RANZCP homepage
Contact
Log in Log in
  • Become a psychiatrist
    • Psychiatry training
      • About the Fellowship Program
      • Entry requirements
      • How to apply
      • Time, fees and costs
    • Assessment of international specialists
      • Specialist assessment
      • Area of Need
      • Vocational registration (New Zealand)
      • Specialist specified training
      • Get to know the Australian healthcare system
    • The Psychiatry Interest Forum (PIF)
      • Join PIF
      • Opportunities for PIF members
      • Aboriginal and Torres Strait Islander PIF members
      • Māori and Pasifika PIF members
      • Posters, printables and videos
    • What a psychiatrist does
      • Specialist areas in psychiatry
      • A day in the life
      • Information for high school students
  • Training, exams & assessments
    • Fellowship Program
      • Program overview
      • Stage 1
      • Stage 2
      • Stage 3
      • Formal education courses
      • Reading list
      • Fellowship competencies
      • Training programs and zones
    • Advanced Training
      • About Advanced Training
      • Addiction psychiatry
      • Adult psychiatry
      • Child & adolescent psychiatry
      • Consultation–liaison psychiatry
      • Forensic psychiatry
      • Psychiatry of old age
      • Psychotherapies
      • See all Advanced training
    • SIMG placements
      • Partial comparability
      • Substantial comparability
      • Extensions, breaks and reviews of comparability
      • Fees for SIMG
    • Exams & assessments
      • Results
      • Timetables
      • Applying for exams and assessments
      • Exams
      • Psychotherapy Written Case
      • Scholarly Project
      • Self-paced online learning
      • Rotation assessments
      • List of EPAs
    • Fees
    • For assessors and supervisors
    • Certificate of Psychiatry
    • Help centre & support
    • Go to InTrain
  • Clinical guidelines & publications
    • Journals
      • Australian and NZ Journal of Psychiatry
      • Australasian Psychiatry
      • MEDLINE Ultimate
      • British Journal of Psychiatry
      • DynaMed
      • Explore all journals
    • Publication library
      • Clinical guidelines
      • Codes of ethics & conduct
      • Position statements
      • Reports
      • Submissions
      • Explore all documents
    • Explore by topic
      • ADHD
      • Electroconvulsive therapy
      • Ketamine
      • LGBTIQ+
      • Psychedelics
      • See all topics
  • CPD program & membership
    • CPD program
      • CPD overview
      • Program guide and requirements
      • Key dates
      • Templates and CPD activities
      • Peer review groups
      • Practice Peer Review
      • Join the CPD program
      • CPD policies
    • MyCPD
    • Support, breaks & deferrals
      • Leave and return to practice
      • Deferral or exemption of CPD
      • CPD while living and working overseas
      • Reinstatement of membership
      • Retirement
      • Refresher and remediation
      • Mentoring
      • Wellbeing support
    • Types of membership
      • Fellowship
      • Affiliate membership
      • Associate (trainee) membership
      • CPD only membership
      • International Corresponding Membership
      • Honorary Fellowship
      • Membership for junior doctors and med students
    • Membership services & benefits
      • Member benefits
      • Discounts and partner programs
      • Fees and payments
      • Expense reimbursements
  • Events & learning
    • Upcoming events
      • Conferences
      • Webinars
      • Courses
      • See all upcoming events
    • Catch up & learning
      • Past conference talks
      • Webinar recordings
      • Podcasts
      • Explore all catch-up
    • Series
      • rTMS courses
      • ECT courses
      • Psych Matters podcast
    • Go to Learnit
    • Congress 2025
  • Grants, awards & giving
    • Awards & member recognition
      • RANZCP awards
      • Faculty and section awards
      • Branch awards
      • Membership milestones
      • Honour board
    • Grants
      • Event grants & scholarships
      • Research grants
      • Trainee grants
    • RANZCP Foundation
      • Donate
      • Your impact
      • About the Foundation
      • Our patrons
      • Foundation Partners
  • News & analysis
  • College & committees
    • About
      • What the College does
      • Board
      • Our members
      • Executive team
      • Annual reports, AGM and evaluations
      • Governance
      • Accreditation of the College
      • Our history
      • Current projects
    • Public & partners
      • Find a psychiatrist
      • Media centre
      • Feedback and complaints
      • Advertising and endorsements
      • Consultation Hub
      • For health services with STP posts
      • Career opportunities
    • Key focus areas
      • Aboriginal & Torres Strait Islander mental health
      • Māori mental health
      • Lake Alice apology and actions
      • Gender equity
      • Rural psychiatry
      • NSW workforce crisis
    • Committees & groups
      • Committees
      • Faculties
      • Sections
      • Networks
      • Working & advisory groups
      • Committee openings
      • Board elections
    • Tu Te Akaaka Roa NZ National Office
    • Australian branches
      • Australian Capital Territory
      • New South Wales
      • Northern Territory
      • Queensland
      • South Australia
      • Tasmania
      • Victoria
      • Western Australia
  • Contact
Back to results

Direct-to-consumer advertising of pharmaceuticals

Position statement Last updated: Jul 2016 Published in Australia Reference: PS #88

Direct-to-consumer advertising runs counter to the principles of best possible care for mental health consumers. Accordingly, the RANZCP advocates for a revision of the current legislation allowing direct-to-consumer advertising in all countries where it is currently operating.

