Review of the Regulation of Direct-to-Consumer Advertising of Prescription Medicines
in New Zealand

Submission on Ministry of Health Discussion Paper

From College of Nurses Aotearoa (NZ)

A decision was made by the New Zealand Government (Medicines Act 1981) that enabled drug companies to place advertisements on television, in magazines, newspapers, billboards and other media with the purported goal of ‘educating' consumers about prescription drugs. This was to be known as direct-to-consumer advertising of prescription medicines (DTCA). DTCA is any paid form of non-personal communication of prescription medicines by manufacturers and distributors, the effect of which is to induce the prescription, supply, purchase and/or use of those prescription medicines (World Health Organisation, 1988).

The populations of developed countries are ageing and living longer. People in developed countries are becoming more interested and involved in their healthcare and the expenditure on health care is increasing. These consumers are becoming aware through DTCA of the availability of certain prescription medicines. Direct-to-consumer advertising is only permitted in the United States of America and New Zealand but has been considered in other developed countries. DTCA of prescription medicines is permitted in New Zealand under conditions set by the Medicines Act 1981 and the Medicine Regulations 1984. Although DTCA has been enabled for over twenty years it has only recently become a popular way of the consumer being aware of the availability of certain prescription medicines. The critics of DTCA express concern about consumer safety, increased costs and pressure to patient-doctor relationships. New Zealand has already experienced the DTCA of Celebrex and Viox, resulting in the increase in the sale of these drugs and then the dilemma in the withdrawal of these damaging drugs.

2. Background

The College welcomes the opportunity to make comment on the DTCA of prescription medicines in New Zealand . This submission is collated from relevant literature and the responses by members of the College of Nurses Aotearoa , who are registered nurses and includes nurse practitioners with experience in prescribing.

Nurse Practitioners with prescribing rights are now included as prescribers along with doctors. Therefore the concern of nurses is not only in their role as a partner in the nurse-patient relationship but as a prescriber.

3. Reasons for seeking a ban on DTCA

New Zealand nurses share concerns about the ongoing DTCA of prescribed medicines. These include:

•  The need for consumer protection

It is the consumer's right to be informed (President Kennedy, 1962) and everyone has the right to freedom of expression, including the freedom to seek, receive and impart information and opinions of any kind (New Zealand - Chen Palmer, 2000). Television is a highly used medium in DTCA and uses problem solving and emotional appeal to communicate the drug company message. However, consumers are concerned at the clarity of information in the advertisements, older consumers found them confusing (Harker & Harker, 2006), and although the benefits of the advertised drug were included in the advertisement the risks were not. Many consumers do not have any idea what these drugs do – they just see images of happy, healthy people on television who have been hired to play roles in these drug advertisements, and the consumers think they want to feel that way too, so they go to their doctor and request these drugs ( Adams , 2005). Pharm-specific advertising does seem to add lifestyle activities to the medication therapy but it seems the listener has a hard time hearing that part and this approach seems to relay the message that cures may be as simple as swallowing a pill which is concerning (personal communication, Nurse Practitioner, 13/04/2006).

•  The poor quality of information regarding the advertised medicines

Consumers seek information to meet their health needs. However, information from the drug companies is often biased and seeks to sell the product rather than objectively inform. This is a concern for nurses as nurses practise according to ethical principles, which includes the principle ‘to do no harm' to their patients/ consumers, and prescribing or administering medicines under pressure can be harmful.

•  The medicalisation of non-medical conditions

There is some concern that consumers are being persuaded, by DTCA, that non-medical conditions are defined and treated as medical conditions (Lexchin & Mintzes, 2004); for example baldness and erectile dysfunction.

Most of the advertising is aimed at well populations and people with minor or cosmetic complaints. People are directed towards pharmaceutical solutions for problems that are social or lifestyle in origin and could be addressed by non-drug means such as exercise or diet. These products create a dependency on the medical system and pharmaceutical solutions.

•  The increased cost to consumers and the health budget

If doctors agree to their patient's request, so as to maintain a relationship, keep the consultation short or because they believe in their patient's choice to anything, then this will channel health dollars away from effective expenditure on real health needs. This is a concern when health dollars are short. In the case of people with Community Services Cards, there is a direct cost to the health budget for doctors visit.

•  The undermining of the doctor/nurse practitioner-consumer relationship

Doctors and nurse practitioners are under increasing pressure due to DTCA to manage busy practices, devote adequate time to their patients (Gallagher & Levinson, 2004) and feel a need to meet the requests of their patients (Harker & Harker, 2006).

4. Conclusion

Nurses are concerned with the ongoing practice of DTCA on prescribed medicines. These concerns include the need for consumer protection, the poor quality of information regarding the advertised medicines, the medicalisation of non-medical conditions, the undermining of the nurse practitioner/doctor-consumer relationship, the increased cost to consumers and the health budget. It is on this basis that the College of Nurses Aotearoa recommends a ban on the DTCA of prescribed medicines.

Thank you for the opportunity to participate in this submission process.

Ann McCleland

RN, BA, MN, MCNA(NZ)

Board Member

Reference List

Adams , M. (2005). Direct- to- consumers advertising must be banned as part of FDA reform. Retrieved 20/4/06 from http://www.newstarget.com/003204.html

Chen Palmer (2000). A new human rights institution for New Zealand . Retrieved 21/04/06 from http://www.chenpalmer.com/Default.aspx?tabid=73

Gallagher, T. H., & Levinson, W. A. (2004). Prescription for protecting the doctor-patient relationship. American Journal of Managed Care, 10(2), 61-68.

Harker, M., & Harker, D. (2006). Direct-to-consumer-advertising of prescription medicines: A consumer perspective. Retrieved 20/04/06 from
http://www.caanz.co.nz/attachments/dtca-research-findings-g-wiggs.pdf

Kennedy, J.F. President (1962). Special message to the congress on protecting the consumer interest. March 15 th. Retrieved 23/04/06 from http://www.jfklink.com/speechs/jfk/publicpapers/1962/jfk93_62.html

Lexchin, J., & Mintzes, B. (2004). Transparency in drug regulation: Mirage or oasis? CMAJ, 171 (11).

World Health Organization (1988) Ethical criteria for medicinal drug promotion. Geneva : World Health Organization. Retrieved on 20/04/06 from http://mednet2.who.int/tbs/promo/whozip08e.pdf .