At the risk of a gratuitous self-plug, the use of these medicines in young children was one of the issues of concern that Ray Moynihan and I highlighted in our book, Ten Questions You Must Ask Your Doctor (Allen & Unwin, 2008). We came across several references raising concerns about these products’ use in children when researching the book back in 2007.

So the TGA is certainly not rushing the jump.

Nonetheless, the move will be such a challenge to accepted practices that it will need to be backed by a long-term educational campaign. So argues Ron Batagol, a Pharmacy and Drug Information Consultant.

He writes:

“In a move that is likely to provoke much spirited debate amongst doctors, pharmacists and, most importantly, the parents and carers who look after the day-to-day health issues of  young children in their care, the Therapeutic Goods Administration (TGA) has given notice that it is intending to  “upschedule” over-the-counter cold and cough products to Prescription Only for children under six years and Pharmacist Only for children aged between six and 12 years.

As part of the upscheduling exercise, the TGA has also recommended cough and cold medicines should not carry dosage instructions for children under six years old. The TGA says that this approach would bring the regulation of cough and cold preparations in Australia into line with measures in place in the UK and Canada.

After extensive  internal and external reviews of the evidence surrounding both  efficacy and safety in use, the proposed changes are stated by TGA to have been made ” in light of the current lack of evidence of efficacy and the historical profile of adverse drug reactions (ADRs) in Australia and overseas”.

It is certainly true, that the  consensus of informed opinion amongst paediatricians about the usefulness and propensity of side-effects of these products is in concurrence with the TGA assessment.

Now I must say that there is a whole fascinating social phenomenon associated with parents and carers buying cough ands cold products for children in their care.

This has, in fact,  been noted in the TGA External Review, where they raise the concept of  “social medication” which researchers have found is, in part, aimed at modifying child behaviour to more acceptable patterns, and in part a ‘coping strategy, and that cough and cold medicines were a common “social medication” in this respect’. Pharmacists at the “coal face” will be very familiar with this belief amongst their clients and the associated behaviour patterns.

Presumably, in recognition of  the social behavioural re-scheduling moves would certainly make them feel to some extent disenfranchised, turning on its head as it does, a long-held, even if erroneous, understanding that recommending a suitable cough and cold product for use by children served both a therapeutic and, as discussed, also a “social” function.

It seems to me that there will need to be long-term educational campaign on this issue, if the  proposed changes are adopted.

Indeed, TGA has said that the changes recommended would need to be widely promoted and explained to medical practitioners, pharmacists, parents and caregivers, and that particular efforts be directed towards educating consumers, medical practitioners and pharmacists that OTC cough and cold medicines have not been shown to be effective, and are potentially harmful in children under 6 years of age.

From recent discussions of this issue, when I raised it on our major pharmacy internet discussion website Auspharmlist, I have no doubt that at all that education and explanation will certainly be needed for many of my pharmacist colleagues, and their professional organizations!  This is, of course, quite understandable.

After all, on the face of it, the proposed issue is somewhat analogous to the lengthy but ultimately quite successful campaign over the past 5-10 years, to “educate” doctors and inform the broader community that antibiotics are not required to treat a whole range of common infections, and may ultimately promote bacterial resistance.

Five to ten years ago, of course, patients virtually demanded an antibiotic from their doctors in such situations.  These days, most patients are aware of this or, at least, do understand the situation when it is explained to them.

But, with TGA inviting responses from  stakeholder organisations, it is going to  require a huge effort to achieve the aims of broader community understanding of the rationale for the move by TGA to restrict availability of this group of widely-used, and generally well-regarded  infant and childrens’ medicines.”

• A terrific piece bringing some much-needed perspective to discussions about mental illness, especially in the wake of recent murders. By Dr Tanya Ahmed, a registrar in psychiatry and a principal of the health and communications consultancy RaggAhmed.

• More than a million premature deaths across 30 OECD countries could be prevented each year if income inequality was reduced. That’s the best guess of a meta-analysis of studies involving around 60 million people, reported in the BMJ. The authors note that there are many caveats to their findings, including a lack of evidence from developing countries, but say their results have “potentially important policy implications for population health”. Meanwhile, I’m heartened to read that a fellow Crikey blogger is also putting inequality on the public agenda.

