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E-DRUG: DTCA - a response to David Gilbert

E-DRUG Direct to Consumer Advertising (3)

David gilbert is to congratulated for having the courage to take on this
challenge.  Even a moments consideration reveals how wide the subject is.
If you will excuse the rather disjointed (no time to gather the thoughts
into a logical sequence) nature of these ramblings and a tendency to teach
my grandmother to suck eggs, here are some ideas.  (If you dont excuse that
dont read it!!)

What constitutes 'advertising'?  Does it have to relate to specific product
or service, or can it be less specific, e.g. 'news' reports about an area
of treatment?  Is there a distingtion between 'good' adverts (eg used to
promote change in habits of the population in edp's, breast-feeding
promotion, etc) and 'bad' adverts ( promotion by individuals or small
groups for the purpose of personal gain)?

On the debit side adverts may be misleading - deliberately or accidentally.
 Deliberate misinfromation may arise from a number of sources (well
documented and promoted by MaLAM) and relate to such issues as the method
of portrayal, the range of information given, the implied information in
the advert, and how and where portrayed (peer pressure, social position),
for example.  Accidental misinformation arises from the level of
understanding of the recipient (already aware of this in advertising to
professionals), a misunderstanding of the nature of human drug response, of
the context of treatment possibilities, and the lack of realisation that
the treatment may be worse than the disease.

For sure the relationship with the prescriber will change, and some may
argue that it is changing anyway.  There would clearly be much more
discusion about the treatment choices.  In many ways this could be seen as
beneficial in as much as it may promote concordance (the agreement with the
patient of treatment goals, treatment pathways, and the indicators that
tell us when we've got there).  It may be difficult for patients and
precribers to confront the void that we often dont know what is wrong with
them (for only 25% of primary care patients do we have a working
diagnosis).  Will widespread advertising change our threshold of
ill-health?  Will it change symptom presentation in as much as the symptoms
will now match the advertised treatment?

If there is to be DTCA (can we stop it?) should there be any controls?  The
widespread advertising and use of antibiotics is some parts of the world is
associated with multiple resistance.   From a public health point of view
is there any situation where the greater good would over-ride the
individuals access to information?  Is there a distinction between the
information subject to possible editorial control of, say, a magazine
advert and that contained on the internet?  Is it possible to agree the
range of information that is known about a medicine before it is advertised
to the public?  How does that fit with DES or, to use a more up-to-date
example, tamoxifen as a prevention of breast Ca?

The bottom-line for me is that this process is unstoppable (even with the
current regulations in countries where DTCA is not permissable, the public
acquire information in other ways and use that to influence their 'access'
to medicines) and we should simply embrace it.  For sure advertisers will
be liable for the accuracy and veracity of their advertisements (who will
guard this and prosecute where required?), for sure it will make
consultations different (maybe more fun!), and for sure it will place
pressure of healthcare professionals to counter disinformation, but isn't
that our job to advise and inform the public about the choices and outcomes
of treatment possibilities (remember the RSPGB's campaign - 'ask your
pharmacist, you'll be taking good advice')

Tim Dodd
Director of Pharmacy
Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan


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