While it’s illegal to advertise prescription medicines directly to the public in Australia, pharmaceutical companies can circumvent this with ‘awareness’ ads for the conditions their drugs treat – without naming their products overtly.
And they’re already doing it.
Novo Nordisk and Eli Lilly are running advertising campaigns they say aim to highlight obesity as a chronic disease. The ads make no mention of semaglutide (Wegovy) or tirzepatide (Mounjaro), but instead urge people to discuss their weight with their doctor.
So should pharmaceutical companies be allowed to run awareness ads for diseases or conditions their drugs treat?
Four out of five academics asked this question by the Conversation said no. But when Healthed asked over 1000 GPs in a national poll on 28 October, 59% said yes.
Just 41% of GPs felt pharmaceutical companies should not be allowed to run these ads.
More than 500 GPs in the survey explained the rationale behind their views. Here’s what they said.
Those in favour of allowing drug companies to run awareness ads largely viewed any increased health education or information as a positive – provided it is accurate and the medicine is not mentioned.
“Creating awareness, done ethically, is always a positive endeavour, as it improves knowledge base, and makes patients more informed about their condition,” one GP commented.
Others cited improved health literacy, compliance, more proactive discussions with their GP and better self-management as benefits.
“I think this would encourage patients to get involved in the care of their conditions and perhaps, see their doctor if they suspect they may have the condition,” one GP commented.
“Community awareness generally leads to more patients seeking advice from their GPs, hence allows us to educate our patients and make them aware of management options,” another said.
However, many GPs who expressed broad support did add caveats such as, “as long as the condition and its significance is portrayed realistically,” or “as long as it is not false and misleading.”
The lone academic who said yes to the question posed by The Conversation also felt there should be conditions.
Dr Jennifer Power, sociologist and principal research fellow at La Trobe University, said awareness campaigns have a place, but only when they are clearly in the public interest and aligned with health promotion priorities.
For example, Dr Power argues that when done well, awareness campaigns can help overcome barriers to preventative care, particularly stigma and shame.
“Pharmaceutical companies have the resources to run large campaigns that raise awareness of new treatments and prevention options for HIV and other stigmatised conditions,” she said, adding that regulations may be needed to ensure ads align with community interests, rather than lining corporate pockets.
The over-riding concerns – expressed by both GPs and academics — were that the framing of the ads would be mired by bias and conflict of interest.
“Pharmaceutical companies have a vested interest in their awareness ads and anyone looking at these ads would not much difficulty ascertaining which medication is being promoted. I think awareness ads should only come from agencies that do not have a profit motive,” is how one GP expressed it.
“It falsely skews public belief about condition importance based on advertising budget, not public need,” a GP in Healthed’s survey said.
Dr Fiona Willer, a Queensland University of Technology lecturer, dietitian and bioethicist also made this point.
“We need public health information – on a whole range of conditions and diseases – to be run by public health authorities, and void of any real or perceived conflicts of interest,” Dr Willer said.
“We don’t need drug companies inserting their agendas into the very private conversations we have with our health-care providers.”
One GP who supports awareness ads suggested that “the messaging should be reviewed by nominated public health / other medical experts in their field nominated by the Medical Board of Australia.”
“Public health campaigns are much more appropriate if public messaging is needed outside of primary care,” another GP said.
A number of GPs expected awareness ads would lead to more patients coming in with preconceived expectations or anxieties:
“It creates more work for the doctor. We end up trying to guess what agent the patient is talking about (they usually don’t remember enough specifics about the ad) and we often look not up to date if we haven’t seen the ad ourselves.”
“They will finish the presentation by telling the audience: “go and visit your GP or health professional. We are now a reducing number and usually fully booked and the consultant specialists are difficult to access.”
“It will increase patient googling and perhaps making the wrong assumptions about what is available and the relevance to them. It can increase pressure to prescribe certain agents like GLP-1s to patients who do not meet the PBS criteria.”
“Creates anxiety and overprescribing environment.”
Barbara Mintzes, a professor in pharmaceutical policy at the University of Sydney said the obesity ads are a clear example of the problems with this trend.
“Even if they don’t name the drug, this is still product promotion, pure and simple. Disease-awareness ads stimulate sales. In one long-term analysis from the United States they had stronger effects than ads with product names,” Professor Mintzes told the Conversation.
“Due to social media, consumers are very aware of what is out there, and so even if the drug names are not used, it is easy to identify what they are talking about. So it is indirect marketing,” one GP in Healthed’s survey said.
Another GP argued that “marketing drugs directly or indirectly to people will lead to drug consumerism.”
David Menkes, Associate Professor in Psychological Medicine at the University of Auckland, said restrictions on directly marketing prescription medicines exist “due to concerns about costly and unnecessary treatment, drug-related harms, and distortion of the doctor-patient relationship” And the ads amount to a strategy to get around this.
“’Awareness’ advertising skirts this restriction by omitting mention of specific products. These ads shouldn’t be allowed because, as wolves in sheep’s clothing, they pose essentially the same risks as ‘full’ direct-to-consumer advertising, where drug names are mentioned.”
Dr Ray Moynihan, an overdiagnosis researcher at Bond University, agreed.
“Company-sponsored ‘disease awareness’ campaigns are designed to expand sales of the newest, most profitable products, by turning people into patients,” he wrote.
“Unnecessary care is now recognised as a major threat to both human health and the sustainability of health systems, taking precious resources from those who need them most.”
It’s not black and white…
A major theme in GPs responses in the survey was that many GPs see potential for both risk and benefit – and while six out of 10 GPs are supportive – they believe it’s important to tread carefully. Here are some of their comments:
“It’s very important to increase awareness and knowledge, but companies have to be careful not to advertise their products. It’s a very thin line which might be difficult to manage.”
“As long as the information is accurate, then it is good for people to be more aware – but so many diseases that don’t have lucrative treatments will be ignored in ads.”
“Education of consumers and medical practitioners must be two pronged. Consumers can enquire about a medication, but the practitioner must be equally equipped to respond to requests.”
“It is always good to educate the general public about health conditions, provided this is done with facts. There is always a risk the influence may not be to the patient’s advantage if information provided is slanted solely to the drug company use.”
“It’s important for the patients to be aware of drugs used to treat different conditions. On the other hand, it can bring false expectations that their conditions should be treated by the specific medication, not knowing that the presumed medicine was approved as second or third line of treatment, not the first!”
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