Medical Matters:"The blind faith which some people have in medicines illustrates too often the greatest of all human capacities - the capacity for self-deception" - Sir William Osler
These words may have been written in 1909, but they are still relevant today. Especially when the world's top 10 drugs earned their manufacturers an impressive €41 billion in 2003. And even more so now that the European Commission has issued a report signalling the likely introduction of direct to consumer (DTC) advertising in the EU.
The report, Current practice, with regard to provision of information to patients on medical products, concludes: "Member states may not be in a position to fully address patients' needs in terms of the substance of information and the access via different means.
"In turn, the pharmaceutical industry possesses the key information on their medicines, but this information can currently not be made available to patients and healthcare professionals through Europe."
But why not allow the advertisement of medications in the same way that we can freely watch television advertisements for beauty products or read newspaper ads extolling the virtues of a newly launched car?
After all, we are moving away from medical paternalism and the previously accepted maxim that doctor knows best. What is wrong with a prospective patient arriving into a surgery wanting to know if a named product would be an appropriate treatment?
Patients have a right to be informed; they are no longer passively taking what is prescribed for them but wish to manage their own health in association with doctors and other health professionals.
As consumers, patients look for information on the efficacy of a medication for a particular disease, the cost of treatment and the reasons why a specific drug is prescribed. A lack of information may result in poorly informed choices and may contribute to late diagnosis.
Notwithstanding these arguments, the European parliament rejected DTC advertising in 2002, citing concern about the difficulty of expecting the pharmaceutical industry to provide balanced and comprehensive information to consumers.
The experience in the US and New Zealand, the only two countries in the developed world that allow DTC advertising of prescription medicines, suggest the legislators were right to be cautious. Last year drug companies spent more than €3.6 billion on DTC advertising in the US; this amount has increased at a rate of 20 per cent per year since 1997, twice as fast as the spending on drug promotion to doctors. And more than 50 per cent of DTC spending went to advertisements for just 20 drugs.
With evidence mounting of poor compliance with DTC guidelines put in place by the Food and Drug Administration (FDA), a report by the US Government Accountability Office (the equivalent of our Comptroller and Auditor General) was critical of the FDA's oversight role.
Under US law, advertising materials must contain a "true statement" of information that includes a brief summary of effectiveness, side effects and contra-indications. But the FDA usually reviews ads after publication and broadcast; the Government Accountability Office established that it took, on average, four months to issue a regulatory letter, by which time most ad campaigns had run their course.
The problem with drug-industry-generated ads is they are most likely to push expensive new drugs, even when less expensive and sometimes safer treatments are available. Should we be surprised that the primary purpose of DTC advertising is to sell lucrative, brand-name drugs?
By pushing hard for consumers to request new brand-name drugs, DTC advertising works against the safe prescribing principle that it is best to stick to tried and tested therapies whose entire side-effect profile has emerged.
While the intended effects of DTC advertising have been well analysed, what about its unintended effects?
Do these campaigns challenge assumptions about what being a doctor or patient means, or even change cultural expectations about illness and health? And if they do, is this necessarily a bad thing?
The most important aspect of this debate is that public health be protected and enhanced. What Europe needs is an independent information source, free of industry influence, that provides unbiased evidence-based information on drug treatments. Ideally, both prescribers and consumers would share an accessible database of independent information.
Allowing the pharmaceutical industry to fund objective information sources may prove too tempting and merely facilitate the manipulation of consumer choice.
European regulators need to tread very carefully in any planned relaxation of DTC advertising rules.
Opening this particular Pandora's box may only succeed in releasing a marketing tidal wave with unpredictable economic and public-health consequences.
Dr Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he is unable to reply to individual medical queries.