An Interview with Sir Tom McKillop, Chief Executive of AstraZeneca and New President of the European Federation of Pharmaceutical Industries and Associations (EFPIA)

D&MD: At the EFPIA’s Public Conference, European Commissioner Erkki Liikanen commended the EC’s proposal that there should be a five-year pilot phase in which the pharmaceutical industry would provide information to patients about prescription drugs for three specific groups of long-term and chronic diseases—AIDS, asthma and chronic bronchitis, and diabetes. He said that the proposal only recognized that patients have the right to information and that the pharmaceutical industry should be able to provide that. But he also said that it had proved to be a most controversial proposal. Why should the pharmaceutical industry in Europe not have the right to advertise prescription medicines direct to consumers (DTC) when DTC advertising has proved to be successful in the US?

TM: In the beginning, the US pharmaceutical industry did not itself seek to get into DTC advertising. It all started with demands from patients for more information about their medicines, particularly new medicines. At first, there were advertisements in journals and magazines and then advertising on television in a small way. Since then, it has grown rapidly and has become very expensive for the industry, so that it is a huge cost for companies to bear. But they have found that they have to continue to spend the money on DTC advertising if they want to stay in the market.

In Europe, we have never asked to be allowed to advertise our prescription products on television. However, we would like to see patients given more access to high-quality information that is provided by the industry. Also, we know that patient groups are very influential and we believe that they could use the information that industry provides.

D&MD: The data that I have seen from the US seems to show that what really sparked the rapid growth in the sales of prescription pharmaceuticals, which has meant that the US market has grown much faster that the European market, was the introduction of DTC advertising that informed patients about the availability of new products that they could then ask their physicians to prescribe. How can European pharmaceutical companies catch up with their US counterparts if they are not allowed to advertise direct to consumers to increase sales in Europe?

TM: Well, I’m not sure that DTC advertising is really that effective in practice. It is really to do with a difference in culture. US patients always want the latest new products, whereas patients in Europe are more conservative in their approach to prescription medicines.

Also, in the USA, it is now necessary for companies to spend more on DTC advertising just to stay in their markets, as it is so very competitive there.

DTC advertising does work in some product areas, those that are nearer to the over-the-counter (OTC) types of medicines, such as antihistamines, so you can influence their sales if you advertise them at the time of the hay fever season. Patients will then go to their physicians and ask for the latest new products that they have seen advertised on television.

DTC advertising also works in creating awareness about new drugs coming to the market. But the US market has always been keen to take up new products anyway, unlike the UK, which is very conservative when it comes to new drugs—which is why you don’t need NICE (the National Institute for Clinical Excellence, the UK government body charged with assessing whether the National Health Service should make new treatments generally available).

D&MD: Data from the US shows that there is almost a direct relationship between the amount that companies spend on DTC advertising and their growth in sales in the US—the companies that have spent the most on DTC advertising have had the greatest increase in sales. Is that not evidence that DTC advertising works?

TM: If you look at the statistics in detail, it is more the other way round. Once you’ve started DTC advertising in a particular market, you need to carry on spending more and more just to maintain market share. The data show that, if you then stop, the US market is so competitive that you lose market share very quickly.

D&MD: The EC’s High Level Group on Innovation and Provision of Medicines (G10 Medicines group) has backed the EC’s proposals on patient information (that there should be better access to information for certain prescription products, that it should be patient orientated and controlled, that it should not be DTC advertising, that it should be subject to EC-set Good Information Practice, and that there should be a pilot phase to be reviewed in five years). What do you think of these proposals?

TM: EFPIA is not in favor of DTC advertising on television, but we do want to be able to provide high-quality information to patients. After all, we have the liability for the products that we sell, and sometimes the information about them that others, such as newspapers, give can be misleading.

However, the EC’s proposal is completely unsatisfactory, as it would be at least ten years before the results of these three trials were analyzed. It is a very inadequate response to patients’ real needs for information.

We recognize that patients need more information and the pharmaceutical industry wants to work with patient groups to provide that. However, let me be quite clear: we are not allowed DTC advertising on television and we are not seeking it.

D&MD: European Commissioner Liikanen said that the G10 Medicines group’s report and the EC’s review of European pharmaceutical legislation should be considered together. How long do you think it will take the EC to introduce new regulations based on these?

TM: EC legislation could take years, but not all of the G10 Medicines group’s recommendations necessarily require legislation, so they could be introduced rapidly to improve things for the European pharmaceutical industry.

D&MD: Is this going to be sufficient to prevent the European pharmaceutical industry looking more and more to the US, where the market is forecast to grow more rapidly?

TM: Probably not. Already Novartis and Merck have announced relocation of at least some of their R&D to the USA. Even my company, AstraZeneca, which is the most European pharmaceutical company, or should I say the most committed to Europe, last year opened AstraZeneca R&D Boston in Waltham, Massachusetts. The relocation may not happen dramatically, but it will gradually over time. For example, you could imagine the furore there would have been in Switzerland if Novartis had announced the closure of its R&D laboratories in Basle in order to transfer them to the USA, so it is not going to happen like that.

D&MD: How significant has political lobbying been in creating the right climate for the US pharmaceutical industry in the US? For example, there was a recent report of a Republican Party fund-raising dinner that raised $20 million from US industry, much of it coming from pharmaceutical companies. Is this a factor in the US pharmaceutical industry getting its interests heeded by its government?

TM: I don’t think that there is anything particularly new in that story. They have a different way of conducting politics in the USA. That’s the way that they raise money for elections, and it’s not just the Republicans, it’s the Democrats as well, and companies can give to both parties. But it’s the way that politics works in the USA. Even at plant level, employees can donate to a political fund and then decide whom they want to support with it, although in the UK AstraZeneca does not make political donations.

This interview was conducted by D&MD contributor Alex Crawford. A complete review of the issues surrounding direct-to-consumer advertising in Europe can be found in the September 2002 issue (Vol. 13, #9) of D&MD Newsletter.

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