Time for transparency?

Should pharmaceutical companies be allowed to advertise prescription drugs on television? Nick Ross and Michael Allen argue the case for openness

In Europe there is an instinctive revulsion to the idea of turning ill people into drug consumers. In orthodox best practice, potent medicines are prescribed by doctors who know best. The idea of directly advertising to stimulate demand is anathema. Just imagine it: TV commercials for powerful sedatives, anti-depressants, heart and cancer drugs!

Yet the US has permitted DtCA (Direct to Consumer Advertising) and it was inevitable that the European Commission should at least consider the idea. The European Parliament, like most people perhaps, is horrified. But is the knee-jerk "no" justified? Alone among consumer groups, we do not think so. HealthWatch is a registered charity that promotes evidence-based assessment of all forms of treatment. We aim to provide the public with reliable information about healthcare. We have no vested interest; our sole concern is in the honesty, reliability and transparency of claims made to people who are ill or who may be persuaded they are ill.

Thus, our starting point is a general principle that free expression is preferable to censorship. We consider that reliable information is more likely to emanate from openness than from over-regulation. Our test must be: will DtCA do more harm than good, and if so how can the harm be minimised and the good exploited? Only if the harm manifestly outweighs the benefits should DtCA be outlawed.

There is obviously great potential for harm. Ill people are often frightened and vulnerable. Most have no pharmacological training or much scientific literacy and might be manipulated. And all health systems (not just in the UK) are already racked by cost inflation - if drug companies push their high-price drugs, health services are bound to suffer.

Yet some of these concerns amount to condescension; and we believe the real issues can be controlled. In fact the idea of doctor as gatekeeper and patient as mute supplicant is not just becoming unfashionable - it is fading in practice. We now have patient information leaflets (reliable), acres of newsprint (much of it unreliable), widespread advertising of "alternative remedies" (a great deal of it manipulative and confusing) and increasingly the old rules on prescription drugs are being circumvented by the internet (which peddles uncontrolled falsehoods as well as honest information) and by the financial support pharmaceutical companies provide to patient organisations (creating links which are rarely transparent).

So how can people's desire to know more be squared with the pharmaco marketing departments' ambition to maximise sales and profits?Not, we think, by the European Commission's current proposals. They plan to allow DtCA for a limited number of conditions, with self-regulation by the pharmaceutical industry overseen at national level. These "limited number of conditions" look suspiciously like the thin end of a very big wedge. Moreover, given recent failures of self-regulation in other fields one does not need to be a cynic to have doubts about the intended mechanism of control.

Pharmaceutical companies claim that if DtCA is permitted the industry will act in the public interest. HealthWatch suggests we get them to put their money where their mouth is.

In principal we make five proposals:

This is necessarily a highly edited summary. We believe HealthWatch's detailed proposals provide a framework which liberates the patients, physicians and the pharmaceutical industry. Let there be more light than heat.