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Victoria
After growing tired of having patients ask for an oral treatment for their discoloured toenails, 3 Dutch family physicians decided to fight back by using the same medium that brought them the patients. Not only did they send a letter to a Dutch medical journal calling for a boycott of the drug company that was responsible, but they also issued the same call in a televised interview.
The doctors were left fuming by a month-long advertising campaign that they say encouraged Dutch television viewers to use terbinafine (Lamisil), an antifungal treatment for onychomycosis and skin infections. The advertisement did not name the product, which is manufactured by Novartis, but it is the only drug of its type.
The letter calling for a boycott appeared in June in Medisch Contact, published by the Royal Dutch Society of Medicine. The physicians argued that a "a full and national boycott" might force the company "to act in a more responsible manner." They also appeared on the television program 2Vandaag in July.
Dr. Remon Hendriksen says the main reason for their action is the time the ads force physicians to spend trying to talk patients out of taking an inappropriate drug. "Novartis is unnecessarily scaring people into seeing their doctors," he told CMAJ. "It is very easy to scare people but it is much harder to explain to them what is appropriate treatment." (In May 2001, the US Food and Drug Administration issued a public health advisory about terbinafine because of 16 possible cases of liver failure associated with it [www .fda.gov /cder /drug /advisory /sporanox- lamisil / qa .htm]).
Despite the physicians' objections, a Dutch judge recently ruled that the advertisement does not violate Dutch law because no drug was named. Canada and the Netherlands have similar laws banning outright direct-to-consumer (DTC) advertising. Health Canada has received complaints about DTC advertising for 2 drugs marketed here, sildenafil and bupropion (see CMAJ 2001; 165[4]:462).
This is not the first time Dutch physicians have challenged DTC advertising. In 2000, a letter in the same medical journal from a group of GPs criticized the pharmaceutical industry for directing its marketing toward consumers and asked that physicians "protest en masse against this form of medicine propaganda."
Novartis spokesperson Patricia Klijn-van Rossum says that a "boycott at the expense of patients is unworthy of the medical profession." In a written statement, she said the "information campaign" is permissible by law and may even "move all of the patients being treated with a product from our firm to another product."
The protesting doctors hope the boycott forces physicians to consider how DTC advertising can create fear in patients and result in inappropriate visits to physicians. This fall, ministers of the European Parliament will be debating and voting on changes to European Union laws that restrict DTC advertising of prescription drugs. — Alan Cassels, Victoria
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