Promoting good health with information or marketing?

Direct advertising to patients is still controversial in Europe, writes Jennifer Rankin.

The promise of relief from pain and anxiety delivered by people with glossy hair and good teeth: the results of a quick internet search throw up an obvious difference between European and American healthcare systems.

The US, along with New Zealand, is one of the few countries in the world that allows direct advertising to patients. And it is usually the American example that many Europeans have in mind when they debate the merits of loosening controls on information to patients from pharmaceutical companies.

The debate is hotting up because the European Commission will in 2008 publish proposals on information to patients on pharmaceutical products. Although the last directive regulating the industry was published as recently as 2001, the Commission argues that the rules need updating, following enlargement and the take-off of the internet.

Industry representatives say that they do not favour advertising to patients on the American model. Brian Ager, director-general of the European Federation of Pharmaceutical Industries and Associations (EFPIA), says: "We are not seeking an American solution, but the balance is wrong." He would like pharmaceutical companies to be able to provide "non-promotional information" on their websites. Ager says that "at the moment we are the only ones that can’t provide information [while] anyone can set up a website".

Ager argues that this is an issue fundamental to patients’ rights. Because there is so much information from American websites as it is, the current laws are "discriminating against parts of the patient population who do not speak English and who are not computer-literate". Around 50% of European citizens are regular internet users although this varies from 28% in Poland to 78% in Malta.

Patients’ groups, which are often industry-funded, also couch the issue of information in terms of patients’ rights. The European Patients’ Forum (EPF) says that patients have "a fundamental and legitimate human right to access quality information about their health".

The EPF is against direct to consumer advertising, saying that "prescription medicines should never be treated like ordinary consumer goods that are advertised to the public" and that "direct to consumer advertising tends to give emotive and incomplete messages". "There is genuine concern that such advertising would create unrealistic expectations," the EPF says.

But the patients’ group adds: "Pharmaceutical companies should be able to be a source of non-promotional information alongside other sources, on their products. They should be able to provide validated information for people actively seeking out further information on their conditions and available medicines. However, it is crucial to ensure that when patients seek information from pharmaceutical companies, they get full information, including for example negative side-effects."

EPF is almost entirely funded by the pharmaceutical industry, though it is diversifying its sources of funding. In addition, it has a code of conduct on transparency and ethics to protect its independence of view and prevent it being tied to funding.

But consumer groups are opposed to any relaxation in the regulations. "It is very difficult to distinguish between advertising and information," says Ilaria Passarani, a policy officer at the European Consumers’ Association (BEUC). Passarani fears that if the restrictions come down then patients will have to negotiate numerous "biases" in information. She says that companies might fail to give patients the full range of options, neglecting to give information about cheaper drugs, rival products or the option of doing nothing. She thinks that companies can already provide adequate information about their product through the patient information leaflet.

The industry and consumer viewpoint is far apart on this issue, but on one point they do agree. Both say that the patient information leaflet could be much improved, to make it more patient-friendly and easier to read. The difference is whether they see this leaflet as the beginning or the endpoint for drugs companies providing information to patients.

Direct advertising to patients is still controversial in Europe, writes Jennifer Rankin.