• When the law meets public health – Simon Chapman, professor of public health at the University of Sydney, considers the implications of a recent High Court judgment. It dismissed a duty of care negligence claim against a Tasmanian hotel owner who handed back motorcycle keys lodged for safe-keeping to an insistent, belligerent patron who on leaving the pub was killed in a crash while showing a blood alcohol level of 0.253.

• Investigating the ties between drug companies and doctors – A group of researchers from Australia, Canada and the US have done an indepth analysis of disclosures of pharmaceutical sponsorship of gifts and educational events, as has been required of Medicines Australia members since 2007. They conclude that the disclosure does not go far enough and also give some interesting examples of how companies are wooing doctors. Novartis, for example paid flights, accommodation, food, beverages, and conference registration fees for six ophthalmologists to attend a two-day conference in Spain, at a cost of AUD$10,993 per person. For those who follow this field, it will come as no surprise that the researchers include Ray Moynihan, Lisa Bero and David Henry. The other authors are Jane Robertson and Emily Walkom from the University of Newcastle.

It turns out the doctors aren’t the only ones taking Coca-Cola’s money. Believe it or not – dentists have too.

It’s enough to make your teeth ache.

Obesity control expert Professor Boyd Swinburn has sent in his observations while travelling in the US. He writes:

“I am currently in Boston and read with interest the comments about Derek Yach and Pepsi’s PR mission to Australia.

The TV in the US is currently carrying a series of advertisements about a regular Mom complaining that the government is thinking about raising taxes on foods and drinks (actually the talk is only about taxes on sugar-sweetened sodas).

“They say its only going to be pennies, and it may not matter to those people in Washington but it matters to me when I am struggling to feed my family”. Who is behind the ads: an outfit called Americans Against Food Taxes.

And who is behind this front group: Pepsi Co and all the other usual suspects.

One of the most powerful influences big food has is in undermining public health initiatives. Pretending to be the good guy at the same time gives it an even greater influence over government as we have recently seen with the softly, softly Preventative Health Taskforce report.

Derek used to speak  for the benefit of public health, now he speaks for the benefit of food giants.”

• Boyd Swinburn is Professor of Population Health, and Director, WHO Collaborating Center for Obesity Prevention

He writes:

“The pity is that Melissa clearly did not absorb the objective data I offered re modest but important examples of change across food companies (from 60% less calories sold in schools in the USA; to tons of less salt in many products in the UK; to 90& reductions in certain ads to kids across Europe; to 30 000 products reformulated for many nutrients; to real impacts of portion sizes on total calories consumed)…all the data being measured and mostly independently audited!

Many of these changes do not come with increased profits in the short term and are part of deep structural changes underway across industry. They include responding to the World Health Organization’s call for support of the Global Strategy on Diet and Physical Activity; developing coordinated approaches across many multinationals to tackle a variety of nutrition issues; and stepping up investments in innovation.

Further, to call addressing hunger a distraction is the very worst type of cynicism. I attach our CEO’s speech from last week at the World Food Prize on this. Some might call it a giant distraction–most I work with regard it as an imperative we cannot and must not avoid tackling!

Melissa would do well to relisten to the debate and take note of the above points as well as many impediments to progress in tackling obesity that require more effective actions by governments, NGOs and individuals. For Australia this includes fully supporting the new Preventative Task Force recommendations.”

“To my frustration I missed the Rosemary and Derek show at Sydney Uni – but it would have been a bit of a drive home…

But it seems we are asked to pick between 2 narratives here.

1. The public health warrior -fresh from wins in the tobacco wars bringing proven commitment and skills to offer direction to the well meaning but slightly misguides food conglomerates, to modify their business practices to the benefit of humanity

OR

2. The clever and once pure champion of the people who has sold out to play the role of chief PR man and government manipulator – driven by a big salary but with the prime goal to prevent or at least substantially forestall meaningful and effective regulation to reduce the so far unfettered commercial freedoms of the multinationals who are profiting while driving the international obesity epidemic.

The truth may be 1. or 2. or more likely, some complex combination of both.  But ultimately the importance of the accuracy of the narrative plays a very poor second fiddle to this essential question.

Is Pepsico, and big food more broadly, increasing, decreasing or remaining static on the hard measure of the amount of sugar, fat and salt being poured into the world’s food supply?

