Update from Denmark

In April the Marketing Overdose blog highlighed a complaint filed by the Danish Consumer Council againtst Pfizer to the Danish Medicines Agency. The company had mentioned one of its own products on a page on its website that should only have provided information about a medical condition.

This, as the Consumer Council rightly pointed out, was in clear violation of Danish Law, which prohibits the advertising of prescription drugs directly to consumers.

To their credit, the Danish Medicines Agency took swift action and ordered Pfizer to remove all references to specific products from the web pages in question.

The Medicines Agency also recently ruled on another of the Consumer Council's complaints. This case involved Panodil (Paracetamol), which was being promoted on a website providing advice about joint pain.

As it is an over-the-counter drug, it is perfectly legal to advertise Panodil directly to the public. However, the Consumer Council found that important information on adverse side effects, dosage recommendations and mixing with certain foods was either entirely absent, or presented in such a way as to make it very difficult for consumers to find.

The Medicines Agency agreed that this was in breach of regulations and asked the website's operator, global pharma giant GlaxoSmithKline, to make the necessary changes.

This blog also reported on a joint letter sent by the Danish Consumer Council and other health organisations to the Minister of Health, expressing concerns about the European Comission (EC)'s 'pharmaceutical package'. They were particularly critical about the legislative proposal concerning the provision of information about prescription medicines to the general public. It is is widely felt that implementing this proposal would pave the way for the legalisation of direct-to-consumer-advertising (DTCA) of prescription drugs in European Union (EU) member states.

Proponents of the package claim that this proposal contained within it will only allow pharmaceutical companies to provide 'reliable' information to consumers. Consumer organisations throughout Europe reject this notion, on the grounds that any information provided by a company about its products - apart from data approved by the appropriate authorities - can be considered to be marketing. DTCA is currently only legal in New Zealand and the USA.

The Danish Minister of Health declared his sympathy for these concerns and even read the letter out on national radio. Not long afterwards on 8 and 9 June 2009, the EU Council of Health Ministers expressed strong reservations about the proposal question, with many delegates fearing it would open the door to DTCA.

The proposal will continue to be debated by the Council and by the newly elected European Parliament in the Autumn. The European consumer movement will continue it's efforts to ensure that the interests of patients are respected, and that DTCA does not become a reality in the EU.

International developments in the promotion of prescription drugs

Consumers International (CI) is currently undertaking a global study on the promotion of prescription medicines in nine countries across five continents. As part of this research, CI is reviewing industry codes of conduct, national legislation and company practices.

Prior to publishing a final report later in the year, CI has released a research briefing to coincide with the 2009 World Health Assembly. This briefing outlines the research methodology used, as well as presenting preliminary analysis on one of the project's key focus areas: the regulation of gift-giving.

The final report will be expanded in scope to cover free samples, medical sales representatives, promotional materials and direct communication with patients. It will draw links between these issues and comment on compliance/enforcement mechanisms.

For more information download the briefing in full, and read the other reports that CI has produced as part of the global Marketing Overdose campaign.

Calls for greater disclosure of doctors' ties to companies in France and Holland

Dutch Minister of Health Ab Klink recently called for more transparency in the relationships between the pharmaceutical industry and healthcare practitioners. Minister Klink made these comments after the release of a report by the Council for Public Health and Healthcare, and independent advisory body to the government. The report found that financial ties between industry, doctors and scientists in The Netherlands are commonplace and frequently non-transparent in nature.

As reported in the Volkskrant newspaper, drug companies are substantial providers of training to doctors and specialists, but often with an emphasis on their own products. They also distribute gifts and bonuses to practitioners, and strongly influence medical research.

Although a proponent of self-regulation, Klink is said to be considering supporting legislation in this area. He has suggested a requirement that any gift over €500 in value should be declared.

Meanwhile, further south, the French consumer organisation UFC-Que Choisir has also stepped up the pressure for proper disclosure of the relationships between doctors and pharma companies. Existing legislation in France requires healthcare professionals to declare any potential conflicts of interest arising from links to industry when speaking publicly about medical products. However, as reported in Le Monde, UFC are concerned that this law is widely being ignored.

They recently filed complaints against nine prominent physicians for not complying with the law. The doctors in question were chosen by UFC because they are considered to be opinion leaders and have a public profile. However, the organisation contends that these individuals represent but a drop in the ocean.

The catalyst for this action was a survey recently undertaken by Formindep, a collective of heath professionals. They monitored the activities of over 150 doctors in the media and at conferences. Although more than 60 had links to drug manufacturers, not one had declared any conflicts of interest.

The complaints were made to all the relevant departmental (provincial) boards of the Order of Physicians. This professional association is responsible for regulating the relationships between doctors and companies, and enforcing the legislation in question.

A representative from one local chapter of the Order countered the allegations, saying that details of the contracts in their possession "are and must remain confidential. (However) due to our own research we have discovered links between, often serious, among some doctors and the pharmaceutical industry,..."

