Dutch GPs call for ban on Novartis products

Three Dutch GPs are calling on doctors not to prescribe Novartis products in protest at the Swiss based pharmaceutical company's “information campaign” urging people with onychomycosis, or ringworm of the nails, to visit their GP.

In a row reflecting concerns across Europe, Dutch doctors and the government's advertising code commission had criticised the Novartis campaign, claiming that it promotes the company's prescription only product terbinafine (Lamisil). The Dutch Society of General Practitioners shares the concern that such information campaigns are an unnecessary burden, threatening the efficiency of prescribing and focusing attention on unimportant health problems. Spending on terbinafine for 2001 is estimated at €31.5m (£20.1m; $30.5m), triple the figure for 1997.

However, in May a Dutch court ruled that the Novartis campaign did not contravene laws banning direct to consumer advertising of prescription drugs, as neither Novartis nor terbinafine is specifically named. Terbinafine is, however, the only effective treatment for onychomycosis, according to prescribing standards set by the Dutch Society of General Practitioners.

The campaign, which included TV advertisements and road shows, has been relaunched despite “negative reactions” from doctors. GPs from Best, in the south of the Netherlands, are now calling for the Novartis boycott in a letter to the journal of the Royal Dutch Medical Association, Medisch Contact.

The doctors write that ringworm of the nails rarely requires treatment, but that Novartis, “with dollar signs in their eyes, persist in this undesirable and improper form of advertising.” They call on all prescribing doctors to refuse to see pharmaceutical representatives and not to prescribe Novartis products unless there is no “medically acceptable alternative.”

One of the GPs, Remon Hendriksen, said, “We are angry. This advertising is an undesirable development. In five years we will have 10 more adverts offering cures for such diseases. If a patient has a physical complaint he should discuss it with a doctor. This advertising interferes with that.” He explained that if there were good medical indications for using terbinafine, such as pain or diabetes, the doctors would prescribe it; the boycott applies where there are medically satisfactory alternatives.

Novartis's dermatology product manager, Ms Patricia Klijn-van Rossum, said that a boycott, which tramples on the interests of patients, is unworthy of the medical profession. She argues that doctors do not choose their products without good reason. One in seven Dutch people suffer from ringworm of the nails, and in one in three cases this leads to serious pain.

The consumer health lobby group Health Action International, based in Amsterdam, said that the blurring of the line between advertising and information is of increasing concern across the EU. The group's co-director Margaret Ewen said that it supports good quality, objective information on drugs but that the Novartis campaign was part of a “marketing strategy designed to increase sales.”