Friday, August 17, 2007

Drug Marketing Regulations

Bayman previously touched upon advertising regulation in his comments here. The Globe and Mail has an article about the history of pharmaceutical advertising laws and some of the surrounding issues (sorry, subscription required). Believe it or not, ads for prescription drugs are illegal in Canada (over-the-counter meds can still be marketed). Since 1954, the Food and Drugs Act has banned the advertising of prescription drugs "to protect the purchasing consumer against injury to health, and against deception." CanWest Global is currently launching an assault on these laws in the courts, claiming they violate free speech. So why do we see so many horny elderly couples on TV, sneaking away for some afternoon delight under the shadow of a Cialis or Viagra logo?

The answer lies in a loophole built into the act, also under the guise of consumer protection. An exemption was included to allow pharmacies to post price comparisons, so buyers could get the best deal, but only the name and the price could be included in the ad - no medical conditions or claims of effectiveness. So now, as Canadians, we're treated to two kinds of 'reminder' ads: The Guy Lafleur erectile dysfunction type, that mention a condition but no drug (talk to your doctor about ED) and the Viagra type that mention a drug but no condition (Viagra...ask your doctor) and leave the rest to inference and innuendo. Be careful, though, about running the two too close together: a few years ago, Health Canada cracked down on Wyeth for running acne awareness ads in the same commercial block as their drug Alesse - a birth control and anti-acne drug, using similar themes to link the two in consumers minds.

While Canadian drug marketers have to rely on coy and uninformative (though imaginative) advertising, our neighbours to the south face a different situation. The United States is one of only two nations that allow direct to consumer pharmaceutical advertising (New Zealand is the other). Instead companies can advertise their wares, but must include extensive information about negative side-effects.

Which system is best? That's a tough call. If we must be at the mercy of advertisers, my inclination would be a US system that includes both positive and negative about the drug. It's a rare person that doesn't know what Viagra is for, but probably far fewer are aware of the side-effects. In this sense, the uninformative Canadian ads may be more harmful. However, it's been argued that allowing all-out drug advertising increases the cost of pharmacare since drug companies pass the ad expenses on to consumers. (I fail to see how allowing only Canadian-style ads reduces this expense). Finally, with all drug advertising, there's the issue of mis-prescribing. Studies have shown that if a specific drug is asked for, the chances of it being prescribed increase, regardless of whether they manifest the correct symptoms: "The fact that they asked for the antidepressant was a stronger determinant of treatment than whether they had the conditions the drug was meant to treat."


Bayman said...

Very informative post. I always thought we had laws against drug advertising and wondered why they've recently seemed to become more and more commonplace on television.

I also had no idea Global Canwest has been launching this type of aggressive move to increase corporate influence on Canadian health. As for fighting for "free speech", my ass. Since when is TV advertising about "free" speech? How ironic to refer to advertising rights worth billions of dollars as "free". TV ad time is pretty much the furthest thing from "free" as has ever existed in human civilization.

The distinction between Canadian and US law is interesting, but I'd bet that in the end, the result is basically the same. "Ask your doctor about Viagra" while some old man gets lucky in the background is pretty much as of an ad as anything. Although advertising for drugs might be banned here, seems like its happening anyway.

Personally I'd just as soon see the government enforce the law and have the ads taken off the air all together, because:

a)they confuse and misinform the public and

b)people can easily find out about drugs through their doctor, books or the internet when the need arises.

However I could also see two problems with and outright ban:

a)the slippery slope - which products can and cannot be advertised? (although personally I'd just as soon get rid of TV ads altogether, they're an unnecessary drain on the economy) and

b)one could argue that banning ads would potentially reduce the general public's awareness of which drugs are available and therefore increases their dependency on the physician as the exclusive broker of pharmacological information. This then becomes a bit scary as doctors are by no means immune to powerful back-door lobbying by drug companies. In a way this is similar to advertising, but it happens privately in medical offices, fancy restaurants, and conference halls (well out of the public eye). The end result is the silent undermining of the physician's loyalty to the best interests of the patients who are now in such a position of dependency. (However, one might counter that in practice drug-company funded ads do little to empower the public with any real information, and if ads were banned, we would still have access to the wealth of information available in libraries and on the internet.)

So although I see no problem banning drug ads, I can see why some might be wary. Perhaps an alternative is to allow drug companies to keep their "free" billion dollar TV propaganda platform, but bolster the influence of other perspectives that balance the message.

Obviously, non-profit public interest groups have no chance of competing for advertising time with the big corporations. So how about if for every 30 second time slot that a TV network sells for pharma advertising, it must also provide 30 seconds free of charge to a relevant public-interest group. For example, if you sell advertising for a cancer drug, you must give equal billing to an informative and balanced ad produced by the Canadian Cancer Society.

The Canadian Cancer Society's (and other groups) website and other public awareness campaigns have already made it clear that such a group can bring together the thoughts of physicians, scientists and patients to provide balanced and accurate information for the public good. We just need to make sure that such groups striving to serve the common good get heard in a world full of loud, self-serving, corporate noise.

Kamel said...

I find it curious that it's Canwest that's launching the court action and not Big Pharm themselves, but I guess they have a lot to lose with lost advertising revenue.

As for the idea of giving public interest groups equal airtime, I like it. The US laws take a step in that direction with the mandatory side-effect disclosure. Still, in some cases it might be hard to imagine the counter-point group for some of the more recreational pharmaceuticals. Who does the public interest counter to Viagra? Heart and Stroke foundation, I suppose.

I agree that Canada should better enforce their drug advertising laws. I think a treatment choice should be made between doctor and patient, not doctor/patient/advertiser. Big Pharm should not be influencing health care decisions, especially when the ads are so uninformative. As you point out, that still leaves a problem of lobbying directly to doctors (another area where there should be strict regulations) but at least part of the issue will be taken care of.

For more reading on the subject of drug promotion, check out Health Skepticism. The library section in particular has an extensive list of studies and opinion from the literature.

Kamel said...

Just to follow-up, the New England Journal of Medicine has a study reviewing the past decade of direct-to-consumer drug marketing in the US here

Bayman said...

"A second indication of weakening FDA oversight of direct-to-consumer advertising in recent years is that the number of staff members who are dedicated to reviewing advertisements has remained relatively stable, whereas the use of such advertising has grown substantially. In 2002, three FDA staff members were dedicated to reviewing direct-to-consumer advertisements."

Wow. Three people to regulate a $3 billion pharma advertising activity. Talk about governmental neglect...

Bayman said...

"Dr. Donohue reports receiving consulting fees from GlaxoSmithKline and CanWest Global Communications"