Introduction

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) encourages its members to implement best practice principles and make clinical decisions based on the best available evidence. A key role of the RANZCP is promoting the best possible care for mental health consumers. In the view of the RANZCP, direct-to-consumer advertising runs counter to these principles. Accordingly, the RANZCP advocates for a revision of the current legislation allowing direct-to-consumer advertising in all countries where it is currently operating.

Definition of DTCA

Direct-to-consumer advertising (DTCA) is a form of promotion that aims to market prescription pharmaceutical products to the end patient rather than health care professionals. DTCA for pharmaceutical products can appear in a variety of media, including magazines, newspapers, social media, TV and radio. DTCA can have a variety of purposes – for instance, to convince customers that a company’s pharmaceutical products are the best, inform consumers about uses for established products or announce new products (FDA, 2015; Ventola, 2011).

Background

Only a few countries currently permit DTCA, including the United States and New Zealand. In Australia, DTCA is prohibited under the Therapeutic Goods Act 1989 and the Competition and Consumer Act 2010. In New Zealand, the Medicines Act 1981 outlines the regulations relating to the advertising of medicines and medical devices. When the legislation was enacted in 1981, prescription medicines were not widely advertised and it was not until 1997 when the United States relaxed regulations around advertising pharmaceuticals that New Zealand experienced an increase in DTCA.

Impacts of DTCA

The RANZCP has carefully considered both the negative and positive impacts DTCA may have on the provision of healthcare:

  • Providing information to consumers - The pharmaceutical industry argues that the benefits of DTCA include disseminating health information about illnesses and treatment, reducing stigma and empowering consumers by providing information and encouraging choice. However, research suggests that information provided to consumers by the pharmaceutical industry is likely to be biased in favour of benefits over potential harms. A recent study found that only 13% of pharmaceutical advertisements provided any evidence to support their claims about efficacy (Schwartz and Woloshin, 2013). Where evidence is made available, the data tends to exaggerate the magnitude of the benefits (Every-Palmer, Duggal & Menkes, 2014).
  • Issues relating to prescribing and potential harm - Studies conducted in the United States found that consumers exposed to DTCA were more likely to believe that they needed medication, to request products advertised on television, and to receive prescriptions for these products (Gilbody et al., 2005). There are also examples where significant harm has arisen from under-reporting of safety risks. For example in 2012, Glaxo Smith Kline promoted the safe use of an antidepressant in a paediatric setting despite established concerns about the risk profile in this population (Bond, 2013). DTCA also encourages health professionals to engage in prescribing off-label uses of pharmaceutical products where the potential to cause consumer harm may increase further (Humphreys, 2009).
  • Impact on the doctor-patient relationship - DTCA may affect the doctor-patient relationship inseveral ways. Most commonly, DTCA prompts consumers to request advertised drugs. Whilesometimes useful, many doctors (especially general practitioners) find themselves being asked to prescribe medications that they do not consider are clinically indicated (Robinson et al., 2004; Humphreys, 2009). Resisting consumers’ requests may place the therapeutic relationship under stress and may lengthen the duration of consultations (Robinson et al., 2004).
  • Potential cost implications for the consumer and tax-payer - The pharmaceutical industry invests significantly in marketing and promoting branded products, which often have no efficacy advantage over generic alternatives. Higher costs are passed on to the consumer and tax-payer. In 2011, GSK phased out the asthma inhaler Becotide and replaced it with the more expensive but generally equivalent Flixotide. GSK developed a million dollar promotional campaign targeted at consumers that generated sales of $3 million (McMillian, 2011) demonstrating how DTCA can increase pharmaceutical costs.

The NZ national drug purchaser PHARMAC has been successful in containing pharmaceutical costs by sourcing generic pharmaceuticals, making the New Zealand health sector one of the most costeffective
in the OECD (Commonwealth Fund, 2014). A British study found that potential savings of £1 billion (out of a total pharmaceutical budget of £9 billion) could be made by doctors prescribing generic alternatives (Moon et al., 2011).