A slightly less polite response was received from a counterpart in a different province: "We do not have to answer your extremely insidious questions."

UFC are calling for a publicly accessible database containing full details of all conflict of interest declarations made by doctors in the country.

Focus on Denmark

The Danish Consumer Council has filed a formal complaint against Pfizer to the Danish Medicines Agency. They are concerned about a page on the company's Danish website that provides information about incontinence.

As well as background information about the condition, the page clearly identifies three of Pfizer's own products that could be used to treat it. The Consumer Council believes that this effectively constitutes disguised advertising. This violates Danish law, which currently prohibits direct-to-consumer advertising of prescription drugs.

The Consumer Council have also written a joint letter to the Danish Minister of Health expressing their concerns about the 'pharmacuetical package' recently adopted by the European Commission (EC). The package includes legislative proposals that would lead to changes in the rules governing the provision of information about medicines to patients in European Union member states. They are worried about the increased freedom to communicate directly to consumers about their prescription-only drugs that pharma companies will have under the legislation proposed.

Many experts believe that it's impossible for patients to clearly distinguish between non-promotional information and marketing. Patients have a right to independent, unbiased information, which companies cannot provide due to an obvious conflict of interest. Instead, patients should be encouraged to consult trained healthcare professionals and relevant public authorities.

As pointed out in another joint letter, this time addressed to EC President José Manuel Barroso, and signed by the European Consumers' Organisation: '...existing legislation already allows pharmaceutical companies to provide information to the public on health and diseases (Article 86 of Directive 2001/83/EC). They make most of the opportunities provided by this provision, often going beyond with disease awareness campaigns and even disease mongering. On the other hand, several experiences have shown that pharmaceutical companies fail to disclose important information regarding their products...'

The Danish Consumer Council was also featured in a recent edition of Kontant, a Danish flagship TV current affairs show. The episode explored the issues surrounding disease awareness campaigns, and how unethical promotional practices can contribute to the phenomenon of disease mongering.

It also featured the Marketing Overdose campaign's very own infomercial on the benefits of Strivor, a fictional antidote to the debilitating (and equally fictional) Motivational Deficiency Disorder.

Celebrity Overdose

ABC News recently turned the spotlight on celebrities who lend their support to disease awareness campaigns while discretely receiving lucrative fees from pharmaceutical companies in return. It would appear that not much has changed since the New York Times highlighted this issue in 2002.

Stars such as Marcia Cross (left), Kathleen Turner, Rob Lowe, Kelsey Grammar, Bob Dole and Cybill Shepherd have all been involved in high profile campaigns funded directly by drug manufacturers. There are even PR firms such as Amy Doner Group that exist soley to match 'well-known personalities from film, television, sports or music with leading pharmaceuticals...and advertising agencies to take their messages directly to the public'. Leading celebrity agents such as Brooks International also appear to offer these services.

In many countries the public put enormous trust in celebrities, and when they speak out in support of causes people listen. And, of course, product endorsements are a well-established and lucrative form of income for many celebrities, proving the influence they have over consumers.

Some would argue that using famous stars in this way is an effective way to raise awareness and encourage people to find out more. But the large payments that celebrities receive, and pharmaceutical companies provide, suggest this is a more commercially inspired activity.

Disease awareness campaigns are meant to raise awareness about a medical condition and encourage people to take preventative action and/or seek treatment. There has been a lot of controversy around the fact that many of these campaigns are industry funded. There is a very thin line between a campaign like this and outright direct-to-consumer advertising, which is illegal in most countries. Critics argue that pharma companies are able to increase their sales by associating themselves or their products with certain medical conditions. There is a danger that in this way companies are effectively able to bypass restrictions and promote prescription medicines directly to consumers. Indeed, as reported previously in this blog, they have often been quite flagrant in doing so.

Advertising is more often about creating needs based on image and aspirations. But promoting prescription drugs is very different to lending one's name to a chocolate bar or a sports shoe; drugs can be lethal if taken by the wrong person or in the wrong dose.

There is also the worry that industry funded awareness raising can contribute to the phenomenon of disease mongering. As it is clearly in their interest to do so, pharma companies often emphasise medical solutions to conditions even when non-medical options would be more appropriate. Prescription medicines should always be taken on the advice of a trained healthcare professional. Consumers need independent, scientific information to inform their decisions, something that pharma companies cannot provide.

Patients down under want greater transparency

We thank Elena Pasca, of Pharmacritique, for alerting us to the results of an interesting study by the Medical Journal of Australia.

In 2007, 906 patients in and around Sydney were surveyed to gauge their perceptions and opinions on doctors and their relationships with the pharmaceutical industry.

