Direct-to-consumer advertising (DTC advertising) usually refers to the marketing of pharmaceutical products directly to patients/consumers. Ethical and regulatory concerns regarding DTC advertising have been identified, specifically the extent to which these ads may unduly influence the prescribing of the prescription medicines based on consumer demands when, in some cases, they may not be medically necessary.
While direct to market advertising for prescription pharmaceuticals is permitted here, the practice is shrouded in controversy. New Zealand and the United states are the only two western nations where it is allowed. There have been large lawsuits against Johnson & Johnson in the US centered on the promotion of off label uses which found that the ‘marketing campaign had mislead doctors and patients about the drugs health risks and benefits’.
Advertisements for Risperidal Consta – a long acting antipsychotic injection- have started appearing on our television screens. The New Zealand campaign by Janssen is more careful in how it promotes its product: it does not promote off label uses and the website describes medication as part of a treatment plan ‘that should also include support from your healthcare team, friends and family’. It does however promote what is arguably an overly simplistic biomedical claim about the cause of schizophrenia asserting that ‘Schizophrenia is caused by a chemical imbalance in the brain’.
There is still huge debate in the medical fraternity about these disorders. A recent statement by the British Psychological Society (BPS) calls for “an approach that fully acknowledges the growing amount of evidence for psychosocial causal factors, but which does not assign an unevidenced role for biology as a primary cause, and that is transparent about the very limited support for the ‘disease’ model in such conditions.”
There are even doubts about the validity of the labels, the BPS also noting “that functional psychiatric diagnoses such as schizophrenia, bipolar disorder…. due to their limited reliability and questionable validity, provide a flawed basis for evidence-based practice, research, intervention guidelines and the various administrative and non-clinical uses of diagnosis”
Even though the Risperidal Consta site manages to avoid making any overly bold claims regarding stand alone efficacy it is clear that the advertising is designed to create the impression amongst consumers that this product in particular will help them.
People that have been diagnosed as having schizophrenia have a very broad range of symptoms and have a varied response to different kinds of therapies. There really is no one size fits all when it comes to a treatment path. Slick TV ads and websites that suggest otherwise (while still placing all of the responsibility for correcting any misunderstandings back onto physicians) do consumers and their clinicians no favors whatsoever.
Unless we are talking placebo, the effectiveness of any particular drug is something which is determined by factors other than a person’s susceptibility to advertising or their exposure to a marketing campaign. That is why almost every other western country sees no role for direct to consumer marketing for prescription medicines. New Zealand needs to think carefully about the consequences of this practice– who benefits and who doesn’t?