When Derek and mates can answer that question – via independently audited means – we’ll have useful information to wrestle with. The rest is largely spin.”

In the US, Coca Cola has done a deal with the American Academy of Family Physicians new corporate membership program, enabling it to help “educate consumers about the role their products can play in a healthy, active lifestyle”.

Closer to home, Dr Derek Yach, a former tobacco control advocate with the WHO who is now a senior executive of PepsiCo, has been visiting Australian health and research organisations, spruiking the industry’s willingness to change to address global obesity concerns.

Last week, Yach participated in an evening debate at the University of Sydney with public health nutritionist Dr Rosemary Stanton in which he argued that the food industry in general and his company in particular were making changes to address the concerns. You can watch the debate at SlowTV.

A trouble with these sort of staged events is that they don’t really lead to a free-flowing discussion that enables competing arguments to be measured and weighed – everyone is usually in too much of a hurry to get home.

To keep the discussion going, here are some of the responses that Croakey has gathered from those who attended.

Jane Martin, a Senior Policy Adviser to the Obesity Policy Coalition

I made an effort to hear what he had to say because I know Derek’s work in tobacco control (which is my background), he was incredibly smart and really knew his stuff, but I disappointed at the extent of his ‘corporate capture’. In hindsight I probably should not have expected anything less from someone who has moved from public health to the corporate world.

I thought the presentation was a PR stunt and an opportunity for Pepsi to talk about what they are doing that they feel will appease the public health community and, more importantly – government.  We saw the letter to Rudd about their fabulous work.  Just as an aside, it would be good to find out if he is meeting with Rudd and Roxon, giving Pepsico’s take on the PHT recommendations, along with presenting the Pepsico “responsible corporate citizen” agenda.

I think that Pepsico has made changes, but these are developed by industry, for industry and do not meaningfully limit many of the ways used to market and sell their products.  The focus for business is about protecting the bottom line and maximising profits. For example, they have moved advertising away from Pepsi Max to sugar-free varieties and this has not eroded their brand share of full sugar products.

From their point of view changes are are allowable, but they have to be on their terms.  For example limiting marketing to under 12s is a good example, targetting the television programs which are predominantly this audience has only a minor effect because there are very few programs that would be viewed predominantly by children under 12, kids are watching prime time television and this is where food advertisers spend their money so as to reach the greatest number of children.

I felt insulted, but also very concerned, that he boasted that he knew the Preventative Health Taskforce reports and recommendations better than those attending the lecture.  That shows how important and relevant obesity prevention initiatives are to their business, it is also concerning that they are likely to be working to influence government to adopt the recommendations that are less effective and to lobby against those that are likely to have an impact.  For example, Pepsico threatened to move their corporate headquarters out of New York when the state was examining the potential of a sales tax on sugary soft drinks.

I was hoping for a more sophisticated take on areas where collaboration could work, however this was not the agenda. I think that there are potential areas where industry could work together with others, however there are clearly areas where government intervention is required, such as with unhealthy food advertising to children and taxing unhealthy foods.

I thought it was interesting that he said that “tax was a blunt instrument” particularly given the US situation, see above.  I would argue that they may describe it as blunt, but likely to be very effective as it passes the Chapman “scream” test….

****

Professor Louise Baur, consultant paediatrician, Children’s Hospital, Westmead

I think Derek Yach is genuinely trying to effect change.  HOWEVER, I think that, for Pepsico, this is more PR than anything else, at  least at this stage.  We did not see any data on whether junk food products were going down  in consumption. I suspect everything is going  up!

An interesting note from the presentation: Nine food companies control 83% of retail food expenditure (correct?) internationally.

We need people trying to effect change from both inside  and outside. At this stage there is still a lot to be done in flying the public health flag and influencing public opinion (the Rosemary approach!).  The important player who must be involved is the Federal government as we need  governmental regulation on such issues as FOP labelling (this may drive change  in food composition) and  marketing.

***

Lesley King, Executive Officer, Physical Activity Nutrition Obesity Research Group (PANORG)

Pepsico are making minimal and almost cosmetic changes rather than substantive changes. As Yach said, he is able to dsicuss changes in a number of categories – marketing, labelling etc; however, the proposed changes amount to very little.