Here's what they had to say:

• 76% of patients were unaware of any relationship between their doctor and pharma companies
  
  
• 71% wanted to know if their doctor obtained any benefits in cash or kind from the pharma industry
  
  
• 69% wanted to know if their doctor received financial incentives for research participation
  
  
• 61% wanted to know if their doctor received sponsorship to attend conferences
  
  
• 84% agreed that disclosure of competing interests by doctors is important
  
  
• 80% would have more confidence in their doctors' decisions if interests were fully disclosed
  
  
• 78% believed that this disclosure would help them make better informed treatment decisions
  
  
• 78% supported verbal disclosure during consultations

Call for ban on gifts to British doctors

Medical experts in the UK are calling for an end to gifts to doctors. A new report from the Royal College of Physicians says this would do much to restore patients' faith in prescribers.

According to the report, 'relentless pressure on doctors, exerted by pharmaceutical marketing masquerading as education, is common.' As well as looking at gifts, the report takes a comprehensive look at industry involvement in other areas such as medical conferences, education and research.

Recognising that some consultants would not be able to attend conferences for 'continuing medical education' and improving their skills without drug company support, the report recommends replacing individual sponsorship with an industry-funded pool for doctors to attend events. It also suggests that the National Health Service (NHS) and other medical associations could contribute to these costs.

Among the many issues covered, the report also highlights the industry practice of 'using educational initiatives as promotional tools.' Many undergraduate medical students and doctors in training in the UK are found to lack sufficient 'prescribing knowledge', and 'professional development programmes are too dependent on industry support.' In fact, it is estimated that pharmaceutical companies fund over half of all postgraduate medical education.

In total, the report sets out 42 recommendations on how to improve the relationships between the NHS, academia and industry with the aim of improving patient care and confidence.

As reported last year on this blog, Consumers International (CI) released the results of a survey which found that none of the major drug companies had made a global commitment to disclose their educational grants. Speaking to The Guardian newspaper at the time, CI Head of Campaigns Justin Macmullan said:

"Pharmaceutical companies will tell you that what they are funding is medical education. But our concern is that this is really effective, well-targeted marketing. This throws any notion of impartiality out of the window and jeopardises a doctor's ability to make an informed, balanced decision about the most appropriate treatments."

Controversial weight loss drug available over the counter in Europe

The European Commission (EC) has decided to make the weight loss pill Alli available to consumers through pharmacies, despite protests from European consumer organisations.

It is widely recognised that a relatively small number of people do need medication to control their weight. But making this pill available without a prescription will inevitably mean fewer people will address issues of diet or lifestyle which are much safer and more reliable weight-control methods.

There is a real risk that the over-the-counter availability of Alli could lead to inappropriate selling, irreponsible marketing and irrational drug use.

Australia's experience of selling weight loss products over the counter should have been a warning to the EC. After conducting a series of mystery shopper trials, the Australian consumer organisation Choice found that pharmacists often failed to ask the right questions and sold the product to women who did not have a weight problem.

Choice was also concerned that the product was being advertised during programmes popular with teenagers, such as Teen Idol.

Consumers International, the global federation of consumer groups, also believes that the EC's decision was not in the interest of consumers and that Alli should remain a prescription drug.

Big pharma on the offensive as Obama is inaugurated

As Barack Obama is sworn in as President of the United States, big pharma is gearing up for a multi-million dollar advertising campaign to improve it's image.

As well as facing projected growth figures in the low single digits, drug companies are bracing themselves for the combined prospect of a President apparently committed to healthcare reform and Democratic-controlled Congress sympathetic to his aims. The aim of this new media blitz is to reposition themselves as supporters of Obama's vision for universal healthcare coverage.

As recently reported in the New York Times, the industry has also announced a voluntary commitment to stop distributing certain kinds of gifts to doctors. This 'self regulation', they freely admit, is an effort to pre-empt much stronger regulation by a newly empowered Food and Drug Administration.

Many are hoping that President Obama does not, as his predecessors have done, capitulate in the face of the seemingly infinite resources of the pharma lobby and that any overhaul of the US healthcare system includes an end to the unethical promotion of pharmaceuticals currently so commonplace.

Doctors in India cash in

"Cars, frost-free refrigerators, television sets, digital cameras and silver coins." Just some of the rewards offered to doctors in India by drug manufacturers, such as Torrent Pharmaceutical in Gujarat.

As reported recently in the Times of India (TOI), pharma companies have been distributing 'gold' and 'platinum' coupons to physicians in return for prescribing their products. They are entered into competitions to win prizes, the more coupons the higher the chance of winning.

According to TOI, Torrent Pharmaceutical also took Sri Lankan doctors on a safari trip to Kenya, as well as paying for doctors and their families to attend a conference in Turkey.

Following TOI's article, the Department of Pharmaceuticals of the Indian Ministry of Chemicals and Fertilisers wrote to the country's pharma industry associations urging them to "take action" on the "misuse of promotional expenditure". The newspaper, however, was far from impressed by the letter's "mild, almost apologetic tone".

For more on how drug companies influence health in the developing world visit www.marketingOverdose.org and download the Drugs, Doctors and Dinners report.