Submission on Direct-to-Consumer Advertising
In April 2019, Changing Minds and Dr Helen Hamer submitted a response on Direct-to-Consumer Advertising, part of the Therapeutic Products Bill.
In particular we responded to C52:
“Please provide any comments on the advertising requirements and enforcement tools.”
Part of our submission noted the DTCA of psychotropic prescription medicines continues to be a contentious issue:
Impact of Advertising
The pharmaceutical industry spends hundreds of millions of dollars each year for a return on profit margins and invest heavily in DTCA because they know consumers exert huge and effective pressure on prescribers. When prescribers feel pressured to support the patient’s choice, this may limit full disclosure about the best treatment options available e.g. a cheaper generic version of the advertiser’s product, or alternatives such as ‘prescribing’ a talking therapy approach. The risk to the patient is that they will be given medicines they don’t need at that time.
Pharmaceutical advertisers’ interest is in promoting health worries or risks amongst the population, yet reluctant, for commercial reasons, to confront any misconceptions about their products yet promote presumptions about their products based on uncritical biases in the claims they make in their adverts.
Commercially-driven advertisements employ the architecture of marketing strategies that carefully crafts the message to sell their products. This strategy can perpetuate false or misleading information in an advertisement, such as misrepresentation or misunderstandings about the origin and cause of mental distress/illness (i.e. depression is a chemical imbalance in the brain that can be corrected with drugs).
Recently in New Zealand, a second-generation anti-psychotic medication in injectable form was advertised in the mainstream media e.g. television, non-medical journals and magazines, and at bus stops. The advertisements did not depict any additional or alternative therapy. These advertisements include on-screen endorsements by healthcare professionals. The life-size posters at bus stops made emotional depictions in their caption ‘When you have schizophrenia, people may nag you to take your pills and that can lead to conflict’. Risks and side effects required readers to go to a website of the pharmaceutical company.
Impact on the patient
As consumers we enjoy free-expression, choice and rely on openness about products available. However pharmaceutical products are different from food or clothing. Proper or improper use of pharmaceuticals can lead to harm and the safety of the patient therefore relies upon the strong relationship between patient and prescriber.
With persuasion by adverts, people may seek access to the medication from other unreliable and risky sources e.g. order on the internet. Drugs acquired through alternate means raises concerns about whether the medication is what it is purported to be or a dangerous substitute; whether it is appropriate for the consumer even if it is as advertised (as there is no prescription involved); the dangers of injecting it incorrectly; the risk of overdose; polypharmacy; and where and how the person disposes their used needles. This increases a service user’s risk of harm exponentially.
Impact on the therapeutic relationship
Traditionally, health practitioners’ decisions about treatment were accepted by patients without question or discussion. The rise of the knowledgeable consumer-citizen and a democratisation of how information about medicines is available has resulted in patient’s expectations that they will be informed of uncertainties about products marketed in the media and what the alternatives may be. Further, both and/or prescriber and patient may believe that they will have to rely on psychotropic medication long-term (often in long acting injectable form). Also, individuals can become dependent on the medications as the only treatment alternative, have difficulty reducing or stopping the medication or are too daunted or defeated by the idea, usually due to the side effects themselves.
The risks associated with DTCA (as above) are amplified when dealing with vulnerable populations, for example people with serious psychotic disorders such as schizophrenia and concerns for the overprescribing of this medication for Māori and Pacifica.
Such direct marketing further relies on the health practitioner/prescribers to give a full account of all side effects etc. particularly psychotropics, whose side effects are toxic and known to reduce life expectancy. Therefore, in practice some prescribers are reluctant give a full disclosure of the risks and therefore informed consent is limited. However, when positive results have been the emphasis of the advertising it provides conflicting views that have the potential to rupture the therapeutic alliance between the patient and health practitioner in the face of the promises of good health outcomes by the commercial drug companies.
In summary, pharmaceutical advertising is strictly for profit: The argument for DTCA pharmaceutical advertising is that it provides helpful and empowering information to consumers, but the intent of any advertiser is to sell something, not to charitably educate their audience. For accurate, unbiased information on medication, consumers and physicians can turn to peer-reviewed literature and international clinical guidelines. If New Zealand is unable to repeal DTCA, we have made some suggestions to make it a fairer and safer process.
Download Changing Minds and Dr Helen Hamer’s Submission on Direct-to-Consumer Advertising