Parsing First Principles

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  • 03/04/2006

According to the Jerusalem Post, “The timing of Austria’s conviction and imprisonment of David Irving for denying the Holocaust could not have been worse. Coming after the deaths of at least 30 people in Syria, Lebanon, Afghanistan, Libya, Nigeria and other Islamic countries during protests against cartoons ridiculing Muhammad, the Irving verdict makes a mockery of the claim that in democratic countries freedom of expression is a basic right.”

What does this have to do with Actually, quite a lot.

I’ve just returned from London where I had the opportunity to speak with various European think tanks and pharmaceutical companies on the issue they call “information-to-patients” (ItP). That’s what we “on the other side of the pond” refer to as “direct-to-consumer-communications.” In Europe they choose to abstain from using the “A” word — “Advertising.”

But rhetoric counts. “Information TO patients” seems quite paternalistic when compared to the more New Worldly “DIRECT to consumer” moniker.

I learned a lot about the very restrictive national and EU laws that make it illegal for pharmaceutical companies to do almost any kind of “information-to-patients” programs and how the pharmaceutical industry’s representatives in Brussels are trying to, politely, inch towards incremental change. Unfortunately (at least as far as I could see) there are no go-forward ideas, no white paper, no consensus as to what more progressive European ItP policy might look like. Right now the only position is that it shouldn’t be the American model. That’s not a plan, it’s the pharmacrats dancing with the eurocrats. And the music is atonal, sounding more like a dirge than a motion-oriented Vienna waltz. It should really be more of a tango or passo double.

On the one hand europharma wants to have more options in the ItP arena, but on the other they don’t want to unduly upset the apple cart. And they CERTAINLY don’t want “American-Style” advertising. Heavens no. THAT’S off the table entirely. It’s also not based on any knowledge of how DTC advertising has impacted the American health care debate.

But facts are stubborn things. I felt obligated to point out to my European colleagues that DTC advertising drives patients to visit their physicians, creates an environment for more robust doctor/patient conversations, enhances compliance, destigmatizes diseases such as depression, and does NOT increase prices.

As Julian Morris of the London-based International Policy Network quipped, “Europe is running out of failed alternatives.”

But what caused the most noticeable discomfort was my pointing out that there is a larger issue at play — that of Free Speech. And having theses conversations at a time when Europe is regularly parsing what “Free Speech” means (David Irving, Ken Livingston, etc.) made these chats even more, shall we say, stimulating.

They are, after all, called “First Principles” for a reason.

And that brings me back to the Jerusalem Post article. While Brussels sprouts restrictions on all kinds of speech, much of europharma is content to demurely request an audience to obliquely begin a quiet and polite conversation on incremental change

Which is fine. But starting that conversation by stipulating that Free Speech can (and indeed should) be limited (i.e., by stipulating that direct-to-consumer advertising should now and forever be off the table) is, de minimus, strategically negotiating from a position of weakness.

The Danish prime minister recently said (in the wake of the cartoon scandal) that “Freedom of Speech is absolute. It is not negotiable.” That’s a good place to start when discussing ItP with the folks in Brussels.

Yielding the moral high ground may result in short-term success, but please consider that this is the same excuse that Yahoo and Google are using when they allow the People’s Republic of China to block search terms like “democracy.” After all, it’s just business, right?


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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