WHO on direct to consumer advertising of drugs

Discussion in 'Health and medical' started by mfg, Sep 2, 2003.

  1. mfg

    mfg Guest

    Much to think about here: should drugs be advertised like shampoo? Is
    it alright to scare the living daylights out of people so they'll beg
    their doctor for statins? The letter is written to Lancet by the World
    Health Organization, Department of Essential Drugs and Medicines
    Policy, Geneva, Switzerland.


    Ensuring ethical drug promotion--whose responsibility?

    Sir--Cardiovascular diseases are a major cause of death in many parts
    of the world.

    Smoking, a sedentary lifestyle, an unbalanced diet,
    hypertension,obesity, diabetes, and high blood cholesterol
    concentrations are some of the most commonly cited risk factors.1

    In France, from February to April, 2003, an extensive media campaign
    purportedly sought to increase public awareness of cardiovascular
    disease
    risks. In newspapers and magazines, an advertisement displayed a
    corpse in
    a morgue, along with the caption: "A simple test of blood cholesterol
    could
    have avoided this". A 30 s television commercial was equally shocking;
    it
    depicted a couple celebrating a birthday, followed by the husband's
    collapse. His wife then watches while he is taken away in an
    ambulance.
    Finally, a voice declares, "You may think you're healthy, but too much
    cholesterol in your blood can cause a heart attack."

    The campaign was sponsored by the French Committee for the
    Coordination of
    Research on Atherosclerosis and Cholesterol (ARCOL) and Pfizer. There
    is
    no mention of the campaign on ARCOL's website, but Pfizer's French
    website promotes it, and offers briefing documents and the television
    sequence for
    free download. We believe the key message of the campaign is that high
    cholesterol concentrations cause cardiovascular mortality. Other
    cardiovascular risk factors are mentioned, but are seemingly used
    primarily to strengthen this message--ie, the more cardiovascular risk
    factors you have, the lower your cholesterol concentrations need to
    be.2

    To us, the implication is that smokers, obese individuals, or those
    who live a
    sedentary lifestyle can safely continue to smoke, remain overweight,
    or
    take little exercise, provided they take medication to reduce their
    cholesterol
    values.

    Of all the major factors accepted as cardiovascular disease risks,
    only
    cholesterol is addressed--the campaign's stated aim is not pursued. No
    mention is made of an actual medical product, but the campaign
    coincided
    with publication, in The Lancet, of the Anglo-Scandinavian Cardiac
    Outcomes Trial-Lipid Lowering Arm study,3 showing reductions in major
    cardiovascular events after use of atorvastatin.

    We believe the campaign could have worried patients, encouraging them
    to
    request a prescription for statins. If so, we suggest that the
    campaign
    meets the definition of promotion noted in the WHO Ethical Criteria
    for
    Medicinal Drug Promotion:4

    ". . . all
    informational and persuasive activities by manufacturers and
    distributors,
    the effect of which is to induce the prescription, supply, purchase
    and/or use of medicinal drugs".

    Moreover, we believe the campaign did not respect several of WHO's
    ethical
    criteria, in that it is neither accurate, informative, or balanced.
    Finally,we think the information used contained misleading statements
    and
    omissions likely to induce medically unjustifiable drug use or to give
    rise to undue risks.

    We conclude that this experience underscores the need for health
    authorities
    and those charged with reimbursing or for paying for medicines to
    urgently
    increase their vigilance with respect to drug promotion. In our
    opinion, they must also decide how they can play an active and
    effective part in regulation of promotional activities, and ensure
    that balanced health information is readily available to the public,
    so that prescribing is not unduly affected by drug promotion
    activities.

    Jonathan D Quick*, Hans V Hogerzeil, Lembit
    Rägo, Valerio Reggi, Kees de Joncheere

    *Department of Essential Drugs and Medicines
    Policy, WHO, Geneva, Switzerland (JDQ, HVH, LR, VR); Regional
    Adviser for Pharmaceuticals, WHO Regional Office for Europe,
    Copenhagen, Denmark (KdJ)
    (e-mail:[email protected])


    1 WHO. World Health Report. Geneva: World
    Health Organization, 2002.

    2 Pfizer. Nos dossiers thématiques: le
    cholestérol.
    http://www.pfizer.fr/Desktop
    Default.aspx?tabindex=1&tabid=62&file=/files/dossierThematique/91f7fbf6-7ad4
    -498d-b6a9-ebc64e36105c.xml#7 (accessed June 10, 2003).

    3 Server PS, Dahlöf B, Poulter NR, et al.
    Prevention of coronary and stroke
    events with atorvastatin in hypertensive
    patients who have average or
    lower-than-average cholesterol concentrations,
    in the Anglo-Scandinavian
    Cardiac Outcomes Trial-Lipid Lowering Arm
    (ASCOT-LLA): a multicentre
    randomised controlled trial. Lancet 2003;
    361: 1149-58.

    4 WHO. Ethical Criteria for Medicinal Drug
    Promotion. Geneva: World Health
    Organization, 1988.
    Access Essential Drugs Monitor #32 at
    http://www.who.int/medicines/mon/mon32.shtml

    copied as fair use
    www.lancet.com

    MFG (Janey Canuck)
     
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