Opinion: Brussels Sprouts

Free-speech debates are nothing new in Europe. Now, pharma's entered the fray, as its representatives in the region's capital inch toward incremental changes in policies on DTC marketing. But, the sincerity of their efforts is up for debate.
May 01, 2006

Peter J. Pitts
I've just returned from Europe, where I spoke with various think tanks, thought leaders, 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 with the new-worldly "direct-to-consumer" moniker.

I learned a lot about the restrictive national and EU laws that make it illegal for pharmaceutical companies to do almost any kind of information-to-patients programs, and about how pharma's representatives in Brussels (the capital of Europe) are trying to inch toward incremental change. Unfortunately (at least as far as I could see), there are no go-forward ideas, no white paper, and 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, it doesn't want to unduly upset the apple cart. And it certainly doesn't want American-style advertising. That's off the table entirely. It's also not based on any knowledge of how DTC advertising has affected the American healthcare 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 like 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 in conversations with European industry leaders and regulators was the larger issue that's at play: free speech. And having these conversations at a time when Europe is regularly parsing what "free speech" actually means (David Irving, Ken Livingston, etc.) made the chats even more, shall we say, stimulating. They are, after all, called First Principles for a reason.

While Brussels sprouts restrictions on all kinds of speech, much of europharma is content to demurely request an audience to obliquely begin a polite conversation on incremental change. That's fine, but starting that conversation by stipulating that free speech can—and should—be limited (by stipulating that direct-to-consumer advertising should now and forever be off the table) is strategically negotiating from a position of weakness.

The Danish prime minister recently said, in the wake of the cartoon scandal, "Freedom of speech is absolute. It is not negotiable." That's a good place to start when discussing ItP with folks in Brussels.

Yielding the moral high ground may result in short-term success, but europharma ought to 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?

Peter J. Pitts is director of the Center for Medicine in the Public Interest and former Associate Commissioner at FDA. He can be reached at

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