Drug advertising bad for medicare, CMA says
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By ANDR� PICARD (G & M)
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.
