Clearly, in the USA, DtoC advertising is a big part of Pharma companies marketing strategy. I would be very surprised if there were not regulations in place governing the content of such adverts. In the UK there are adverts for medicines, however to my mind these are usually only over the counter medications e.g. simple analgesics which patients do not need to visit a doctor to be issued a prescription. Another way that patients may demand a particular therapeutic is in the case of new drugs e.g. the monoclonal antibody Herceptin for breast cancer a few years ago, where patients in certain areas were given the drug and patients living elsewhere were denied the drug-a so called ‘postcode lottery’. This created a lot of media attention and patient groups and charities put pressure on hospital authorities to allow the drug to be used in those denied it. The National Institute of Clinical Excellence (NICE) was created to take an analytical approach by estimating the additional benefit in relation to the additional cost of treatment with new technologies. It then produces national guidelines which has helped remove this ‘post code lottery’.

Dear Tom, I am a new member of the Lancet Student and have just finished reading your article on the relationship between the pharmaceutical industry, doctors and patients. I thought the subject matter was very interesting and thoroughly researched. The point where you mention direct-to-consumer advertising in the United States particularly caught my attention. I live in the US and have been exposed to TV commercials for drug companies for at least the past ten years. When this market campaign first began commercials were vague and ambiguous; one for Claritin/antihistamine initially just showed outdoor scenes, hot air ballooning etc. without ever stating the drug’s target for treatment. Now the trend has evolved into commercials that are more explicit with a voice over providing an exhaustive laundry list of all possible side effects from the drug being advertising. In particular drug commercials now seem to attempt to create patient pro-activeness as each spot usually closes with the phrase “talk to your doctor”. Ads often list symptoms of a disorder, asking the viewer if they share these symptoms. Next it is suggested to the viewer that they may have this disorder but there is hope in the drug that is being advertised. I personally can’t picture coming in for a doctor’s appointment, telling the physician that I think I may have a certain disease or disorder and then requesting a specific brand of prescription medicine by name. Honestly, the pharmaceutical advertising campaign in the US has always confused me and while I can’t see its effectiveness it is absolutely continuing. I don’t see patients becoming more well informed of their drug treatment options because there are no comparisons or statistical information offered in the advertisements to promote educated consumers. The only result I can see is an increasing sense of hypochondria or perhaps if the patient is prescribed a drug with a name brand that they recognize some blanketed feeling of security in the quality of the drug due to the association through TV advertising. So it wasn’t clear to me from the article if you felt direct to consumer advertising in the United States was a positive as far as eliminating the influence of the drug companies with their motive for commercial profit. Do you think direct to consumer advertising would improve the situation in the UK? I would say that consumers are definitely more aware of the name brands of drugs and their associated illnesses but absolutely without complete understanding of the different options or even the diseases/disorders the advertising drugs purportedly treat. I would be interested to know your thoughts on this and if you think a modified consumer education program would be effective. Again, to my mind, the issue is the bias caused by whomever will profit from the advertising, in this case again, the drug companies; providing limited information to their own benefit.
Thanks for the article, Katie

Dear Katie, I have not had much exposure to ‘direct to consumer’ advertising and as such did not really expand on my comment. I mentioned DtoC advertising simply to compare the amount of information patients have across the Atlantic, from here. I understand that it could be perceived that I believe this form of advertising is a good thing. However, I had not thought in great detail about the disadvantages of this and concentrated on the problems associated with intense marketing towards the medical profession. Your points are very interesting, and I believe DtoC advertising is going too far the other way! With regards to a modified consumer education program, I believe if patients are driven to find out about their illness and treatment options they will use the Internet to satisfy their curiosity so see no real benefit of such a program. This is just my opinion! Tom