The European pharmaceutical industry: coming to a screen near you?

The European Commission Pharmaceuticals Unit is currently developing a legal proposal to increase the public provision of information about prescription medicines. Their preliminary proposal would achieve this by permitting pharmaceutical companies to provide unsolicited information about their prescription-only products directly to the public via the mass-media.1 The permitted channels of dissemination would include television, radio and print media, as well as standalone products distributed directly or via healthcare professionals. The stated intention of this controversial proposal is to meet a public need for high quality, reliable information about medications. Legislative debate in this area is not new. In 2002, the European Parliament debated a proposed five-year pilot scheme of mass-media advertising limited to drugs for diabetes, asthma and AIDS. The proposal was rejected by 494 votes to 42.2 Currently, the USA and New Zealand are the only developed countries that permit direct-to-consumer advertising (DTCA) of prescription-only medications; it is a contentious issue in both.3,4 The preliminary proposal insists that our ban on advertising should be maintained, instead forwarding a suggestion that the pharmaceutical industry be able to disseminate ‘non-promotional information’. Herein lies the conundrum, as the distinction between ‘advertising’ and mass-provision of unsolicited information by industry is not immediately obvious. Indeed, despite widespread agreement that such a distinction is absolutely crucial to the current proposal, neither the proposer nor any stakeholder has yet offered a clear means to achieve this.5 Opponents therefore fear that permitting such legislation would be tantamount to allowing advertising in all but name.6 The importance of this debate cannot be underestimated: widespread information dissemination has the potential to significantly impact the public's understanding of health, disease and medications, and to alter the nature of the doctor-patient relationship. Whilst this debate may be relatively new to Europeans, it is both long-standing and familiar in North America and Australasia. We are therefore fortunate to have the benefit of others' experiences. Indeed, we are urged to learn from these experiences by physicians in New Zealand. They fear that Europe's current trajectory represents a ‘slippery slope’ to their own situation in which drug advertising is omnipresent, though unpopular with doctors and with patient groups.7 Within this article we draw on international experience to contextualize and consider the potential European policy. We summarize the discourse that surrounds DTCA in the USA and New Zealand and present a taxonomic framework. Starting from a discussion of Canada's experience, we discuss the distinction between information and advertising. We consider how Europe could draw all of this together to carve its own path towards world-class provision of patient-centred information.

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