The fine print on Wegovy billboards will have to be bigger after a recent complaint, but the ad wouldn’t exist at all if not for our unique medicine advertising laws.
NZ and the US are the only high-income countries that let drug companies advertise prescription meds directly to consumers.
Meanwhile, recent changes will bring patient voices into more stages of Pharmac’s decision-making.
Previous research shows how drug company ads can drive patient requests for specific, often pricier, medicines.
The Science Media Centre asked experts to comment. Feel free to use these comments in your reporting.
Associate Professor David Menkes, Psychological Medicine, Waikato Clinical Campus, University of Auckland, comments:
“GLP-1 drugs like Wegovy are extremely profitable, blockbuster agents for industry and their vigorous promotion is an international phenomenon – more overt and potentially dangerous here because of our permissive policy regarding direct-to-consumer
“Most drug adverts include characteristic features like emotional appeal, exaggerated benefits, and minimised harms (in this case via minimised font!). Because of their weight loss properties, GLP-1 drugs have potentially huge appeal and this has been massively exploited by industry using direct-to-consumer
“The patient voice to Pharmac is very important, but subject to industry influence, not just by advertising but also by sponsorship of patient organisations and lobby groups. So I think a policy recognising and controlling for this would be wise. Patients free of such influence are often appropriately skeptical of advertising and sponsorship and would be important to include a plurality of patient voices to help shape NZ’s drug policy.”
“Have a look at our 2023 paper on direct-to-consumer
Conflict of interest statement: “David Menkes is a paid member of the Mental Health Advisory Committee, PHARMAC, New Zealand Government. He was paid by Atai Life Sciences for sessional supervision of a Phase One trial of dimethyltryptamine, a psychedelic drug, in healthy volunteers (2022). He is a coinvestigator in two clinical trials, neither of which is industry funded, both commencing in 2023: MDMA-assisted psychotherapy in terminal illness (charity funded); Low dose LSD in adult major depression (Health Research Council funded).”
Dr Janet Hoek, Professor of Public Health, University of Otago, comments:
“People need clear, balanced, and well-explained information about the risks, side effects, and potential benefits of medicines before they can have an informed discussion with their doctor. Can a 30-second advertisement with key details displayed in small print or scrolling across a screen provide this information? I would argue not.
“Advertisements are designed to sell a brand and so emphasise benefits rather than risks. Because people typically pay limited attention to advertising, they are more likely to remember the advertised brand’s claimed benefits than its potential risks, which may be serious. For example, a quick search of Wegovy’s side effects indicates these range from digestive discomfort to kidney and gallbladder problems (among many others).
“Unbalanced information can lead people to develop unrealistic views on a medicine’s likely effects and suitability and may encourage them to spend time and money discussing inappropriate treatments with their GP. There is considerable debate over whether prescription medicine advertising, in any medium, can support informed conversations between patients and doctors. It is timely to reconsider whether a 30-second advertisement can provide lay people with the complex information they need to have informed discussions about a medicine with their GP.
“One concern is that direct-to-consumer advertising of prescription medicines creates demand without creating knowledge. While it is important for people to play active roles in their health care, the medicines they take may need to manage multiple conditions. Individual drug promotions can distort this balance and risk reframing healthcare as a commercial transaction driven by marketing rather than an expert assessment of the optimal health outcomes for each individual patient.
“The Wegovy complaint illustrates a second concern, namely that product risks may not be clearly communicated. Failure to ensure “Written text [is] large enough, clear enough and present long enough to be easily read” breaches principle 1 of the self-regulatory code and may mislead consumers about a medicine’s suitability, a breach of the self-regulatory code’s second principle.
“Fundamentally, prescription medicine advertising aims to maximise profit; doctors aim to maximise health and wellbeing.”
Conflict of interest statement: “When I worked as a marketing professor, I was persuaded that prescription medicine advertising could be beneficial and provide patients with helpful information. In the late 1990s and early 2000s, I received grants from the Association of NZ Advertisers to conduct two surveys examining consumers’ views of prescription medicine advertising. The more I undertook research on prescription medicine advertising, the more I realised that the information provided was neither balanced nor complete. I am now a public health professor, and my research has examined commercial determinants of health with a particular focus on the tobacco industry. I co-direct the ASPIRE Aotearoa Research Centre at the University of Otago; I have received funding from the HRC, Royal Society Marsden Fund, Cancer Society and NHMRC.”
