Drug advertising bad for medicare, CMA says (Canadian Socialized Medicine)

The Globe and Mail ^ | Sept. 2, 2003 | ANDRÉ PICARD

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Allowing direct-to-consumer advertising of prescription drugs in Canada would be a bonanza for the media, generating an estimated $360-million a year in new ads.

But the demand it created would also spur as much as $1.2-billion a year in new drug sales, and the beleaguered medicare system would have to bear most of that cost, according to an editorial in Tuesday's edition of the Canadian Medical Association Journal.

In a strongly worded piece, editor John Hoey says prescription drugs should not be advertised in the same manner as other consumer products because that could lead to dangerous excesses, as has occurred in the United States.

There, pharmaceutical companies spent $2.7-billion (U.S.) on advertising in 2001, more than triple the amount they spent in 1996.

From a business perspective, it was money well spent. For example, each dollar that went to publicizing the allergy drug Claritin increased sales by an estimated $3.50. The return on anti-impotence medication such as Viagra and drugs to counter hair loss is believed to be even higher.

"By being marketed in media traditionally used to flog cars, fast food and shampoo, prescription drugs have become name-brand commodities, enveloped in the kind of fantasy and desire that surrounds the purchase of lifestyle product," Dr. Hoey said.

Further, the barrage of advertising contributes to the "medicalization" of the normal human condition and transforms people into "two-legged bundles of diagnoses."

In another commentary piece in Tuesday's edition of the CMAJ, David Gardner of the College of Pharmacy at Dalhousie University in Halifax argues that while advertising of prescription drugs aimed directly at the public is prohibited in Canada (and most other developed countries, with the exception of the United States and New Zealand), lack of enforcement has made a mockery of the law in Canada.

"Some forms of advertising of prescription drugs to consumers have become widespread," he wrote.

Three types of prescription-drug advertisements are aimed at the public: Product-claim ads that include both the product name and specific therapeutic claims; reminder advertisements that provide the name of a product without stating its use; and help-seeking advertisements, which tell consumers about a new but unspecified treatment option for a condition.

In the United States, all three forms are permitted. In Canada, the three forms of ads contravene the Food and Drugs Act but, in recent years, the latter two forms have been used routinely.

Dr. Gardner said the rationale for prohibiting direct-to-consumer advertising is public safety, but enforcement of the rules by Health Canada has been ineffectual at best.

He notes that television ads for the smoking-cessation drug Zyban ran for months even after Health Canada deemed they contravened the law. And the maker of the birth-control drug Alesse skirted the law by running reminder and help-seeking type ads concurrently.

"In practice, this means the regulation of the accuracy of [direct-to-consumer advertising] in Canada is haphazard," Dr. Gardner said.

He said this "regulatory creep" is unacceptable because the changes are occurring behind closed doors and called for the legislation banning prescription-drug advertising to be strictly enforced or, if change is deemed appropriate, he asked that it be put to public and Parliamentary debate.

"The issues at stake — public health and the sustainability of health-care services — are too important to be quietly set aside," Dr. Gardner said.

A third article published in Tuesday's CMAJ shows that there is indeed a link between advertising and prescribing of drugs. Barbara Mintzes of the Centre for Health Services and Policy Research at the University of British Columbia compared the behaviour of doctors and patients in Sacramento, Calif., (where advertising is permitted) and Vancouver (where it is not, but where there is a lot of spillover from U.S. media).

She and her colleagues found that 7.2 per cent of Sacramento patients requested advertised drugs from their doctors, compared to 3.3 per cent of Vancouver patients. And the higher a patient's exposure to advertising, the more likely that patient was to request advertised prescription drugs.

"Our results suggest that more advertising leads to more requests for advertised medicines, and more prescriptions," Dr. Mintzes said.

She said the ads, more than anything else, open a conversation between a patient and physician that "is highly likely to end with a prescription, often despite physician ambivalence about treatment choice."

Canadians spent $14.6-billion last year on prescription drugs, according to the Canadian Institute for Health Information.

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Canada wants to maintain the ban on perscription drugs because it will cause more people to see their doctors and that will drive up healthcare costs. Even though patients would benefit via education. Have to keep people from seeing their doctor so the government can save a buck. And it undercuts free speech. But it is Canada, where corporate interests are always against the common good.