So, discussing the idea of limiting marketing to children under 12 when they are a majority of audience means little or nothing. For example, if children are less than 20% of a population, how frequently would they be a majority of audience? We know from Australian audience data that this is never on free TV! Thus my scepticism is coloured by knowing how insignficant their marketing commitments are, and therefore suspecting that other proposed changes are equally thin.

There was nothing said last night that suggested further depth of change. What is really disappointing is that society could benefit greatly if industry really did behave responsibly; yet even though they now see the need to reorient their profile and look as if they are behaving responsibly, there is no evidence that they actually are.

Nothing was suprising, except that the presentation wasn’t especially glossy or persuasive (I expected something cleverer really). The data on the ACCENTURE evaluation of changes in marketing in Europe is not publicly available as far as I know – although I understand it has been presented to WHO as part of their industry consultations. The graph showing 56% decrease in overall food marketing (not just to children) is of some interest – but unfortunately there were no epidemiological or methodolgical details that would help us know where  this came from, what it covered etc./ The use of /FORESIGHT I guess was there to establish show some expert credentials. The position of representing PEPSICO but not food industry generally (so only  responsible for 5%) was disappointing and designed to ’slide through’  any challenges. So obvious and simplistic!

Public health and media have made obesity a political issue – and industry clearly believes it needs to look more responsible. So the next round has to be to get them to actually make some changes. However, there is no current indication that they will make real changes unless there is a large consumer driven change. So it seems that the problem needs people on the outside to push hard and strongly – lots of people playing many different roles. Perhaps that creates opportunities for public health people on the inside to operate in health interests – that I wouldn’t really know. Perhaps they are only there so they have face validity in PR with politicians and for window
dressing.
***
Bridget Kelly, NSW Cancer Council

PepsiCo are certainly making all of the right moves to “look like” they are being responsible – hiring figurehead public health people, developing an international code on food marketing to kids, claiming that they will display large tabs showing energy content on drinks (yet to see this…).

However, I think the devil is in the detail. The front-of-pack labelling for example will use %DI labelling – which has been shown in consumer studies to be less effective in guiding people towards healthier choices. And as we have seen with industry marketing codes developed in Australia, for which PepsiCo is a signatory, these really lack any teeth. Despite Derek’s claims, these do not have adequate monitoring or complaints systems, do not cover all forms of marketing to kids and the nutrition criteria guiding the types of foods that can be advertised are very lenient.

There is definitely merit to the approach of working both within and in opposition to industry (We call it the “pincer movement”). Although, associating yourself with industry has the effect of delegitimizing your reputation. Take the Heart Foundation’s Tick program after it was associated with McDonald’s.

But we can’t forget that industry is a big and powerful lobby and some public health interventions will be very difficult/lengthy to achieve if all public health groups and industry are too polarised. So, I think it is important to have public health people working within industry – as long as they are doing it for the right reasons.

I think that it is worth highlighting that during the discussion some points were made about the potential effectiveness of taxing unhealthy food. Derek responded that this taxation would be a blunt instrument, however the taxation of tobacco products was highly successful in decreasing tobacco use – and is precisely the type of policy that Derek himself would have supported!

**
Simon Chapman, Professor of Public Health, University of Sydney (who was overseas at the time of the debate but helped organise it)

I have the utmost respect for what he did with tobacco regulation, and I completely agree that the food industry must be part of the solution. Growing all one’s own food is completely beyond the reach of most people, so we are all obliged to interact with the food industry. Many of us try to patronise companies which really try — like Sanitarium.

But PepsiCo? I heard Derek talk about changing the company from the inside, but from here in Cambodia and Laos from where I write, full-cal Pepsi advertising is everywhere and low-call is nowhere to be seen. Same in Thailand and India where I was earlier in the year.

I fear that the company may see him as a kind of strategic investment in ‘air cover’ which allows them a profile among public health circles associated with striving to be a company selling healthy products, while down the corridor in the global marketing division, its business as usual.

***
Kathy Chapman, NSW Cancer Council

I think Pepsico has taken “fairy steps” in the right direction due to pressure from public health groups and consumers.  There was still the usual line about reinforcing the need for physical activity.  It would have been useful to have a step by step critique from Rosemary on what Pepsi has undertaken – eg where their nutrient criteria fall down and the limitations of the times when Pepsi have decided not to advertise to children.

