“Direct to consumer” advertising of drugs in Canada could add £550m to healthcare costs

If “direct to consumer” drug advertising were allowed in Canada, spending on pharmaceutical drugs would increase substantially, and most of the spending would come out of the public purse, an editorial in the current edition of the Canadian Medical Association's journal says (CMAJ 2003;169:381). The editorial estimates that the increase could be as much as $C1.2bn (£550m; $US880m; €790m).

The journal also includes a research report on the effects of such advertising on prescribing decisions. The researchers, led by Dr Barbara Mintzes, from the centre for health services and policy research at the University of British Columbia, compared prescribing decisions in a US setting where direct to consumer advertising was legal and a Canadian setting where such advertising is illegal but where some cross-border exposure occurs.

They concluded that “more advertising leads to more requests for advertised medicines, and more prescriptions. If [direct to consumer advertising] opens a conversation between patients and physicians, that conversation is highly likely to end with a prescription, often despite physician ambivalence about treatment choice”(CMAJ 2003;169:405-12).

The editorial says that the trouble with direct to consumer advertising of prescription drugs is not that it is directed at patients, who have every right to know about the therapeutic products potentially available to them. “The problem is simply that it is advertising, whose purpose is to deliver messages, not information. Those messages are intended to promote the use of newer, more expensive drugs (even if older, cheaper, ones work as well) and to increase brand recognition (but not an awareness of side effects, or of nonpharmacologic options for treatment and prevention).”

The editorial adds later: “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 products. At the same time, the constant barrage of [such] advertising contributes to the ‘medicalization’ of normal human experience by which the authority of medicine and our modern inability to accept the normality of illness and death has turned us into ‘two-legged bundles of diagnoses.’”

Advertising of prescription drugs aimed directly at the public is prohibited in Canada, as in most countries, but a shift in interpretation of Canada's policy governing this marketing strategy has occurred, resulting in its partial introduction without public and parliamentary debate, says one of the commentaries in the same issue (CMAJ 2003;169:425-7). And although the Canadian Medical Association, the Canadian Pharmacists Association, and the Consumers' Association of Canada have all taken strong policy positions against such advertising, some forms of it have become widespread.

“The current state of DCTA [direct to consumer advertising] in Canada, with regulatory creep occurring behind closed doors, is unacceptable,” say the authors of this commentary, adding: “Legislation banning [it] either needs to be reinforced or put to public and parliamentary debate.”

Recent policy statements from the federal health department have allowed advertisements to be released to the general public without being reviewed by government regulators or their delegated bodies, say the commentary authors.

“Response to complaints tends to be slow … and, arguably, ineffectual. For example, a television advertisement for Zyban (bupropion) was allowed to run for months, although Health Canada judged it to contravene the law.”

Also “advertisements that appeared concurrently for Alesse (ethinyl estradiol and levonorgestrel) were each individually judged to be legal. In practice, this means that regulation of the accuracy of DTCA (direct-to-consumer advertising) in Canada is haphazard.”