Allowing the drug industry to supply information on prescription medicines direct to patients in Europe will have serious implications for public health, warn experts in this week's BMJ.
The European parliament is considering allowing the drug industry to have a much greater role in providing information to patients, with no restriction on the type of media, write Les Toop and Dee Mangin from the University of Otago, New Zealand.
In New Zealand and the US, the only two developed countries that allow direct to consumer advertising of prescription medicines, opposition has grown steadily from both the public and doctors.
New Zealand's health system is much closer to those in Europe than the US system. So what can we learn from its experience, they ask?
Last year drug companies spent over $5bn on direct to consumer advertising in the US and tens of millions of dollars in New Zealand. But opposition grew alongside the advertising, and by 2000, New Zealand and US health watchdog groups were becoming more vocal.
The rising concern led the New Zealand Ministry of Health to start a public consultation in the same year. But the advertising was allowed to continue with self regulation and a promised further review of compliance with the rules never took place.
In this context, advertising became more widespread and proved extremely effective. For instance, intensive advertising of celcoxib and refecoxib on prime time television, aimed specifically at long term use in the elderly, resulted in widespread prescribing, despite early warnings of their cardiac risks. Similarly, just a few TV adverts promoting oral terbinafine for toenail infections resulted in a doubling of national prescriptions within weeks.
In response to mounting concern from the public and the professions, the New Zealand government resolved to ban direct to consumer advertising in late 2003. To date, the government has been unable to pass the necessary legislation, despite a recent round of consultation showing strong opposition from health professional groups and almost complete (90%) opposition from independent consumer and patient organisations.
The lesson from the New Zealand experience for Europe is clear, say the authors.
Allowing industry funded objective information will serve only to manipulate consumer choices. It will not help consumers make better decisions about medicines but will increase the pharmaceuticalisation of health and will expose more of the population to new medicines (many of which offer little benefit over existing medicines) at a time when long term safety is unknown.
It will also rapidly drive up drug costs with major implications for already stretched health budgets - all of which will be of net harm to the overall public health, they warn.
The goal should be a global collaborative commitment to facilitate access to the independent information prescribers and consumers need to be able to make better informed decisions about medicines, they conclude.