The presentation was pretty much as I expected it be from a food industry perspective.  I was expecting a bit more about his own personal motivations from going from WHO to the “dark side”.

As to the pros and cons of public health people trying to work from the inside with industry,I think there needs to be a pincer movement – food industry will be more likely to respond if they are getting  pressure from public criticism by people like Rosemary Stanton and groups like Parents Jury, as well as if there is a push from within to deliver healthier food products.

It must be extremely frustrating working within food industry and feel like your are hitting your head against a brick wall.  The public health input is so often used to pad out these little fairy steps that industry is willing to make.

***

Dr Rosemary Stanton

The changes at PepsiCo are more about PR when it comes to obesity although I think they are serious about reducing salt and changing the fats they use. Neither is relevant to obesity, but they are relevant to cardiovascular disease.

Mainly, however, I think they want to avoid being included among the damned. It’s also a way to knowck smaller companies who may produce junk foods, but don’t have the resources that Pepsico does to play in  the same ball park as the big boys of public health.

His bits on reducing advertising to children were as useless as the Australian proposals. They reduce advertising only in programs made specifically for kids. The industry data shows that most kids watch general family TV – eg Australian Idol. The ABC programs made specifically for kids actually rate well. We’re also aware that advertisers are moving away from TV ads to involve kids in advergaming. It’s far more effective as the kids are connected to the product for at least 30 minutes rather than 30 seconds.

Derek Yach was actually a great guy when he worked on anti-smoking campaigns. I can’t imagine why he went to Pepsico, but from his use of photos in the presentation, I suspect he’s trying to prove that he still hobnobs with other Public Health people. Those who are directly employed by Pepsico would be getting salaries that are way beyond the reach of anyone working in PH. I think it’s not all that difficult to justify to yourself that you may be able to make a difference from the inside. The high salary may help the justification process.

***

In short – the general response from the public health crowd seems to be extreme wariness about its “new best friends”.

The Wall Street Journal reports that Merck has just released its list of payments to doctors for giving talks at promotional events. The list also includes some nurses, pharmacists and scientists.

The payments range from $150 to more than $20,000.

The paper reports that many drug companies are moving to do likewise, and that Eli Lilly published its own list earlier this year.  There is also a political push to require drug companies to report the payments.

It seems that Australia really is dragging the chain in this area.

Regular readers may remember that earlier this year Michele Kosky, executive director of the Health Consumers’ Council in WA, asked the TGA and Medicines Australia to investigate whether the consumer advertisement breaches the ban on direct-to-consumer advertising of prescription medicines.

In June, Croakey reported back that Kosky had not had any response from the TGA. Now it is October and, when I checked recently, she still had not had a response. Perhaps someone from the TGA might like to enlighten us about why the long delay?

Meanwhile, in case you missed her story in the Crikey bulletin last week, Dr Agnes Vitry, from the University of South Australia, has been examining some of the broader issues around direct-to-consumer advertising.

“Pfizer is running a big marketing campaign for its combination heart pill, Caduet. Medical magazines have been carrying full-page advertisements, advising doctors that “patients will soon be asking about their suitability for combination heart medications”.

The advertisement includes a sample from a consumer advertising campaign, which advises readers to talk to their doctor about a combination heart pill if they’re taking multiple medicines for their heart. The consumer ad incudes a rip-out section to take to the doctor, which carries a Pfizer logo and says “I’d like to discuss my treatment for high blood pressure or high cholesterol. Please advise me if a combination heart pill is suitable.”

This is occurring despite a Medicines Australia Code of Conduct, which complements the Australian legislation that prohibits direct-to-consumer advertising of prescription medicines. However, the code has several loopholes that allow pharmaceutical companies to subvert the ban on DTCA.

Unfortunately, direct-to-consumer advertising of Caduet is not an isolated case.

De facto direct-to-consumer advertising increasingly occurs in the form of “unbranded” advertisements or campaigns about specific diseases and conditions, which do not mention of the name of a specific medicine, but may include the company name or their logo.

Famous examples of unbranded marketing campaigns include the Viagra “Welcome Back Tiger” campaign. Pfizer, the maker of Viagra, simultaneously advertised to GPs and to consumers in popular magazines. The only difference between advertisements was the “omission” of the product name and product information in the consumer version. The tiger character became prominent in subsequent campaigns, making it synonymous with the product.

