Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Direct to consumer (DTC) advertising comes in many subtle forms as well as the blatant reports on the current affairs programs.
Like many Pharmacists, I become enraged when I am the last person to know that Tagamet is used for warts and that Yasmin is the new wonder drug for weight loss!!
Just look at the increase in diuretic sales after the Shane Warne affair media reports.
The recent calls by Pharmacists on Auspharmlist to have DTC more tightly controlled in Australia led me to ponder all of the subtle ways that we encounter DTC in the practice of Pharmacy.

The more subtle DTC promotions are the ones that are starting to creep in and give you food for thought.
I recently performed an RMMR in a facility for a lady that had a severe stroke and she is taking Neurontin and Ms Contin to control severe debilitating pain.
During a long chat she told me that she had been to a presentation on Durogesic patches and that after discussing her case at the presentation, she (the resident) felt that the Durogesic would be better for her pain management than the Ms Contin.
I enquired how she had come to attend one of these education sessions and she told me that certain residents and nursing staff attended the session by the pharmaceutical manufacturer.
I questioned the RN on duty that day and she told me that often now the residents are asked if they wished to attend these education sessions.
The problem with this lady was the same problem that occurs with the products on the evening current affairs program.
She was adamant with her Doctor that she wanted to try this therapy and he has complied but she does not have a malignant neoplasm so she has to pay for her Durogesic patches.
Her therapy notes and history clearly showed that the Neurontin was having an effect in her pain management but it had not been titrated up to the most effective dose as yet.
She could not be convinced that titrating up the Neurontin dose was the best way forward at the moment-she wanted to try the patches no matter what. (this resident is difficult to manage and the GP deserves a medal for his patience as he has tried hard to raise the dose but she does not believe in the therapy at all and will not comply)

This occurrence is not new in facilities where the nursing staff have regularly been visited by representatives speaking on products for incontinence, wound care, constipation, mobility etc but to add in the products that a Doctor must prescribe and to detail these products to residents as well is becoming a little more like DTC in my opinion.

Some pharmaceutical manufacturers are actively promoting 'lifestyle intervention' programs.
This involves an employee of the manufacturer being 'in-store' or in a Doctors surgery to speak to customers about their lifestyle issues and these representatives may be involved in a screening process eg cholesterol, BMI.
While these are wonderful programs to help the pharmacist and Doctor to reinforce the message that changes to lifestyle are the first step in management of some disease states, Pharmacists must be discerning when we allow these companies to place their representatives in the Pharmacy speaking directly to consumers.
This is an area that some Pharmacies have set themselves up very well to deliver as they have employed appropriate personnel on staff to assist the Pharmacist with counselling on lifestyle, diet, diabetes and asthma management, wound care, incontinence advice etc.
When a Pharmacist employs a health professional eg nurse, physiotherapist, occupational therapist, naturopath etc the Pharmacist would instigate professional guidelines and procedures that must be followed to ensure that all Pharmacy board, WPHS and professional organisations protocols are followed. It is very important that the Pharmacist is acutely aware of how the process will occur with the manufacturer representative, what data is collected and what happens to the data and also whether all of the professional guidelines are being followed.

The other area that is not truly DTC advertising but a subtle area of influence on Pharmacists and GP's involved in medication reviews, is the never ending material arriving from pharmaceutical manufacturers on 'best practice therapy' protocols for medication reviews.
There are many manufacturers following this pathway of advertising and while this material is a useful tool when performing medication reviews, the more discerning pharmacist would be wise to read the material very carefully.
These 'articles' and 'planograms' are not unbiased and they are quick to point out the superior effects of their sponsored product over the rest. It is difficult to host a 'clinical discussion' evening without sponsorship and the pharmaceutical manufacturers are more than willing to assist -but at what cost?

The professional guidelines from the Pharmaceutical Society of Australia for many of the areas mentioned above are in The Pharmacy Practice Handbook 2000 and the Professional Practice Standards 2002.
The practice handbook is currently being placed on the PSA web page and can be viewed at http://www.psa.org.au