by CAIA IMAGE/SCIENCE PHOTO LIBRARY / NEW / Science Photo Library via AFP)


Advertising directs consumers toward a particular approach to dealing with health issues, he said.

"It tends to emphasise medicalisation of what amounts to lifestyle issues... of normal human problems, and that's something we don't want either.

"People who are for example needing better diets or better exercise, or better sleep hygiene, often are persuaded by advertising to rely on a pharmaceutical to manage these problems, rather than to seek advice on how to manage their sleep, manage their diet, get better exercise et cetera.

But chief executive of Medicines New Zealand, the body representing pharmaceutical suppliers, Doctor Graeme Jarvis said the DTCA had been examined by New Zealand authorities: "...Independent reviews done by the regulator and also done by the ministry officials and looked at by cabinet."

There were already a number of rules and regulations that applied to direct to consumer advertising of prescription medicines, and they were working, he said.

"All of the medicines that are advertised in New Zealand - and there aren't a lot of them, there's only about .2 percent of the overall advertising - all of them have been through Medsafe for approval of their safety and efficacy profiles, and 80 percent of them are actually funded through Pharmac," Jarvis said.

"As well as government oversight through Medsafe, there are five other bits of legislation including the Commerce Act and Fair Trading Act as well - codes that must be met when you're doing these advertisements.

"We have the self-regulation process, you engage with the regulator as well to make sure everything is kosher with what you're putting out. And the advertisements have to be balanced, so there has to be what we call mandatory information on all of those advertisements, that includes the pros and cons, the benefits and the risks of taking that medicine. If there is not mandatory information there is no way you get approval for that advertisement to be done - so it's not just the wild west here."

Research papers and studies carried out in New Zealand showed direct to consumer advertising of prescription medicine increased health awareness, patients were encouraged to act on undiagnosed or poorly managed conditions, they felt better about talking to their doctor and being involved in the decision-making, Jarvis told Nine to Noon.

And advertising was a better way for consumers to learn about their options compared to self-research on the internet, he said: "which is completely unregulated and information is available from everywhere."