Emeritus Professor Les Toop, Department of Primary Health Care, University of Otago, comments:
“Freedom of speech comes up as the common excuse / justification to allow direct-to-consumer medicine ads to continue in NZ. Surprising then that every other country, bar America, thinks that it’s a reasonable overrule to their equivalent to our Bill of Rights, some of which are much more stringent than ours.
“Advertising prescription-only medicines doesn’t necessarily mean the people who might benefit most from a medicine achieve greater access, often it is those who will gain little if any benefit over their current treatment who are persuaded by a misleading advert and are assertive with their health provider that end up being prescribed the medicine. So it’s not equitable.
“Truly significant innovations don’t generally need direct-to-consumer advertising as the prescribers are made aware of them by various routes (including the manufacturers). The use of direct promotions of e.g. some childhood immunisations with dangerously dropping rates has a place. These are few and far between.
“The cop-out for New Zealand direct-to-consumer ads has always been the phrase “ask your doctor if xxxx is right for you”. That shifts all the responsibility to the prescribers of explaining all the risks (known and potential) and size of any potential benefits. Prescribers in primary care are mostly GPs who have no available extra time – these days they have less than no time. They can easily become tied up in a 20-30 minute animated discussion with their patient about whether they should have a particular drug (easier to simply prescribe). Done properly, a discussion and an explanation that despite the advert, it is not “right for you” – and often they’ve wasted two valuable appointment slots and resulted in both a dissatisfied patient and doctor who is also now running late. If the doctor saves time and simply says yes, even though they don’t think it’s the right thing for the patient, then they feel bad afterward. There’s no winners.
“The pharmaceutical industry has spent decades honing the art of discrediting sceptical scientists and doctors. This can feed into the growing societal distrust of health systems and professionals (accelerated through the latter half of the Covid-19 pandemic). It’s an easy attitude for Pharma to tap into, fuel and stoke demand and requests to doctors and politicians alike. Astroturfing – funding “grass roots” patient groups is well developed and is used extensively along with many other ways of influencing health systems. These are set out in a comprehensive UK Parliamentary Health Select Committee report in 2005. (Warning, it makes depressing reading and sadly little has changed in the ensuing years).
“I, and many other medical experts, have been explaining at length to politicians of all hues over two and a half decades the real risks to patients when medicines are widely advertised through DTCA. The potential cost of inappropriate prescribing for the health system is enormous. It’s all very well advertising something that costs $1 a day, but if you’re creating demand for things that cost thousands of dollars, where’s that money coming from and what will not be funded in our eternally cash strapped health system as a result?
“DTCA in New Zealand is one of those contentious things you just cannot separate from party politics. I guess I’m more than a little cynical about the process and I don’t think anything’s going to change unless we achieve bipartisan support for a ban. I thought we had, briefly, because in 2020 Shane Reti, the National health minister in waiting, said he would ban it when and if National were elected. In the coalition arrangement that turned out not to be possible. Labour have previously had a long standing policy against direct-to-consumer advertising only to drop it at the last minute during the passed and now repealed Therapeutic Products Act. Direct-to-consumer advertising was previously to have been prohibited as part of trans Tasman harmonisation two decades ago, again it was dumped, even after a huge amount of work had been done in both countries, over petty party politics and no doubt significant and persistent industry lobbying which continues to this day in most countries.
“As I have said many times over the years, if we had never allowed direct-to-consumer medicine ads as did all countries we compare ourselves with, it would be very hard for someone to make the case that we should allow it now. But because by regulatory neglect NZ allowed it, it has proved difficult to make an overwhelming case to remove it against effective well financed industry lobbying.
“Doctors in all countries (including the US) are against direct-to-consumer medicine advertising. Consumer NZ is against it, Grey Power is against it, public surveys have repeatedly been against it, all of the overseas reviews reaffirm their bans of direct-to-consumer ads. All of these can be ignored it seems (hence the cynicism).
“I am clearly in the ‘join the rest of the world and ban it and instead provide independent consumer health information’ camp. If you want balance, try asking your favourite AI: “Is direct-to-consumer advertising of prescription medicines of net benefit or net harm to public health”.
“After 25 years I am weary of the circular debate and lack of political will. Many of our predictions in that report came to pass despite vigorous industry denial and attempts to discredit its authors.
“New Zealand deserves better.”
Conflict of interest statement: No declaration received.