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Healthy Skepticism Library item: 20120

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: news

Turner J
A new Rx for drugs
The Toronto Star 1999 Dec 10


Direct-to-consumer drug ads in US prod examination of Canadian rules.

Full text:

It used to be that patients got prescriptions from their doctors, not always knowing, or caring to know, precisely what they were or how or why they worked.

The scientific arguments, and the manufacturer’s sales pitches, weren’t consumer issues.

These days it’s not uncommon for patients to march into their doctors offices asking, if not demanding, a drug treatment, often by name. They either know of someone who has used it, or have seen any number of ads in the US publications or on American TV, learned of it on the Internet or found it on a drug company Web site. They might even have caught an oblique reference in a Canadian promotion.

Drug manufacturers in Canada aren’t permitted to advertise prescription drugs directly to consumers. They can discuss a disease and encourage consumers to see their doctors. They can mention a product and encourage consumers to see their doctors. But they cannot mention a disease and name a product in the same ad.

A Hoffman-La Roche ad in a Canadian women’s magazine, for example, suggests that “there are weight loss treatment options now available to help you. Talk to your doctor today”.

The giant, multinational pharmaceutical companies insist Canadian restrictions are outdated. They say consumers want and deserve more information.

In 1998, prescription drug companies spent an estimated $1.2 billion (US) on advertising in the United States. They want the Canadian market, too.

So do Canadian media and advertising groups, which are eyeing the potential business.

“The laws regulating the advertising of prescription medicines in Canada were written more than 40 years ago, long before consumers had access to the Internet, and even before television became a standard feature in Canadian homes”, notes Canada’s Researched-Based Pharmaceutical Companies, (Rx&D), which represents the international drug firms, otherwise know as the branded drug industry.

“The current situation is plainly confusing for Canadians at a time when they are increasingly expected to take an active role in ensuring their own health”.

Rx&D quotes a 1998 survey by the Maclean Hunter publishing group, which suggests 71 percent of Canadians would like to discuss treatment options with their doctor, but feel they need more information; 92 percent say patients should be able to get drug information from sources other than their doctor.

Health Canada in Ottawa says it doesn’t have enough evidence to make a recommendation, so it’s commissioned a comparative market study of physician visits and prescribing practices in Seattle and Vancouver. The results are expected by late summer.

“The ultimate question is, ‘What does this do to use? Does it encourage appropriate use or inappropriate use?” says Ross Duncan, a Health Canada policy analyst.

Some believe that if you regulate such ads, you can provide good information, Duncan says. Others feel that advertising is fundamentally about promoting the sale of a product.

Officially, the practise is known as direct-to-consumer or DTC marketing.

“Drugs are not potato chips”, offers Denis Morrice, head of the Toronto-based national Arthritis Society.

Drug advertising is a health issue, he says. Education serves public good. Advertising is self-serving in that it aims to boost market share.

In general, the provinces are opposed to prescription drug advertising. They fear additional pressure on government health budgets – costs associated with more patient inquiry visits to doctors, more provincial drug plan prescription being filled as a result of consumer demand for advertised products, and the costs associated with any inappropriate use.

Consumer health groups maintain that advertising is pure promotion. Some of them – the Arthritis Society, for example – say they could help ensure Canadians get a better understanding of prescription drugs, not merely more information. They want to be included in any new ad policy.

The Canadian-owned generic drug industry agrees consumers want more information, but says drug manufacturers are hardly the best source.

The Canadian Medical Association suggests drug companies “probably have a right to inform consumers, in an unbiased manner, about their products as long as they do no harm in doing so”. It wants the information to be general rather than drug specific.

Insiders here suggest a made-in-Canada deal is in the works – one that would give the drug giants essentially what they have in the US with a few added measures. Possible among them: The ads would have to get clearance from a third party before they could run. And any new drug – many of the most heavily advertised drugs in the US are very new – could not be advertised to consumers until additional safety testing was done.

Merck Frosst Canada Inc. insists patients have a “right” to drug product information and “are smart enough to use it well”.

At a recent industry conference in Toronto, Jeff Spencer, Merck Forsst Canada’s director of marketing communications, said the industry is open to a “uniquely Canadian” solution, including a six-month ad moratorium for new products during which only health professional have been targeted.

He suggested Canadian ads could include who is not at risk and who is not a good candidate, and include references to other sources of information, such as consumer health societies and associations.

Dr Joel Lexchin, a Toronto Hospital emergency physician who has a research interest in pharmaceutical promotion and is a spokesperson for the left-leaning Medical Reform Group, opposes drug advertising to consumers because he doesn’t believe it can be effectively regulated.

He also questions who benefits.
After more than a decade of experience in the United States, in one form or another, there is no scientific evidence that prescription advertising to consumers has resulted in better health care, he says.

The only country outside the US to approve such ads is New Zealand.

Lexchin says the risk/benefit information in US ads is often unbalanced. Details, generally tucked on an accompanying page, in the case of print ads, are lengthy, complicated and delivered in small print.

“This is advertising”, Lexchin stresses. “Information would mean that you would get all the good points and all the bad points with the same degree of emphasis. You would know what all the alternative treatments would be – other drugs, non-drug therapy and no therapy. But you won’t get that from DTC advertising”.

A New York Times story in late March revealed the US federal government has repeatedly reprimanded drug companies after finding they’d made false or misleading claims in TV commercials and magazine advertisements for a wide range of prescription drugs.

In the last year alone, the story noted, the US Food and Drug Administration “admonished” companies about drug ads for allergies, asthma, high cholesterol, high blood pressure, hair loss and sexually transmitted diseases. It also found problems in ads for birth-control pills, anti-cancer drugs and medicines to help people lose weight and stop smoking.

In most cases, the FDA said the ads overstated the benefits, minimized the risk or falsely suggested that one drug was superior to another. The agency also found that many companies had been touting their drugs for uses not approved by the government.

The Consumers Association of Canada maintains prescription drugs are “unique commodities and consumers need unbiased, very accurate information”.

Moreover, “we do not have a sense that consumers are interested”, says association spokesperson Joan Sayer.

A survey funded by the Medical Research Council and done by researchers from the University of Ottawa early this year indicates that the vast majority of Canadians – some 86 percent – want their information from medical and healthcare specialists, consumer health organisations and community support groups, and not drug or healthcare product manufacturers. Also low on the list of preferred sources: pharmacies, governments and insurance firms.

Michael McBane, of the Canadian Health Coalition, a watchdog group funded by the labour movement, says the drug giants “are trying to sell this like it’s education, but none of these companies are educational foundations”.

Health education should be done by government and the medical community and not entities that are obliged to work for their shareholders, he says.

Stay tuned. A detailed look at direct-to-consumer advertising is expected in late winter – part of a wide-ranging review of Canada’s health protection laws.


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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963