Let’s talk about drugs

Paul Tunnah asks if we need to rethink pharma's strict marketing regulations and have a discussion on how best to communicate with patients

I’m writing this from the ‘other side of the pond’, as us Brits would say – the good old United States of America, where I’m attending a conference on pharmaceutical marketing.

There’s no denying the importance of the US market in pharmaceuticals. In a global drug market worth well over a trillion dollars, it accounts for almost half of that revenue and is not showing any signs of slowing down, despite President Trump’s attacks on industry pricing.

It’s also therefore an important market for pharmaphorum, with typically between 40-50% of our online audience visiting from the US and a growing array of clients based in this region. With this in mind, I try to be Stateside at least once a quarter to catch up on the latest trends.

Some common themes emerge that you will find talked about at any pharma conference, irrespective of location – the complexities of multichannel marketing, patient engagement, access to medicines / drug pricing, diminishing R&D returns / the challenges of clinical trial recruitment and the ever-present frustrations of low levels of trust in the industry.

There is, of course, one big difference between the US and the rest of the world (friends in New Zealand excepted) – direct-to-consumer (DTC) advertising of medicines.

Where marketers in other regions come out in a cold sweat at the thought of inadvertently mentioning a prescription drug on social media or other open channels, over here it’s hard to avoid being bombarded by them. Watch TV in the US for any length of time and you’re sure to be affronted by an advert showing how much better a patient’s life has become due to taking ‘Brand X’, shortly followed by an equal amount of time explaining the array of interesting side effects it may impose upon you.

“Medical misinformation is potentially causing deaths in all kinds of disease areas”

There are strong arguments for why DTC advertising for prescription medicines is not allowed in most markets, typically revolving around the fact that the clinical trial data on which they are approved is far too complex for the average patient to interpret, so should stay firmly in the hands of the trained doctors.

Even in the US, DTC promotion has its fair share of critics, with many doctors becoming tired of having to deal with patients bombarding them with their self-recommendations on the basis of such adverts.

But there’s a problem here and we need to discuss it.

The fact is that patients all over the world are increasingly doing their own research on medicines before going to see the doctor. This may be from reputable third-party sides like drugs.com or WebMD, but it could be from far less reliable sources – there is a lot of ‘bad’ health information out there.

If you want a good example of how bad this information can be, then look no further than the continuing furore over the MMR vaccine. Despite the fact that Dr Andrew Wakefield’s paper on the matter was proved to be completely false – and therefore ‘unpublished’ – there is a whole army of anti-vaxxers out there who continue to spread this misinformation.

This has led to a reduction in vaccination rates and a rise in cases of measles in children, threefold in the last year in Europe, according to the WHO. In 2018, 72 children died from measles compared to 42 in 2017. That means 30 children potentially died due to this misinformation. That’s a very sad statistic.

Beyond that extreme example, medical misinformation is potentially causing deaths in all kinds of disease areas. I remember speaking to a major global pharmaceutical company several years ago that was grappling with an outpouring of negative social media stating that one of its medicines was routinely killing people.

The truth was that there probably were some patients who had died as a result of complications of this medicine, but a far greater number had avoided death due to its protective effect.

However, due to the rules about not promoting prescription medicines to the public, they were completely unable to wade into the debate and correct this misinformation. It’s therefore likely that some patients stopped taking their medicine because of the imbalanced negative media and died prematurely because of it.

This potentially happens in all kinds of therapeutic areas. There’s also the much broader and harder to define impact of these regulations, which means the pharmaceutical industry is cautious in general about any patient engagement, which helps fuel the lack of trust in the industry, which in turn further fuels belief in the misinformation.

Of course, the industry has to bear some responsibility for this. I still hear far too often the phrase ‘we can’t talk to patients’, when it’s not true. Pharma can talk to them, just not promote its drugs (outside the home of the brave – and the orcs).

So what am I saying? Should we allow DTC promotion for prescription medicines all over the world so the industry can state its case and correct the imbalance?

No.

I am saying that it’s time to have sensible debate about what the pharmaceutical industry can and cannot communicate about its medicines to patients.

The regulations were put in place to protect patients from the millions of dollars being poured into pharma’s marketing machine, potentially steering them down a course of intervention that wasn’t right for them. However, is it right that the companies that make the medicines – and therefore know more about them than anyone – cannot share what they know, despite a tide of poor quality or false information on them from every other angle?

Maybe it’s time to revisit this and have sensible dialogue around when and where pharmaceutical companies should be allowed to present their product information to patients, in a regulated and non-promotional manner.

Maybe the conclusion will be that the current status quo is the best balance and any alternative would be more harmful. But I think we need to have the debate and I’d welcome anyone’s views on this.

It’s time to talk about drugs.

Disclosure / transparency: Yes, pharmaphorum does receive money from some pharmaceutical companies for our publishing and content consulting services. No, it does not influence our editorial coverage and no pharma company has suggested I raise this topic – it’s my own thoughts.

About the author

Dr Paul Tunnah founded pharmaphorum in 2009, which is a content and communications company offering industry leading publications (www.pharmaphorum.com) and a strategic consultancy (www.pharmaphorumconnect.com). He is a recognised author, speaker and industry advisor on content marketing, communications and digital innovation, having worked with many of the world’s leading pharmaceutical companies and the broader ecosystem of healthcare organisations.