As the European parliament looks at the possibility of allowing pharmaceutical companies more freedom in direct-to-consumer prescription drug promotion, experts caution in this week's British Medical Journal (BMJ) that this could be detrimental for public health.

Les Toop and Dee Mangin, University of Otago, New Zealand, write that as the European Parliament considers opening up this type of advertising with no restriction on the type of media, the implications for public health are considerable.

There are just two developed nations that allow direct-to-consumer prescription drug advertising - The USA and New Zealand. Both these countries have seen a swelling body of opposition to their existing advertising laws.

The writers point out that New Zealand's health system is more similar to Europe's than the US system is. In 2006 pharmaceutical companies spent more than $5 billion on consumer advertising. Tens of millions of dollars were spent in New Zealand.

Growing concern triggered a New Zealand Ministry of Health public consultation in 2000. It was decided that advertising could continue with self-regulation. A promise of a future review of compliance with the regulations never materialized.

Advertising has become more extensive in New Zealand, the writers explain. They give as examples the promotion of celcoxib and refecoxib on television - the adverts were targeted at the elderly for long-term use. The promotion resulted in a considerable increase in prescribing, despite early warning of these drugs' cardiac risks. A number of TV adverts for oral terbinafine (toenail infection treatment) led to a doubling of prescriptions all over the country within a few weeks.

In 2003 the New Zealand government decided to ban direct-to-consumer advertising, in response to growing concern from health care professionals and the public. However, the government has been unable to get the required legislation through. This is despite huge opposition for direct-to-consumer advertising.

Europe could learn from the New Zealand experience, say the authors.

The writers argue that if you allow industry funded objective information you will end up with consumer choices being manipulated. It will increase the pharmaceuticalization of health and do nothing to help consumers make better decisions. The public will be more exposed to new medicines, many of which are no better than existing and cheaper ones - new medicines of which their long-term safety is unknown.

Allowing direct-to-consumer advertising pushes up drug costs - not a good thing for overly stretched health budgets. The result would be, on balance, a net harm for public health overall.

"Industry funded patient information and the slippery slope to New Zealand"
BMJ Volume 335 pp 694-5
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