SAFETY, QUALITY, EFFICACY: REGULATING MEDICINES IN THE <strong>UK</strong> 2.46 Purchas<strong>in</strong>g prescription-only medic<strong>in</strong>es without a prescription carries potentially serious risks: ! self-diagnosis may be <strong>in</strong>correct; ! <strong>the</strong> medic<strong>in</strong>e purchased may not be appropriate to treat <strong>the</strong> condition; ! side-effects from <strong>the</strong> medic<strong>in</strong>e may be serious, <strong>in</strong>clud<strong>in</strong>g exacerbat<strong>in</strong>g o<strong>the</strong>r exist<strong>in</strong>g conditions, and <strong>the</strong>re may be adverse <strong>in</strong>teractions with o<strong>the</strong>r medic<strong>in</strong>es be<strong>in</strong>g taken; and ! <strong>the</strong> quality and safety of <strong>the</strong> medic<strong>in</strong>e is not assured. 2.47 The problem of illegal <strong>in</strong>ternet sell<strong>in</strong>g requires <strong>in</strong>ternational co-operation. None of <strong>the</strong> EU regulators we visited had yet made substantial headway <strong>in</strong> tackl<strong>in</strong>g it, and all recognised that it would be very difficult to achieve full compliance with medic<strong>in</strong>es legislation. The <strong>Medic<strong>in</strong>es</strong> Control Agency has been monitor<strong>in</strong>g <strong>the</strong> problem for two years, and has made this area of enforcement activity a priority <strong>in</strong> 2002-03. Work will focus on commonly purchased prescription-only medic<strong>in</strong>es from <strong>UK</strong>-based websites, whilst sites based overseas will be referred to <strong>the</strong> appropriate national regulatory authorities. In <strong>the</strong> meantime, <strong>the</strong> Agency is tak<strong>in</strong>g enforcement action on illegal <strong>in</strong>ternet sales of prescription-only medic<strong>in</strong>es through <strong>the</strong> closure of web sites and prosecution. Review<strong>in</strong>g medic<strong>in</strong>es advertis<strong>in</strong>g and promotional material A comb<strong>in</strong>ation of statutory and self-regulation covers advertisements for medic<strong>in</strong>es 2.48 Direct advertis<strong>in</strong>g of prescription-only medic<strong>in</strong>es to <strong>the</strong> public is illegal <strong>in</strong> <strong>the</strong> <strong>UK</strong> and <strong>the</strong> rest of <strong>the</strong> European Union. Advertis<strong>in</strong>g of medic<strong>in</strong>es available over <strong>the</strong> counter is, however, allowed. And advertis<strong>in</strong>g of prescription medic<strong>in</strong>es to doctors or o<strong>the</strong>rs qualified to prescribe or supply <strong>the</strong>m is also legal. The control of medic<strong>in</strong>es advertis<strong>in</strong>g <strong>in</strong> <strong>the</strong> <strong>UK</strong> is based on a longestablished system of self-regulation underp<strong>in</strong>ned by statutory powers adm<strong>in</strong>istered by <strong>the</strong> Agency. The three ma<strong>in</strong> bodies <strong>in</strong>volved <strong>in</strong> <strong>the</strong> self-regulatory system are <strong>the</strong> Prescription <strong>Medic<strong>in</strong>es</strong> Code of Practice Authority, <strong>the</strong> Proprietary Association of Great Brita<strong>in</strong> and <strong>the</strong> Advertis<strong>in</strong>g Standards Authority, of which <strong>the</strong> first two adm<strong>in</strong>ister Codes of Practice. 2.49 The Proprietary Association of Great Brita<strong>in</strong>, <strong>the</strong> trade association of companies sell<strong>in</strong>g non-prescription medic<strong>in</strong>es, exam<strong>in</strong>es all advertisements submitted by its members and consults with <strong>the</strong> Agency. When advertis<strong>in</strong>g prescription-only medic<strong>in</strong>es to health professionals, companies are required to comply with <strong>the</strong> Association of <strong>the</strong> British Pharmaceutical Industry Code of Practice. The Prescription <strong>Medic<strong>in</strong>es</strong> Code of Practice Authority, run at arm's length by <strong>the</strong> Association of <strong>the</strong> British Pharmaceutical Industry, handles compla<strong>in</strong>ts aga<strong>in</strong>st <strong>the</strong> Code, publish<strong>in</strong>g its rul<strong>in</strong>gs, and may require advertisements to be withdrawn. 2.50 While <strong>the</strong> Agency has <strong>the</strong> power to require sight of advertisements <strong>in</strong> advance, it usually exercises this power only where: ! <strong>the</strong> product is a newly licensed and <strong>in</strong>tensively monitored medic<strong>in</strong>e; ! <strong>the</strong> product has been reclassified to make it available without prescription for <strong>the</strong> first time; or ! <strong>the</strong> product's previous advertis<strong>in</strong>g has breached <strong>the</strong> regulations. 2.51 The Agency's Advertis<strong>in</strong>g Unit carries out monitor<strong>in</strong>g of prescription-only medic<strong>in</strong>e advertis<strong>in</strong>g <strong>in</strong> medical journals, concentrat<strong>in</strong>g particularly on newly launched products. It also <strong>in</strong>vestigates compla<strong>in</strong>ts about advertis<strong>in</strong>g from any source, <strong>in</strong>clud<strong>in</strong>g health professionals and <strong>the</strong> public. In 2001-02, 50 advertisements were amended or withdrawn after scrut<strong>in</strong>y by <strong>the</strong> Agency, and a fur<strong>the</strong>r 81 potential breaches were identified through compla<strong>in</strong>ts, follow<strong>in</strong>g which action was taken. Exam<strong>in</strong>ation at any stage by <strong>the</strong> Agency does not preclude it from tak<strong>in</strong>g later action if it subsequently decides <strong>the</strong>re has been a breach of regulations, and this was <strong>the</strong> case <strong>in</strong> October 2002 when it requested <strong>the</strong> withdrawal of an advertisement for an oral contraceptive, which had also been exam<strong>in</strong>ed by <strong>the</strong> Prescription <strong>Medic<strong>in</strong>es</strong> Code of Practice Authority. part two 27
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