New Zealand is one of two developed countries that allow
direct-to-consumer advertising of prescription-only medicine.
Critics claim a proposed trade deal could make advertising
more worthwhile if drug-buying agency Pharmac is affected.
Health reporter Eileen Goodwin looks at the issue.
Loathed by many doctors, prescription drug advertising is
probably barely noticed these days by most New Zealanders as
anything out of the ordinary. New Zealand and the United States
are still the only developed countries to allow the practice.
Drug advertising is relatively low-level in New Zealand, but
critics fear that could change if agreement is reached on the
Trans Pacific Partnership (TPP), the controversial commerce
and trade deal under negotiation.
Critics claim doctors' time is wasted dealing with increased
demand for medicine, and that patients are at greater risk of
exposure to newer, potentially riskier drugs.
However, the industry - and a University of Otago medical
ethics professor - argue the time of doctors as gatekeepers
of medical information has long gone. The industry argues
that as advertising is regulated, it is a safer information
source than the internet.
Just over 10 years ago, opponents harnessed health sector
interest groups and ''got within inches'' of persuading
politicians to ban the advertisements, campaign leader Prof
Les Toop recalls.
''We managed the front page of the NBR three times in a row
... saying what awful people we were,'' Prof Toop said.
Prof Toop, a University of Otago general practice authority
at the Christchurch campus, said he still wanted the ads
banned, but acknowledged the industry tightened its
standards. However, the self-regulation framework was
essentially a ''joke''; few medical people bothered
complaining any more about individual adverts.
''I suspect it's still unfinished business for various
The campaign gained momentum because of outrage in the early
2000s about some big-ticket campaigns that doctors felt had
New Zealand lacked an independent source of information about
medicines, and he did not accept advertising filled the gap.
The industry was ''selling hope'' and GPs had to deny
prescriptions to patients who had paid for their
''By the time you go to the doctor, you don't want to hear
the down side.''
The ''cop-out'' was the advertisements' instruction to
patients to ask their doctor if a medication was right for
them. This meant the advertisement itself did not need to
''People who come from overseas are gobsmacked when they see
them,'' he said.
''Trained to believe people'', doctors sometimes felt
overwhelming pressure against a system in which the patient
was effectively an advocate for the drug companies.
''You get 20-year-olds wanting Viagra.''
Advertising sparked requests for newer drugs.
''My advice to patients is don't take any new medicines
unless it's a life-threatening illness. Let other people be
the guinea pigs and see what the down sides are.''
Despite the attention often focused on new medicines, they
were often just chemical rearrangements of older drugs, and
might have significant ill effects that take years to be
He cited withdrawn anti-inflammatory Vioxx, blamed for many
thousands of deaths worldwide, as marketed to the ''wrong
people'' - the elderly. It was ''lucky'' drug-buying agency
Pharmac did not fund it in New Zealand, where its use was
minimal. Pharmac's hold on pharmaceutical spending in New
Zealand is considered a major factor in the relatively low
volume of drug advertising.
He fears the outcome if ''Pharmac gets clobbered'' by the
If the industry secured better terms, expect to see
advertising ramped up because of increased revenue, he warns.
Labour MP and health spokeswoman Annette King was minister of
health when Prof Toop led the charge to ban drug advertising.
When contacted recently, she pointed to improved industry
standards since that time.
In a brief email, she said Labour would carry out a review
before committing to any ban.
Health Minister Tony Ryall said the drug advertising regime
was working well, and referred questions about the trade deal
to Trade Minister Tim Groser.
''It is not in New Zealand's best interests to confirm or
comment on any issue that may be under negotiation. New
Zealand provides for direct-to-consumer advertising under our
law. However, in all areas of the TPP, the Government is
working to ensure that we are protecting policy flexibility
where this is considered appropriate,'' a spokesman for Mr
Groser told the Otago Daily Times last month.
Lindsay Mouat, chief executive of the Association of New
Zealand Advertisers, said people benefited from the
advertising as a source of information. Given patients were
so frequently searching online, he did not accept the
argument they would be better off without the more reliable
information supplied by advertisements. Doctors were no
longer on a pedestal, he said, suggesting the extent of
patient pressure created by advertising had been exaggerated.
''I think there's a strong political lobby amongst the
medical industry that wants to retain control.''
If it blamed advertisements for creating pressure on doctors,
the medical profession was ''abdicating responsibility'' for
patients, whose best interests they had to serve.
The industry had moved away from big campaigns around
products like weight loss drug Xenical, towards a ''more
empathetic'' magazine-style approach focused on referring
consumers to doctors for information. Spending was probably
static to declining, partly because of Pharmac's influence
and partly the waning prominence of TV and other older media.
''There's certainly less direct-to-consumer advertising than
there has been. And that's a reflection of changing media
habits ... ''''As an observation ...
the extent of [the advertising] has reduced over time and we
have certainly not seen the major blockbuster campaigns that
may have occurred in the early days of [direct-to-consumer
advertising],'' Mr Mouat said.
Pharmaceutical lobby group Medicines New Zealand general
manager Kevin Sheehy said that as a former GP, he found
doctors' attitudes outdated and patronising.
''It's incredibly patronising to think that you should be the
only source of information about treatments available.''
Self-regulation was working to provide consumers with a safer
information source than the internet.
He rejected the assertion patients were more likely to become
guinea pigs for newer drugs. Advertising did not expose
patients to increased risk from side-effects; drugs were
evidence-based and there was separate regulation to protect
patients from adverse side-effects. If there was less
advertising these days, it was likely because drugs released
in recent years tended to be targeted to smaller population
groups, he said.
He suggested the industry's code of practice for
advertisements was tighter than standards applied to news
media. This meant articles and stories about breakthroughs or
new treatments could be more unbalanced than an
advertisement, he asserted.
Concern over the TPP was aired in a New Zealand Medical
Journal article last month by Erik Monasterio and Deborah
Gleeson which Mr Sheehy rejected as ''highly speculative''.
Pharmac would still be able to make evidence-based funding
decisions if the industry got the process changes it sought,
he said. He rejected a suggestion advertising ''medicalised''
everyday life. The industry created new treatments to improve
people's quality of life, Mr Sheehy said.
The industry has some support from University of Otago
medical ethics authority Prof Grant Gillett, who agreed the
ads were more helpful than harmful.
''There are a lot of countries in which the doctor's voice
becomes the sole voice that's heard in a therapeutic
The internet was a ''jungle'' for health information seekers.
He agreed with Prof Toop that a proper source of neutral
information was lacking.
Far more worrying than ads, he believed, was the industry's
role in ongoing medical education that posed risks to medical
neutrality. Its influence, shaping the profession's views on
treatments, was too great, he said. Dunedin drug advertising
opponent Dr Katharine Wallis, a GP and University of Otago
general practice senior lecturer, said ads created anxiety in
patients over perceived ailments that might not otherwise
bother them. It was part of a wider trend of medicalisation,
in which even bereavement could be diagnosed as depression
under new international diagnostic guidelines.
Drug advertising was a harmful practice in ''lots of
different ways''. Dr Wallis did not believe there was much
chance of either major party banning the advertisements,
because of the power of the industry.
A spokesman for the Ministry of Health confirmed the last
review of direct-to-consumer advertising was conducted in
2006, and no further work was planned.