Fear as a Tool 2

HSA, Singapore's Quackbuster, makes the news again today:

Drug firms told to stop running 'educational' adverts
HSA says the campaigns are really thinly veiled ads, which are banned here; some also use scare tactics
By Salma Khalik, Health Correspondent

DRUG companies have been told to stop running 'educational' advertisements because they are anything but educational.

The Health Sciences Authority (HSA), Singapore's medicines regulator, is concerned about the increasingly 'creative' slant drug companies are taking. It told The Straits Times that these educational campaigns were thinly veiled advertisements, which are banned here.

It plans to re-look the issue with the industry. It wants stricter rules to ensure that drug companies do not cross the line, using campaigns to push their products.

Like most countries, Singapore does not allow direct-to-consumer advertisements for prescription drugs. It prefers to let doctors tell patients about medicines.

When the HSA agreed four years ago to allow drug companies to run educational campaigns, the understanding was that they would provide objective and unbiased information about a disease.

This would encompass alternative treatments, including the benefits of diet and exercise.

Instead, some advertisements rely on scare tactics and give little information. Some promote new and innovative products that lack long-term safety data, said HSA deputy director Madam C. Suwarin.

She said some drug companies were also becoming 'too creative', such as paying for coverage in newspapers, magazines and on the radio.

A few years ago, the HSA chided Merck, Sharpe & Dohme (MSD) for its bus stop ads. MSD promptly removed them.

MSD marketing director David Peacock said his company had no intention of breaching the rules and all the campaigns that the company has run since then had complied with the regulations.

He felt that there was a role for educational campaigns, especially when many are unaware that they have a disease.

Dr Kevin Tan, vice-president of the Diabetic Society of Singapore, agreed that a review might be timely. But he also felt that campaigns by drug companies had helped patients and he 'would not like to see this end'.
Educational efforts by the Government were not enough and 'coverage would just not be as intense without the help and drive of pharmaceutical companies', he said.

Dr Beh Suan Tiong, president of the Obstetrics & Gynaecology Society of Singapore, also supported industry education. He said: 'They are important components in any disease management and prevention, be it by public or private organisations. Both have their roles.'

Madam Suwarin said the HSA also thought it good for the industry to help patients. She said: 'We know we need to work with others. We want to be a smart regulator, carrying a small stick, like a conductor building a symphony. Not a big stick to hit them with.'

But it must also make sure that drug companies do not push patients into demanding medicines that they do not need.

She said that the focus on depression in the United States has sent the number of prescriptions for anti-depressants soaring. Such medication is meant only for severe depression, but doctors dole it out freely.

The drugs can have severe side effects, including suicidal thoughts in youth.The HSA does not want to see it happen here.

Well, leaving aside what the poster is trying to sell (which is itself another controversial topic), angry doc does think the advertisement aims to hit the heart more than the head. But as he had mentioned before, angry doc has no objections to using fear as a tool in healthcare.

As for the issue of direct-to-consumer advertising (DTCA), angry doc does not have a firm opinion on it, but just takes the conventional view that it is not something desirable because of the likelihood that drug companies will "push patients into demanding medicines that they do not need".

Many doctors will no doubt agree, because DTCA has indeed be shown to be "associated with increased prescription of advertised products and there is substantial impact on patients’ request for specific drugs and physicians’ confidence in prescribing" while at the same time, "[n]o additional benefits in terms of health outcomes were demonstrated". (Neverthelss, the same doctors will likely claim that they themselves will never succumb to such pressure from their patients.)

To angry doc's mind the underlying issue with DTCA is that medicine is a confidence good. Drug companies will always try their best to increase their sales (and they wouldn't be pushing for DTCA to be legalised if they didn't think it increased their sales, would they?), and patients will probably never have sufficient knowledge to discern advertising hype and scare tactics from reasonable concern and risk-benefit ratios.

At the end of the day, it is up to the doctor to understand the products being sold, and deciding if it is beneficial for the patient he is seeing. The fact that DTCA seems to be affecting our clinical judgement speaks poorly of us as a profession, and is another example of how the market fails when it comes to managing healthcare.

Not that angry doc will let his judgement be affected by DTCA, you understand...