Drug companies have tripled their spending on disease information campaigns since 2004. But do patients benefit? David Labanyi investigates.
Pharmaceutical companies are spending increasing amounts of money on campaigns to inform the public about various diseases and to encourage people to seek advice from their doctors.
While the advertising of prescription drugs directly to consumers is outlawed by the European Union, companies increasingly attach their names to "infomercials" about medical conditions.
Typically, the advertisements suggest certain symptoms may be caused by a particular condition, and urge sufferers to seek medical advice.
Drug companies say the advertisements explain often-embarrassing conditions such as incontinence and erectile dysfunction, which can be difficult to discuss with a GP or are mistakenly linked to aging.
However, some GPs are concerned that these campaigns artificially create a need, leading to higher prescription rates. Family doctors have also asked whether conditions targeted by the drug firms are those most deserving of additional information or resources.
What is not in dispute is the dramatic increase in spending in this area over the past three years.
According to the Institute of Advertising Practitioners in Ireland (IAPI), the value of advertising purchased by drug firms for information campaigns in the first six months of this year was €730,000.
This is already higher than the total spend for 2005. And the advertising spend last year was triple that of 2004. The figures include broadcast, print and outdoor advertising.
Dr Martin Daly, chairman of the Irish Medical Organisation's GP committee, feels disease information campaigns "are a blatant marketing tool for pharmaceutical companies. This approach is quite transparent to anyone in the medical profession."
He believes such campaigns are "likely to shift the balance away from evidence-based medicine and create a pressure for increased prescribing".
Almost without exception, a pharmaceutical firm running an information advertisement will also be manufacturing a prescription product to treat the condition concerned.
Paul Reid, therapeutic area director with Pfizer Ireland, says the company chooses campaigns for diseases where it also manufactures a prescription product because "this is where we have an expertise and a heritage". As an example, he cites a collaboration with the Alzheimer Society of Ireland which included television and radio "infomercials", setting up a website and a freephone helpline. The aim of the advertisement was to "detail early signs and try to break the stigma".
Prior to the advertising campaign, the society was receiving about 30 calls a week to its helpline, according to Reid. "This went up to 700 after the campaign. The response was superb. The main goal was to educate people that significant memory loss is not a normal part of aging and that people should see their doctor if that is the case.
"Many of these concerned people also went to see their GP and got diagnosed and hence were put on treatment. [ As a result] we have picked up some [ prescription] increases, but so have our competitors."
Reid says information campaigns are becoming an increasingly important part of Pfizer's marketing activities. "It is certainly increasing as part of our overall spend. You will find that a lot more of our resources will go into informing and educating the public."
Pfizer is the biggest spender on these campaigns in Ireland, having spent more than €500,000 on publicity notices concerning cholesterol, overactive bladder and Alzheimer's so far this year.
While pharmaceutical firms are not allowed to use the name of a prescription product in a campaign, increasingly the company name is included. A Lilly Icos spokeswoman says this is done in the interests of transparency and to comply with a European code of practice for drug firms.
Dr Eamonn Shanahan, chairman of the Irish College of General Practitioners, says the perception among doctors is that the frequency and reach of these campaigns has grown over the past five years.
"There is a creeping commercialisation there and, definitely, companies attaching their names to the end of a campaign is a new development."
He believes some of the campaigns used by pharmaceutical firms are thinly-veiled marketing tools. "If the companies were not getting results, I don't think it would continue for long, and the frequency and reach of these campaigns is growing. It is the thin end of the direct-to-consumer advertising wedge."
Dr Shanahan says Ireland needs to avoid a gradual move to the US scenario, "where it is pure market forces and ads for prescription drugs are in every paper and on every television station".
It is "absolutely right and proper", he adds, that patients should receive all the information available about their illness. But "subtle background marketing" can put subliminal pressure on both patients and GPs, he argues.
"I think it would be fair to link the rise in information and having a better informed public with a parallel rise in medication use."
The pharmaceutical industry self-regulates, and advertising standards are set out in the code of marketing practice operated by the Irish Pharmaceutical Healthcare Association (IPHA).
The code states that disease awareness campaigns "should not in any way promote a brand of medicine, either directly, by naming the product, or indirectly". It recommends that firms talk to the medical profession as well as relevant patients' associations before running any campaign.
Dr Shanahan, however, says this does not always happen. "It would be fair to say that when they do contact us, they'll listen when it is in their interests. When it's not, they disregard our comments."
He argues that if pharmaceutical companies were genuinely altruistic in their wish to improve patient information, they would give "no-strings-attached funding to the [ State] Health Promotion Unit for them to allocate wherever need is greatest".
On average, eight complaints are made each year to the IPHA alleging breaches of its code of marketing practice, 80 per cent of which are upheld. The more serious breaches are referred to the Department of Health.
Stephen McMahon, chairman of the Irish Patients' Association, says: "Pharmaceutical firms are trying to meet the need for additional patient information, most of them in a relatively fair way.
"However, the model should be that your doctor is the information-bearer. If they don't have the resources or time, there should be another mechanism so that you can get reliable information."
Disease information campaigns are common across Europe. A report published by Consumers International (CI) in June examined the promotional techniques used by the European pharmaceutical sector. It described as "shocking" the lack of publicity on how these firms spend their $60 billion (€46.7 billion) annual marketing budget.
CI director general Richard Lloyd says disease information campaigns are just one method used by pharmaceutical companies to influence opinion. Others include sponsoring patient lobby groups and hospitality for medical experts.
Pharmaceutical firms lobbied the European Commission two years ago to change the ban on direct-to-consumer advertising, but the proposal was voted down.