Attempt to undermine European ban on advertising drugs fails in France

BMJ 2007; 334 doi: (Published 08 February 2007) Cite this as: BMJ 2007;334:279
  1. Ray Moynihan
  1. 1Byron Bay, Australia

    A controversial proposal to have drug companies' “patient compliance” programmes declared legal in France has failed.

    Critics described the proposal as a backdoor attempt to introduce into France direct to consumer drug advertising, which is currently banned throughout Europe.

    Compliance support programmes organised by drug companies can include telephone reminders to consumers, personalised information for patients, and even home visits from nurses. The drug industry defends public health programmes as valuable for boosting adherence to treatment; others argue the programmes are Big Brother-style marketing strategies intended to boost profits.

    A recently formed advocacy group called the Medicines in Europe Forum, which comprises patients, professionals, and others, successfully lobbied French politicians last month to reject the proposal. The group claims that compliance programmes are often little more than advertising stunts, designed to build brand loyalty and “increase the quantity of drugs consumed.”

    The group's materials, sent to French politicians, cite examples from the business press in which compliance programmes are clearly described as a way of increasing company revenue. An article in the magazine Pharmaceutical Executive states, “A patient compliance strategy must be part of the DTC [direct to consumer] programme and subsequent patient information materials” (, 1 Sep 2003, “DTC's new job: boosting compliance”).

    Business consultants Frost & Sullivan recently released a paper called “The evolution of patient adherence programmes: moving from mass market relationships to a personal approach.” The consultants, who produce marketing intelligence for industry, explicitly describe these programmes as part of marketing strategies, designed to build loyalty and profits. “It costs less to retain a patient than to acquire a new one,” says the Frost & Sullivan report.

    The body representing French drug companies, Les Entreprises du Médicament, argues that the programmes lead to fewer complications and help patients with long term illness by ensuring correct use of medicines. Also, says the industry body, these programmes would be controlled by government and health professionals, with no direct contact between companies and patients.

    One of the groups critical of the proposal to legalise company backed compliance support programmes is Health Action International, which is based in Holland. “Industry run compliance programmes have no place in patient care,” said a spokesperson. “In a competitive marketplace, it would be naive to think that a pharmaceutical company would be telling patients that they would be better off taking a competitor's product or that they don't really need to take a medicine for their problems.”

    The controversy is part of the wider debate over whether aggressive United States-style drug advertising should be allowed on the other side of the Atlantic, an idea firmly rejected by the European parliament. Despite the ban, industry in Europe is continuing to push to liberalise restrictions on communications with the public, arguing that drug companies can provide patients with valuable health information.

    To counter those efforts, late in 2006 the Medicines in Europe Forum launched a public declaration, together with the International Society of Drug Bulletins and other groups, calling for reliable and independent information for health consumers and a continuation of the advertising ban.

    Although the French plan to legalise company compliance programmes was defeated last month, it will debated again in the French parliament later this year.

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