There are multiple examples of ongoing de facto DTCA campaigns in Australia. For example, Pfizer is currently running the “Master” marketing campaign for Champix (varenicline), a new drug marketed for smoking cessation.

The consumer campaign includes TV, radio, outdoor and online advertising. The “Master” is featured by a pack of cigarettes, “representing the manipulative inner voice of nicotine addiction”. This campaign encourages smokers to seek healthcare professional advice and visit outsmartcigarettes.com, a commercial website listing websites for smoking cessation products such as nicotine replacement product. At the same time, Pfizer is promoting Champix towards doctors and pharmacists and give them promotional leaflets to distribute to their patients.

Wide-scale advertising to the public of new medicines, whose long-term health effects are still unknown, is a threat to public health as two-thirds of the medicines that are withdrawn from the market due to safety concerns have been on that market for less than three years.

While advertising a medicine for smoking cessation such as Champix may seem a laudable objective, Champix is a new drug and as such, may cause severe adverse effects that may only be discovered post-marketing. No surprise, it is actually what happened with Champix.

Since the initial marketing of Champix, medicine agencies around the world have issued stronger and stronger safety alerts. In the United Kingdom, 1241 reports of suspected adverse reactions were received during the first year of marketing, mainly psychiatric adverse effects with headaches, abnormal dreams and nightmares, depressions and depressed moods and suicidal ideations.

In December 2008, the Australian Adverse Drug Reactions Advisory Committee (ADRAC) bulletin stated that they had received 339 adverse reaction reports with varenicline up to October 2008, more than 72% being psychiatric symptoms including depression, aggression, agitation, abnormal dreams, insomnia, hallucination and anger. There have also been reports of suicidal/self-injurious ideation or behaviour.

In July 2009, the US Food and Drug Administration required Champix to carry the agency’s strongest safety warning over side-effects including depression and suicidal thoughts. Despite the new, stricter warnings, the FDA said consumers and doctors still have to weigh the benefit versus the risks when taking the drug. “The risk of serious adverse events while taking these products must be weighed against the significant health benefits of quitting smoking,” said Janet Woodcock, the director of the FDA’s Centre for Drug Evaluation and Research.

Another ongoing DTCA campaign is the Bayer’s campaign on how “low testosterone can take the life out of you” (for example, full-page advertisement in the  August 22-23 Weekend Australian Magazine). This campaign encourages men to see their doctors if they have any symptoms such as “lack of vitality, reduced sex drive, mood swings, poor concentration and reduced strength”.

Bayer’s low testosterone campaign is typical of a disease awareness campaign that is used as a strategy to extend the boundaries of illness and to expand markets for new products. In the case of Bayer’s campaign, men are told to view non-specific and common symptoms that may occur in ageing as a treatable disease that could be cured. It is similar to the promotion of hormone replacement therapy (HRT) for menopausal women.

And when you have the “disease”, look out for the drug! A single internet search showed that Bayer was marketing in Australia a range of testosterone products, such as Reandron 1000 and Testogel. The use of testosterone products (androgens) in men outside very limited indications is not a harmless measure.

Severe adverse effects from inappropriate use of androgens include sodium and water retention, oedema, acne, gynaecomastia, impotence, testicular atrophy, priapism, inhibition of spermatogenesis, degenerative changes in seminiferous tubules, impaired glucose tolerance, hypercalcemia, polycythaemia, decreased clotting factors, increased LDL cholesterol, aggressive behaviour, psychotic symptoms, physical and psychological dependence, withdrawal symptoms etc.

The ban on DTCA is related to the ban on direct sales of prescription medicines. It a health protection measure to prevent unsafe and unnecessary medication use. The ban on DTCA is consistent with regulatory aims to protect health and with the National Strategy for Quality Use of Medicines to encourage appropriate medicine use. DTCA may pretend to be information, but its primary objective is to increase sales of one particular medicine without any consideration for the public health issues.

Unbranded product advertising and disease-awareness campaigns are two of the most common forms of DTCA that should not be allowed in Australia if the current regulatory ban was properly enforced.

