The Greens want to ban it. Labour tried to. And it's illegal everywhere in the developed world, except the United States. Yet DTCA - the direct-to-consumer advertising of pharmaceutical drugs - is, I argued in a paper (5 MB, pdf) presented at the NZ Bioethics Conference on Friday, here to stay.

The debate over DTCA has sputtered away for more than a decade: since 2000, JAMA and the Lancet's journals have published about one article a year on the topic, and the New Zealand Medical Journal is at the lower end of that range. The argument usually seesaws in a yes-but pattern - this aspect is bad! - Yes, but aspect this is good!.

In fact, though, none of the three main arguments against DTCA really hold water. It's a waste of time to refute them.

DTCA raises costs for Pharmac? Not that anyone's ever shown . The theory is this: if you raise disease awareness through DTCA, you'll get a flow-on effect as more people present to their doctor, more diagnoses are made, and, in the end, more prescriptions are written. And you could prove that - if you were a pharma company: to carry out the factor analysis necessary to disaggregate the effect of drug reps, journal ads, samples and DTCA, you'd need to know how much was invested in each, and where. Pharma companies do have that data, but you don't. (Then why do they bother advertising? Because, once one of them starts, everyone else has to pile on in if they want to maintain market share. But a fight for share isn't a fight to grow the market.) In fact, the weak effect of advertising to many people - who may not see an ad, and who may not decide to act on it - has anything like the power of a rep visiting a doctor. Restrict that - as Switzerland did - and pharma companies would really be in trouble.

TCA hurts people because it leads to unnecessary, harmful prescribing? Good luck with that one before the Health Practitioners' Disciplinary tribunal. It's hard to resist repeated requests, and people may be more likely to stick to a medication regimen if they've had a hand in choosing the brand. But arguing that a request leads to prescription and must therefore be pre-empted by legislation ignores the gatekeeper role of GPs, and is an abdication of professional responsibility. Remember, people make specific requests all the time - for benzodiazepines, for example. For opiates. For methylphenidate. Part of the GP’s job is not to give it to them. The FDA - no slouch when it comes to imposing restrictions - concluded many years ago that, despite "years of print DTC advertising, no rigorous evidence has been presented to demonstrate that DTC advertising has had any of the hypothesised ill effects"

... and so we should amend the constitution to ban it. Except that we probably can’t. S. 14 of the NZ Bill of Rights Act 1990 protects freedom of expression, and s.29 applies it to corporations. True, you can restrict it, but only as far as you can reasonably justify "in a free and democratic society.” And DTCA is already regulated - by the Medicines Act (which tells you what you have to include in your ads), by the Medicines Regulations (which tells you what you must leave out) and by the Advertising Standards Authority’s Therapeutic Products Code (which elaborates further). In light of the existing regulation, it’s difficult to see that abrogating a constitutional right because of potential but unproven harm, or because patients make GPs’ jobs harder by making a nuisance of themselves with product requests, is really going to fly.

AuthorNicola Rowe