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Direct to Consumer Communications: Better Health and Better Information
Europe can improve on direct to consumer advertising, if they are willing to empower patients.

Peter J. Pitts
Medical Progress Today
April 14, 2006

I've just returned from Europe where I had the opportunity to speak with various think tanks, thought leaders, and pharmaceutical companies on the issue they call "information-to-patients" (ItP). That's what we "on the other side of the pond" refer to as "direct-to-consumer communications."

I learned a lot about the very restrictive national and EU laws that make it illegal for pharmaceutical companies to do almost any kind of "information-to-patients" programs and how the pharmaceutical industry's representatives in Brussels are trying to, politely, inch towards incremental change.[1] Unfortunately there are no substantial, go-forward ideas, no white papers, and there is no consensus as to what a more progressive, European ItP policy might look like. Right now the only position is that it shouldn't be the American model—vulgarly saddled with the 'A' word: 'Advertising.'. But this is not a plan; it's just an endless dance between pharma-crats and euro-crats, and the music is atonal, sounding more like a dirge than a motion-oriented Vienna waltz.

But facts are stubborn things. I felt obligated to point out to my European colleagues that studies show DTC advertising drives patients to visit their physicians, creates an environment for more robust doctor/patient conversations, enhances compliance, destigmatizes diseases such as depression, and does NOT increase prices.[2] By simply determining what they should not do, rather than what they should do, Europe is unnecessarily shooting itself in the foot. As Julian Morris of the London-based International Policy Network quipped, "Europe is running out of failed alternatives."

However, citizens may have already seen direct-to-patient information as a solution. A recent consumer survey in Europe done by the Stockholm Network and Populus asked people in Great Britain, the Czech Republic, France, Germany, Italy, the Netherlands, Spain and Sweden what reforms would most likely increase their quality of care. In every nation, by a large margin, they answered, "giving patients more information about their illness."[3]

Health care education is the consumer's Rosetta Stone, and direct-to-patient-communications may provide a medium for it.

What needs to be first understood in this debate is that DtP pharmaceutical information isn’t just about selling. It’s about saving lives and saving our health care system. It’s about improving disease awareness and defeating patient non-compliance – estimated to cost European health care system billions of dollars a year in increased emergency room visits, unnecessary surgeries, expensive hospital stays, and lost productivity.

Today Europe has the opportunity to devise a system—indeed must design a system—wherein direct-to-patient information acts both as a savvy marketing strategy and a powerful public health tool—not mutually exclusive concepts by any means.

That being said, it's imperative to understand and accept in this debate that we are living in a post-Vioxx world where direct-to-patient information can no longer exclusively mean direct-to-consumer advertising (DTCA). Today it must mean DTCC—direct-to-consumer communications, or DTC.

In addition to these practical issues, there is a larger issue at play. Something that caused the most noticeable discomfort in conversations with European industry leaders and regulators In addition to these practical issues, there is a larger issue at play. Something that caused the most noticeable discomfort in conversations with European industry leaders and regulators was the fact that there is the mammoth issue of Free Speech. And having this debate at a time when Europe is in the process of determining what "Free Speech" means in the context of the Danish cartoon protests makes these discussions even more important. They are, after all, called "First Principles" for a reason.

While Brussels sprouts restrictions on all kinds of speech, much of euro-pharma is content to demurely request an audience to obliquely begin a quiet and polite conversation on incremental change. This is fine, but starting that conversation by stipulating that Free Speech can (and indeed should) be limited (by stipulating that direct-to-consumer advertising should now and forever be off the table) is, de minimus, negotiating from a position of weakness.

In the wake of the cartoon scandal, the Danish prime minister stated "Freedom of Speech is absolute. It is not negotiable." That's a good place to start when discussing ItP with the folks in Brussels.

Yielding the moral high ground may result in short-term success, but please consider that this is the same excuse that Yahoo and Google are using when they allow the People's Republic of China to block search terms like "democracy." It is even more disquieting when the birthplace of the Enlightenment embraces restrictions on the free flow of information.

[1] Direct-to-Consumer Prescription Drug Advertising: The European Commission's Proposals for Legislative Change
[2] Additional research is available on the FDA's Web site.
[3] Impatient for Change, Stockholm Network (2004).

Peter J. Pitts is Director of the Center for Medicine in the Public Interest and a former Associate Commissioner at the FDA.

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