Over the past 20 years, several complaints have been sent to Medicines Australia about unbranded product advertising and disease-awareness campaigns. To our knowledge, they have never been upheld if the name of the advertised product was not explicitly mentioned in the advertising campaign. Any further complaint to the TGA would just remain ignored because of their absolute “trust” in the efficacy of the self-regulatory system for the control of drug promotion.

In the past few years, the successive waves of international scandals have revealed to a wide public that misleading drug promotion and unethical behaviour of top international drug companies were systemic problems and not isolated cases. The passive attitude of regulatory agencies will have to change if they want to keep the trust of the Australian public.

Parliamentary Secretary for Health Mark Butler recently declared that the government has begun to conduct a complete review of how the relationship between pharma companies and doctors is regulated. We hope that the Australian government will take vigorous steps to enforce the ban of DTCA in Australia including unbranded product advertising and disease-awareness campaigns. We hope that we will regain confidence in the Australian regulatory agencies to achieve what they are meant to achieve: preventing unsafe and unnecessary medication use and protecting the Australian public from the harm of misleading drug promotion.”

• Dr Agnes Vitry is a member of Healthy Skepticism and Health Action International

The paper says that 46 per cent of the state’s secondary students have registered for the Maths Online tutoring program. Nationally, more than a third of Australia’s 1.46 million secondary students have registered for the program since March this year.

When students open the program on computers they see the McDonald’s logo and the words: “Proudly provided by your local McDonald’s restaurant.”

Federal Education Minister Julia Gillard has reportedly commended the firm. And she’s a former Opposition health spokeswoman!

It really makes you wonder whether all the talk about cross government action to tackle obesity is just that. Talk. And pretty insincere talk at that.

So what do the public health crowd think?

Nutritionist Dr Rosemary Stanton writes:

“Parents have a right to know why the education of their children has passed from the government to vested interests.

McDonald’s haven’t sponsored this (and other) programs out of the goodness of their hearts. They want customers. Their sponsorship of this program also means that teachers won’t feel free to criticise McDonald’s, their products and even their marketing methods.

It’s also unlikely that governments who are now obligated to McDonald’s will do anything to bite the hand that feeds them. And our young trusting children will also think McD’s are good guys – or their teachers and parents wouldn’t endorse their products.

Are our education departments really so thick that they can’t see through this? And are we happy for sell our children to McDonalds?”

***

Jane Martin, a Senior Policy Adviser to the Obesity Policy Coalition and Professor Elizabeth Waters from the University of Melbourne, write:

“The Maths Online tutoring program is ostensibly supported by local McDonald’s stores, however it is likely McDonald’s funded the website and its development, and paid for expensive advertisements on prime time television – adding value to their positioning around corporate social responsibility.

Obesity prevention groups are concerned about this development because McDonald’s is in the business is selling burgers and fries, not education. This is a backdoor way to ensure that their branding reaches children, under the guise of education.

If the company was truly serious about providing tutoring to children, they should do this without using the distinctive McDonald’s branding.

The reach of the program, outlined in the press today, illustrates what good value this is for McDonald’s – particularly to target secondary school children.

This is a group who have more independence with their food choices as they are less likely to be under the control of parents and beginning to make independent decisions about what they eat, and how they spend their money, when they are out with their friends.

The recommendations of the recently released Preventative Health Taskforce strategy have acknowledged the importance of protecting children from the promotion of unhealthy food.  This example illustrates how the internet and educational programs are being utilized by fast food companies to reach and influence young people. This is an underhanded way to create and build a relationship with young people and the McDonald’s brand.

This is a situation which is more common in the United States, but likely to be something that we see more of if restrictions are phased in on junk food marketing to children through commercial television.”

PostScript: Jane Martin and Elizabeth Waters have sent in this additional comment:

“There is also evidence that migrant families new to Australia, and those with low literacy, may think that these sponsored programs mean that schools and governments support McDonalds and implies that McDonalds products are healthy.  This “halo” effect is similar to when McDonalds is placed in children’s hospitals – people think that the franchise provides financial support to the hospital, that the food is healthier and its presence means they are also more liklely to purchase the fast food.

Many schools, including those in NSW, have introduced policies and programs in these settings to ensure consistency in the approach around the promotion of healthy lifestyles.  This is undertaken by ensuring a healthy food supply in schools, through the curriculum and within broader school community.  The relationship with McDonalds and the educational curriculum creates inconsistency and undermines these policies and messages.”