Frequently asked questions

What’s wrong with drug marketing?
Prescription drugs have helped millions of people, but taken by the wrong person or in the wrong dose they can be lethal. The prescribing of drugs should be based on scientific evidence not marketing spin.

But the current regulations are clearly failing to protect the public.  

• In Australia and the UK during 2005, 19 of the 20 largest companies (95%) failed at least once to keep within the standards that the industry had written for itself.   
• In Brazil,1998, researchers analysed prescription drug advertisements gathered from private clinics and hospitals in southern Brazil. They reported that none of the 127 advertisement inserts that were analysed complied with all the criteria specified by Brazilian legislation.
• In Germany, 2004, research showed that 94% of drug advertisements were not supported by scientific evidence.
• In Thailand, 2003, Chulalongkorn University examined 256 advertisements targeting the general public. Of the 256 advertisements 79 were from Big Pharma and 38 were for prescription-only drugs despite the fact that such advertising is illegal in Thailand.

What effect does drug marketing have on health?
Deciding on the right treatment for a medical condition should be based on scientific evidence, not on marketing spin. It is estimated that in some countries up to 50% of drugs are wrongly prescribed, dispensed or taken.

If you take the wrong medicine it is unlikely to make you better and you may have an adverse reaction.

What effect does drug marketing have on the cost of health care?
Drug marketing is often aimed at getting doctors to prescribe their branded drug rather than the generic equivalent, even though this may have no added medical value.

A French study of medicines used to treat gastro-esophageal disorders, arthritis and blood pressure concluded that prescribing new branded drugs rather than generic drugs cost the health care system €650 million over a four-year period.

Another study in the US estimated that in 2000, direct-to-consumer advertising (which is banned in most countries) alone boosted drug sales 12%, at an additional cost of $2.6 billion to consumers and insurers.

This suggests that drug marketing can have a huge impact on the cost of healthcare. This is particularly serious in countries where budgets are much smaller. In many developing countries medicines already account for 60-90% of household expenditure on health.

How do drug companies influence doctors?
Doctors are literally bombarded with information from drug companies. CI worked with one Malaysian doctor to monitor the information he received from drug companies and – in just one month - he spent 17 hours meeting with drug company sales reps and received five boxes full of materials!

• Sales reps - drug companies employ sales reps to visit doctors. These reps are well trained in how to influence and use the latest techniques of marketing. Because it is a one-to-one conversation between closed doors it is hard to monitor the quality of the information. 
• Gifts - drug companies offer doctors all sorts of gifts to encourage them to prescribe more. In extreme cases the value of the gifts increases if the doctor prescribes more of the product. However, studies have shown that even the smallest gift can be effective in making the doctor feel the need to reciprocate.
• Adverts - medical journals are full of adverts for drugs, but despite strict guidelines these adverts sometimes miss important information. Many of the adverts also use emotive images and phrases that aren’t supported by science.
• Opinion leaders - drug companies know that doctors are more easily influenced by their colleagues and therefore spend a lot of effort persuading opinion leaders. There have been cases where they have ghost written articles for leading doctors.
• Continuing Medical Education (CME) - all doctors have to update their medical training and as public funds for CME have fallen, drug companies have stepped in. However, the information that drug companies give is sometimes far from independent.

What are doctors doing about it?
Many doctors and medical institutions are trying to limit the influence that drug companies have on the medical profession.

Doctors who are members of ‘No free lunch’ take a pledge to, ‘accept no money, gifts, or hospitality from the pharmaceutical industry; to seek unbiased sources of information and not rely on information disseminated by drug companies; and to avoid conflicts of interest in my practice, teaching, and/or research.’

An increasing number of medical colleges are also declaring themselves ‘pharma free’ and do not accept any drug company funding or marketing material.

However, the scale and sophistication of drug marketing means that it is hard to avoid or even recognise. There is little that doctors can do about marketing targeted at the public and patients.

What is Direct to Consumer Advertising?
Direct to Consumer Advertising (DTCA) is when companies can advertise their products directly to the public through adverts on television, the radio or magazines. Most countries, except the US and New Zealand, have a ban on DTCA because of the risks involved.

In the US where DTCA has been allowed since 2000, the number of prescriptions per person rose dramatically after the ban was lifted. Spending on prescriptions also increased. However, there is no evidence that health has improved as a result.

In Canada and the European Union there is pressure from media and drug companies to water down or remove the ban. 

In Europe drug companies want a greater role in giving information to patients and have even talked about a pharma TV channel. However, campaigners believe this would be advertising in everything but name. An attempt by drug companies to remove the European ban was defeated in 2002.

Isn’t marketing a good way to ensure the public has the information they need to make informed decisions?
It’s important that the public has independent, accurate and up-to-date information about drugs, but drug companies are not the right people to provide it. Because they are profit-based, drug companies have a direct conflict of interest between increasing their sales and profits and giving accurate information.

What is ‘disease mongering’?
Drug companies have been accused of using advertising to promote medical solutions to conditions that are not usually seen as being a medical problem.

For the drug companies this creates a whole new market of people, but for the public it means they are taking more drugs and may be distracted from non-medical solutions.

In Ghana, Roche is heavily promoting the weight-loss drug Xenical in medical magazines. According to the Roche advertisement 'obesity is a big health problem, Xenical is the long-term answer'. This ad pushes an expensive drug to deal with a 'lifestyle disease'. However, many experts agree that changes to diet and exercise routines could offer more cost effective solutions in tackling obesity.  

What are ‘disease awareness campaigns?’
Disease awareness campaigns aim to raise awareness about a medical condition and encourage people to take preventative action and/or seek treatment.

However, drug companies have been accused of funding disease awareness campaigns to increase their sales either through disease mongering or by associating their product with the medical condition through product placement or  just associating their company with the condition.

Why regulate drug marketing?
We don’t regulate the marketing of other products.
If taken by the wrong person or in the wrong dose, prescription drugs can be lethal. They should only be taken on the basis of scientific information and with the advice of a trained medical professional.

Advertising is more often about creating needs based on image and aspiration, than giving accurate and independent information.

Why is Marketing Overdose concerned about patient groups?
Patient groups do very valuable work and should be supported. However potential problems arise when drug companies start to fund such groups.

Patients are obviously a key target for drug companies and there is a danger that they are using these contacts to market to patients. There is also a danger that drug companies funding may influence the advocacy and campaigning done by these groups.

So what’s the answer?
At the World Health Assembly (WHA) in 2007 a resolution was passed calling on member states to:

‘enact new, or enforce existing, legislation to ban inaccurate, misleading or unethical promotion of medicines, to monitor drug promotion, and to develop and implement programmes that will provide independent, non-promotional information on medicines;’

This important resolution sets out the steps that governments need to take if they are to accept responsibility for the impact that irresponsible drug marketing can have.

Drug companies can also do more by tightening up their industry codes and issuing stiffer penalties to deter companies from breaking the rules.

In particular Marketing Overdose is calling for governments to support: 

• A ban on gifts to doctors and transparency in all transactions between drug companies and medical professionals and institutions. 
• Transparency in the funding of patient groups, continuing medical education and ‘disease awareness campaigns’ and work towards the establishment of a blind trust mechanism for industry support in these areas. 
• An end to promotion that misrepresents what a drug is licensed for or promotes a drug for a non-medical condition.
• The provision of independent information about prescription drugs.