Direct-to-consumer advertising: should there be a free market in healthcare information?

On June 3, 2003, the European Council of health ministers rejected a proposal from the European Commission to allow drug manufacturers to advertise directly to particular groups of patients; the proposal had already been rejected by the European Parliament subsequent to a heated public debate in which consumer and patient groups almost unanimously argued that it was not the role of drug companies to provide information to patients. The pilot scheme suggested by the Commission would only have applied to patients with three chronic diseases, AIDS, diabetes, and asthma, and would, it was argued, not undermine an overall ban. Drug companies would have been required to abide by a special code of conduct and clear any information given to patients —on web sites or in specialized publications —with national authorities. In parallel with these developments, the European Commissioner for Enterprise and Information Society Erkki Liikanen and Public Health Commissioner David Byrne launched the so-called group of ten or “G10.” This was an initiative that brought together representatives of patients, national governments, and the drug and health insurance industries to discuss ways of increasing the competitiveness of the European pharmaceutical industry and capitalizing on the industry’s potential for improving public health in the European Union. One issue that was discussed was the possibility of lifting the current ban on direct-to-consumer advertising of prescription-only medicines (DTCA) in order to extend the information on healthcare available to patients. In light of political developments, it was not surprising that in June 2004 the G10 recommended that a clear distinction be made between patient information and commercial marketing of pharmaceutical products, and that the ban on DTCA should remain in force. One of the G10 members who most explicitly supported this recommendation was Angela Coulter.1 Amid widespread enthusiasm for liberalization of drug advertising among other health commentators, she argued convincingly that it is inappropriate to delegate responsibility for informing patients to commercial companies, that marketing typically is biased and untruthful, and that a free market for information about medicines would fail to empower patients to make independent decisions about their own care and treatment. Coulter’s argument is largely representative of those opposed to lifting the ban on DTCA and this article takes her position as a starting point. We point out that the evidence on whether DTCA should be allowed in a regulated form or banned is divided. From this preliminary conclusion we proceed to introduce further issues into the debate, which point to the advantages of a much