Have you ever wondered why there are no advertisements on TV or in the press for prescription medicines? If you have lived in the United States, you will be accustomed to direct-to-consumer advertising which promotes the benefits of one blood pressure pill over another. The reason why we are not exposed to pharmaceutical company advertising - with the exception of over-the-counter medicines such as aspirin or paracetamol - is that direct promotion is banned in the EU.
The pharmaceutical industry's own code of practice only allows direct communication with consumers and the general media under the following circumstances: "Information about a scientific discovery of a medical product should normally be supplied only where it is desirable or necessary to do so in the public interest, or where the object is to keep the public informed of scientific and medical progress." (Irish Pharmaceutical Healthcare Association Code of Marketing Practice, 5th Edition.)
The EU ban is being challenged in the European Court at present, although earlier this month the European Commissioner for Enterprise, Erkki Liikanen, said he would slightly ease the ban on the advertising of prescription drugs. Pharmaceutical companies will be allowed market some drugs directly to patients suffering from diabetes, AIDS and asthma.
So is this the beginning of a significant change and a tacit acknowledgement that the ban has been circumvented by the availability of information about drugs on the Internet? Research suggests that 25 per cent of all web content and 40 per cent of all web searches are health-related. In the Republic today, 500 times more editorial media space is devoted to health-related matters than 20 years ago.
The hunger for information is clearly out there. People want the knowledge to enable them to make personal decisions about healthcare options. Is it really fair to continue the ban on direct-to-consumer advertising? At a debate on the topic held earlier this year at the Royal College of Surgeons, the audience voted in favour of lifting the ban.
Hosted by Edelman Health Communications, the audience consisted of pharmaceutical company representatives, patient support groups, the media and medical organisations. And while one could argue that the vote might have been reversed with a different audience representation, the contributions for and against change were illuminating.
The principal argument in favour of direct advertising of medicines is that consumers have a basic right to information and access to all possible treatments. Central to this premise is a belief that consumers will be able to assess and understand such information and that it will be balanced, with full details of potential side effects. It was also suggested that pharmaceutical advertising be regulated by an independent authority with significant powers of sanction.
Those against a relaxation of the current ban pointed out that the pharmaceutical industry is like any other; its aim is to sell more products to more people. Can it be trusted to advertise or promote its products in a way that is fair and balanced? Some contributors held the view that the industry will almost certainly "medicalise" conditions and encourage consumers to self-diagnose by informing them that if they identify with symptom X, they are actually suffering from medical condition Y.
Concern was also expressed about the increasing range of "lifestyle drugs", with a prediction that by the year 2003, five of the top 10 selling medicines will be lifestyle medications. There is some evidence to suggest a cautious approach is best. In the United States, the sales of an antidepressant called Paxil rose 18 per cent last year following a successful campaign to raise awareness of a condition called social anxiety disorder.
Commentators have linked the dramatic increase in the drug's sales to a carefully co-ordinated education and advertising campaign to increase awareness of social anxiety.
The patients' advocacy organisations who willingly participated in the campaign pointed out that the only way for them to disseminate a public health message was to align themselves with a pharmaceutical company. Such groups usually insist on full control over the editorial content of educational campaigns designed to highlight awareness.
We are at an interesting crossroads on this side of the Atlantic as far as direct-to-consumer advertising of pharmaceuticals is concerned. Will we opt for the old, paternalistic, cautious approach, or is it time to acknowledge the consumer's right to detailed information on drugs?
In many ways, the debate has only begun.
You can e-mail Dr Muiris Houston, Medical Correspondent, at mhouston@irish-times.ie or leave a message on 01-6707711, ext 8511. He regrets he cannot reply to individual medical problems.