The cost of men staying harder longer

There have been a couple of interesting posts about Pharmac on frogblog and Kiwiblog over the last few days.

Both posts comment, somewhat as an aside, on the issue of direct to consumer advertising (DTCA) of pharmaceuticals. Unsurprisingly, Frog says: “One could argue that big pharma should not be allowed to advertise to the public, which is the norm in every other country in the world except the USA and NZ. “. David Farrar on Kiwiblog simply responds: “I disagree with Frog about banning advertising… without giving any reasons.

In 2003 a research team of Professor Les Toop, Dr Dee Richards, Professor Tony Dowell, Professor Murray Tilyard, Tony Fraser, and Assoc. Professor Bruce Arroll from the Departments of General Practice at Christchurch, Dunedin, Wellington and Auckland Schools of Medicine undertook a comprehensive study of the impacts of DTCA.

Among their findings were that 69% of GPs surveyed considered that they had “felt under pressure to prescribe advertised medications” and 50% of GPs considered that in their experience “consultations in which patients seek advertised medications can lead to difficulties in the Dr-Patient relationship”.

The study also found:

DTCA has a negative effect on health funding and may lead to distortion in resource allocation in a number of ways

  1. Increasing the proportion of the health budget spent on pharmaceuticals by promoting pharmaceutical solutions over other available options.
  2. Increasing expenditure within pharmaceutical budgets by promoting newer more expensive medicines that have little if any evidence of corresponding increase in positive health outcome over existing cheaper alternatives.
  3. In February 2002 the Centre for Health Services and Policy Research at the University of British Columbia, Canada carried out a review of the literature on DTCA from January 1980 to August 2001. The authors of this review concluded that there is evidence that DTCA affects consumer behaviours and prescribing, and evidence of an association between advertised products and increased costs, while also concluding “No reliable evidence exists to support hypotheses of potential health benefits or to exclude potential harm. In nearly 20 years since the first print DTCA campaign in the U.S, no reliable research evidence had been found to back industry claims that earlier drug use stimulated by DTCA reduced serious disease or hospitalization rates, that extra physician visits stimulated by DTCA led to more rather than less appropriate care, or that DTCA stimulated more appropriate use of medicines by patients. In fact, most advertised drugs are no more effective and safer than older, cheaper alternatives.”
  4. Generating direct and indirect consultation costs. Consultations generated by DTCA result in costs to the health budget for Community Service and High Use Health Cardholders. Consultations also generate costs for the patient, both as the direct cost of consultation fees and unsubsidised or partially subsidised prescriptions as well as the indirect opportunity costs of time off work to see their GP.

The report also reveals that DTCA has serious implications for medicine safety. It results in rapid widespread exposure to potentially dangerous medicines before the risks are fully recognised or even in the face of evidence of those risks. At the time it was written the biggest DTCA advertising spend (US$160.8m) in the US was for the non-stearoidal anti-inflamatory drug Vioxx. Shortly after, that drug was withdrawn because of increased risk of heart attacks and strokes among its users.

The report recommended:

That the New Zealand government introduce regulations and /or legislation to prohibit the advertising of prescription medicines directly to the public, through print and broadcast media or any other means.

That the Government establishes an independent medicine and health information service free of commercial interest.

So why is it that New Zealand still remains the only country in the world apart from the US to permit DTCA of prescription medicines?