1. Drug Companies and the Media by Dr. Angus Robin & Dr. Nabeela Hasan Bradford VTS 2008

2. The Cynical Part of The Presentation  Aims  Look at types of Media drug companies use  Does their use of media affect us?  Advertising in Journals  Quiz –guess the advert  Direct to Consumer Advertising

3. Drug Companies’ Use of Media  Reps  Journal articles  Supplements  ‘Ordinary’ Magazines  Direct advertising to us & patients  Disease Awareness Groups  Television  Internet

4. Ways Drug Companies Use Journals, Articles & Trials (1)  ‘Advertorials’-advertisers may offer to buy advertising if it can be accompanied by favourable editorial mentions of their products  ‘Reprinting Trials’- Drug companies spend money on reprinting well known, valuable trials & put their adverts alongside them

5. Ways Drug Companies Use Journals, Articles & Trials (2)  The best trial asks a simple, medically important question, is properly randomised (to avoid bias), and is conducted on a large scale (to avoid getting the wrong answer by chance).  BUT there are many ways to debase the process for marketing purposes.

6. Ways to corrupt science to promote drugs  Seeding and switching trials  Postmarketing surveillance  Equivalence trials  Doses [ BMJ 2003;326:1202-1205 ]

7. Drug Adverts We all flick through journals and medical papers like pulse and see ads for drugs constantly. Do you read them? Do you laugh at them / pity them? Do you think they have any effect?

8. Advertising  Advertising - most obvious & straightforward way in which drug companies use medical journals  V. lucrative  Many countries have many publications that are sent free to doctors & entirely paid for by advertising.

9.  Pharmaceutical advertising almost certainly does affect prescribing (Gottlieb S. Congress criticises drugs industry for misleading advertising. BMJ 2002;325: 137)  Publishers have calculated a return on investment of drug advertising & argued that it produces a better return than spending money on drug company representatives.

10. Evidence that Drug Advertising Can Be Misleading  A US congressional inquiry reported that from August 1997 to August 2002 the Food and Drug Administration (FDA) issued 88 letters accusing drug companies of advertising violations (Gottlieb S. Congress criticises drugs industry for misleading advertising. BMJ 2002;325: 137)  In many cases companies overstated the effectiveness of the drug or minimised its risks.

11. Disease mongering ‘Medicalisation of life’ was coined back in the 70’s. Describes the widening of illness boundaries to increase markets for treatments (both the sellers and deliverers – ie. Us!). Healthy become patients. Wastes resources. Iatrogenic harm. Professional and commercial interests

12. Recent BMJ piece An American drug company is planning to release a placebo called Obecalp. The idea came from wanting to give a hypochondriacal child something to calm down, and no placebos were in the drug store. Cherry flavoured dextrose pill and planning a liquid version next. [BMJ 2008;336:1316 (7 June)]

13. So here follows a few drug ads most of us will have seen. If you don’t read the BMJ/Pulse/Hospital Dr/GP than you’ll probably still be able to guess what a few of these are for. Try to think; which type of drug? why advertised like this? name of drug?

36. What is Direct To Consumer Advertising?  ‘The promotion of prescription drugs by pharmaceutical companies directly to consumers via broadcast and print media such as television, radio, magazines, billboards, and also the Internet.’

37. Direct to Consumer Advertising  Advertising non-prescription medicines to the public is permitted in the UK  DTC advertising of prescription-only medicines is strictly currently prohibited in UK & rest of EU  Is allowed in USA & NZ

38. Direct to Consumer Advertising (2)  In US, no. of scripts/person & money spent on scripts rose dramatically BUT this did not correlate with improvement on health  Has been recent pressure in EU & Canada to lift ban  Internet is not strongly policed so DTCA can occur in EU

39. Arguments For DTCA  People want and need information on medicines  Advertisements will help people to get needed medical care at an earlier stage  Advertisements will lead to better compliance  A doctor’s prescription is needed, so the patient is protected.

40. Arguments Against DCTA (1)  Prescription drugs are not like other consumer goods. Even when used properly, they can cause serious harm  People are vulnerable when they are ill  Sick and worried patients are less likely to exercise critical judgment of varied information sources.  Adding to medicalisation of conditions (pill for every ill)

41. Arguments Against DCTA (2)  Advertising increases patient pressure on doctors for reasons unrelated to medical evidence

42. REMEMBER  Advertisements aim to stimulate sales.  They cannot provide impartial, objective information.  Be wary of drug advertising & drug reps!  Say no to DTCA !

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