The proponents of DTCA suggest there are benefits in advertising prescription medicines. Some arguments put forward are it ‘meets consumers’ desire for information, that a DTCA-initiated enquiry is positive for health professionals, who can use it to discuss the reason for the request and relevant treatment options’ (Ministry of Health, 2006). DTCA is also argued to prompt consumers to ‘seek more information about their health status and resulting in higher levels of compliance with treatment regimes’ (Hoek, 2001).

The RANZCP considers that the potential adverse impacts of DTCA outweigh the potential benefits. Independent research conducted by Massey University in New Zealand concluded that the benefit information is communicated more effectively than risk information (Hoek, 2001).

The RANZCP supports the prohibition of DTCA in all countries, therefore, we advocate DTCA is discontinued in New Zealand and not introduced in Australia.

Recommendations

The RANZCP recommends the following actions:

  • That the RANZCP works collaboratively with other medical colleges and health organisations to promote prohibition of DTCA.
  • That the RANZCP works with Australian and New Zealand regulatory bodies to improve health literacy to help ensure that consumers / patients are able to make better informed decisions about pharmaceutical products.
  • That dialogue between consumers and health practitioners should be encouraged to ensure that the best treatment options are considered in an environment as free as possible from any commercial influence.

References

Commonwealth Fund (2014) International Profiles of Health Care Systems. Available at:
www.commonwealthfund.org/~/media/files/publications/fundreport/
2015/jan/1802_mossialos_intl_profiles_2014_v7.pdf.

Every-Palmer S, Duggal, R, Menkes, DB (2014) Direct-to-consumer advertising of prescription
medication in New Zealand.
New Zealand Medical Journal 127: 102-110.

Food and Drug Administration, United States (FDA) (2015) Drug Advertising: A Glossary of Terms.
Available at:
www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising/ucm072025.htm#D

Gilbody S, Wilson P, Watt I. Benefits and harms of direct to consumer advertising: a systematic review
(2005) Quality and Safety Health Care 14: 246-50.

Hoek J et al. (2001) Could Less be More? An Analysis of Direct to Consumer Advertising of Prescription
Medicines
. Marketing Bulletin 12, Article 1.

Humphreys G (2009) Direct-to-consumer advertising under fire. Bulletin of the World Health Organization
87(8): 576–577.

Menkes DB (2011) New Zealand doctors and the pharmaceutical industry—time to cut the cord? New
Zealand Medical Journal
1341: 6-8.

Ministry of Health (2006) Direct-to-Consumer Advertising of Prescription Medicines in New Zealand:
Summary of Submissions.


Moon J Fleet AS Godman BB et al. (2011) Getting better value from the NHS drugs budget. British
Medical Journal
342: 30-2.

Robinson AR, Hohmann KB, Rifkin JI, Topp D, Gilroy CM, Pickard JA, Anderson RJ (2004) Direct-to-consumer
pharmaceutical advertising: physician and public opinion and potential effects on the physician-patient relationship. Archive of Internal Medicine 164(4): 427-32.

Schwartz LM and Woloshin S (2013) The Drug Facts Box: Improving the communication of prescription
drug information. National Academy of Science USA 110: 14069-74.

Ventola CL (2011) Direct-to-consumer pharmaceutical advertising: therapeutic or toxic? PT 36(10): 669–
684.


Disclaimer: This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available. 

Your health in mind

For the public

Expert mental health information for everyone
  • Find a psychiatrist
  • Feedback about psychiatrists

About the College

  • Offices and branches
  • Media centre
  • About us
  • For health services with STP posts

Jobs

  • Career opportunities at the College
  • Psychiatry Jobs Hub
  • Committee openings

RANZCP Head Office

309 La Trobe Street

Melbourne VIC 3000

Australia

T: 1800 337 448 (Australia) T: 0800 443 827 (New Zealand) E: ranzcp@ranzcp.org

Contact

  • Contact the College
  • Advertising options
  • Consultation Hub
  • Help centre

We acknowledge Aboriginal and Torres Strait Islander Peoples as the First Nations and the Traditional Owners and Custodians of the lands and waters now known as Australia, and Māori as tangata whenua in Aotearoa, also known as New Zealand. We recognise those with lived and living experience of a mental health condition, including community members and all RANZCP members. We affirm their ongoing contribution to the improvement of mental healthcare for all people.

Our commitment to Aboriginal and Torres Strait Islander mental health Our commitment to Māori mental health
Please be aware that this website and associated resources may contain the names or images of Aboriginal and/or Torres Strait Islander peoples who are now deceased.
© The Royal Australian and New Zealand College of Psychiatrists
  • Privacy policy
  • Terms of use
  • Accessibility statement