Journal of the New Zealand Medical Association, 04-June-2004, Vol 117 No 1195
Finnish physicians show little support for consumer advertising of prescription drugs
Hanna Toiviainen, Lauri Vuorenkoski, Elina Hemminki
Direct-to-consumer advertising of prescription drugs (DTCA) is currently allowed in two developed countries—New Zealand and the United States (US). In New Zealand, the banning of DTCA has been discussed.1 Canada currently prohibits DTCA, but consumers receive DTCA across the border from the US. The European Commission (EC) proposed in July 2001 to allow DTCA, initially in selective diseases; however, the proposal was rejected in June 2003.
DTCA has been defended by its supporters who claim that it increases patients' participation in their healthcare, and they also give the difficulty in preventing and controlling ‘hidden’ DTCA as a reason.
Meanwhile, critics have said that DTCA is uninformative, creates demand via consumers, increases medicalisation, deteriorates the doctor-patient relationship, and increases (irrational) prescribing and drug costs.2–4
The Standing Committee of European Doctors holds a negative position towards the EC proposal for DTCA, but no representative data are available on what practising physicians in Europe think of DTCA.
We carried out a survey on Finnish physicians’ opinions of DTCA and other drug information sources for patients.
The data were gathered as part of the annual physician survey (sent to all working-aged physicians in Finland [n=16,698] by the Finnish Medical Association in March 2002). The response rate was 85%.
The covering letter briefly described the EC proposal for DTCA, and physicians were asked their opinions of the advertising of prescription drugs for consumers, and they were also asked for their opinions on the usefulness of different drug information sources for patients and consumers.
The average age of respondents was 43 years, 53% were women, 42% worked in hospitals, 60% were specialists, and 87 % did clinical work (n=12,255). Age was strongly correlated to other characteristics.
Almost all physicians were against full DTCA (Table 1), but half would allow advertising indirectly via patient organisations or healthcare units; 18 % were against all types of DTCA, and 19 % choose the ‘cannot say’ option or did not answer the question.
Table 1. Physicians' attitudes towards DTCA of prescription drugs (n=14,157)*
*Question asked: In your opinion, should the EU (European Union) allow the following types of direct-to-consumer advertising (DTCA) of prescription drugs? Note: The order of alternatives was different in the questionnaire.
When asked how useful various drug information sources (in general) were, 20% of physicians considered drug advertisements ‘harmful’, and 16 % considered them ‘useless’. Pharmacies were considered to be the most useful drug information sources (84% thought pharmacies were ‘very’ or ‘somewhat’ useful). Patient organisations were also considered useful (82%). Scientific journals, media, and even the Internet received more support than drug advertisements.
Finnish physicians are critical towards ‘product-claim’ full DTCA, but half of them would allow advertising by ‘mediators’ such as patient organisations or healthcare units.
The majority of general practitioners in New Zealand (in 2002),5 and family physicians in the US (in 1997),6 generally had clear negative opinions of DTCA. In a US Food and Drug Administration study in 2002, GPs and specific specialists were divided in their attitudes.7 In that study, physicians were asked to base their responses on a recent specific encounter with a patient.
Physicians' dislike of DTCA may result from their desire to retain traditional professional roles or from their concern over quality of patient care. Salaried physicians may feel that DTCA can prompt patients to seek care unnecessarily and increase physicians' workloads. Indeed, DTCA may lead patients to pressure physicians into selecting certain treatment options, which are not optimal.3,8 Furthermore, physicians may think that DTCA misinforms patients, therefore making them anxious that they are not receiving the correct treatment.
DTCA experience from the US shows that it does not provide good quality information to the patients. Indeed, only a few prescription drug advertisements in magazines describe other treatment alternatives, the duration of the treatment, or even which patients benefit from the treatment.9–10
In summary, further discussion of DTCA and other means of disseminating drug information are needed.
Author information: Hanna K. Toiviainen, Researcher; Lauri Vuorenkoski, Senior Researcher; Elina Hemminki, Research Professor, National Research and Development Centre for Welfare and Health STAKES, Health and Social Services, Helsinki, Finland.
Correspondence: Hanna Toiviainen, National Research and Development Centre for Welfare and Health STAKES, Health and Social Services, PO Box 220, 00531 Helsinki, Finland. Fax: +358 9 3967 2227; email: firstname.lastname@example.org
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