[e-drug] DTCA and Canada 1

[e-drug@healthnet.org]

E-drug: DTCA and Canada 1
---------------------------------------------

[The following articles on Direct to Consumer Advertising (DTCA) have 
been published in the current issue of Canadian Medical Association 
Journal.  They will be sent as separate messages. BS]

2 September 2003; Vol. 169, No. 5
URL: http://www.cmaj.ca/content/vol169/issue5/index.shtml?etoc

1. Editorial:  Ads and prescription pads
[copied as fair use]

CMAJ 2003;169 381
<http://www.cmaj.ca/cgi/content/full/169/5/381?etoc>http://www.cmaj.ca/cgi/content/full/169/5/381?etoc

How does direct-to-consumer advertising (DTCA) affect prescribing? A 
survey in primary care environments with and without legal DTCA
Barbara Mintzes, Morris L. Barer, Richard L. Kravitz, Ken Bassett, 
Joel Lexchin, Arminee Kazanjian, Robert G. Evans, Richard Pan, and 
Stephen A. Marion
CMAJ 2003;169 405-412
http://www.cmaj.ca/cgi/content/abstract/169/5/405?etoc

In 2000, pharmaceutical firms in the United States spent US$2.5 
billion on direct-to-consumer advertising (DTCA) - more than 3 times 
the amount they had spent in 1996, and 35% more than in the previous 
year.1 From a business perspective, this money was well spent: for 
example, it has been claimed that each dollar spent on consumer 
advertising for the allergy drug Claritin has brought in $3.50 in 
increased sales.2 In this issue, Barbara Mintzes and colleagues 
report on the effects of DTCA on patients and physicians3 (see pages 
405 and 425). It seems that DTCA has a primary and a secondary 
effect: patients are susceptible to advertisers' claims, and 
physicians are susceptible to patients' requests for advertised drugs.

Is this necessarily a bad thing? Some common illnesses such as asthma 
and diabetes are undertreated, whether through underdiagnosis or poor 
"compliance," and a substantial proportion of the general adult 
population has pharmaceutically treatable risk factors such as 
hypertension and hyperlipidemia. An argument can be made that 
underprescribing is a medical error (of omission).4

Arguments in favour of DTCA also speak of "empowering" the patient by 
means of providing information on the treatment choices available. 
Those wonderfully cryptic "reminder" and "help-seeking" ads one sees 
on television these days (which slide under the regulatory radar in 
Canada by naming either a condition or a treatment but not both 
together in what might be construed as a "product claim" - see page 
421) may raise awareness of some health problems and reduce stigma, 
thus helping to break down resistance against seeking information, 
diagnosis and treatment. Insofar as DTCA is informative, who are 
physicians and regulators to say it isn't good for patients?

The trouble with DTCA is not that it is directed to 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). Their purpose 
is to create demand by delivering a double message of anxiety and 
hope, encouraging a belief that a condition - hair loss, acne, 
shyness, allergies or osteoporosis - is not only "widespread [and] 
serious" but "treatable."5 In addition to raising general consumer 
awareness, they carve out new and sometimes questionable market 
niches (e.g., through a Viagra ad campaign aimed at younger men).1 
The fact that DTCA is subject to government regulation and voluntary 
standards gives some reassurance, but not much. Advertising standards 
are as tricky to interpret and enforce as marketing gurus are 
creative; moreover, the very fact that DTCA is subject to government 
regulation and advisory-board approval has the paradoxical effect of 
increasing its credibility.1

But perhaps the most noteworthy point about DTCA is that word 
"consumer." 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 DTCA 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."6 Moreover, what 
Ivan Illich so forcefully described in 19767 as an iatrogenic 
phenomenon has now gone corporate: "The social construction of 
disease is being replaced by the corporate construction of disease."5

One launches into such critiques at the risk of sounding hysterical. 
And so we hold back from an alarmist stance that assumes that no 
patient is capable of responding to an advertisement skeptically. But 
consider the following: if US-style, "product claim" DTCA were 
permitted in Canada (the only other country that allows it is New 
Zealand), pharmaceutical firms might spend about Cdn$360 million a 
year and expect drug sales to increase by as much as $1.2 billion. 
These additional costs will be added almost entirely to the cost of 
medicare. Do we know enough about the RCT-proven benefits of the 
advertised drugs to decide whether this is a wise use of our 
resources? Those resources might be better spent in providing 
unbiased "consumer" information about drugs and alternative non-drug 
therapies and prevention. - CMAJ

References

1. US National Institute for Health Care Management. Prescription 
drugs and mass media, 2000. Washington: The Institute; 2001. 
Available: 
www.google.ca/search?q=cache:Mql7xCnuyc4J:www.nihcm.org/DTCbrief.pdf+Prescription+drugs+and+mass+media,+2000.+&hl=en&ie=UTF-8(accessed 
2003 Aug 11).
2. Pill pushers. Economist 2001; Apr. 21. p. 58-9.
3. Mintzes B, Barer ML, Kravitz RL, Bassett K, Lexchin J, Kazanjian 
A, et al. How does direct-to-consumer advertising (DTCA) affect 
prescribing? A survey in primary care environments with and without 
legal DTCA. CMAJ 2003;169(5):405-12.
4. Committee on Quality Health Care in America. Crossing the quality 
chasm: a new health system for the 21st century. Washington: National 
Academy Press; 2001.
5. Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical 
industry and disease mongering. BMJ 2002;324:886-91.[Free Full Text]
6. Illich I. Death undefeated. BMJ 1995;311:1652-3.[Free Full Text]
7. Illich I. Limits to medicine. In: Medical nemesis: the 
expropriation of health. Toronto: McClelland and Stewart; 1976.

--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug