It’s arguably the year’s most important health care story. We’ve heard little about it, though, because media are deeply implicated in it themselves.
Direct-to-consumer advertising of pharmaceutical drugs (DTCA) is unfettered in only the U.S. and New Zealand. Canada, as the world’s eighth largest drug market, makes a juicy target to be next.
But ironically, Big Pharma isn’t the one fighting to legalize pushing amphetamines during Degrassi reruns; it’s CanWest Global (owners of the Victoria Times-Colonist, Global TV, CH TV, Vancouver Sun, Vancouver Province, Dose, Metro etc). CanWest has launched a lawsuit under the Charter of Rights and Freedoms, trying to tear down Canada’s limits on pharmaceutical advertising.
Currently, prescription drugs can be advertised to the general public in two ways: the ad names a drug without describing what it treats, or the ad discusses an illness without mentioning a drug name.
While these laws may seem strange, Health Canada’s legislative history shows how they developed. Early 20th century laws controlling medications and advertising came into force under pressure from physicians concerned about dubious health claims and drug dangers. Blanket bans gradually became more flexible: less dangerous drugs that alleviated common conditions like sniffles could be advertised; makers of cheaper, generic drugs could announce their existence. Later, lifestyle chemicals like diet pills, contraceptives and vitamins challenged definitions of what “medications” were, and leeway was granted for promoting health education. Then came borderless media, permissive U.S. advertising, and underfunded regulatory enforcement, and the resulting mess certainly now needs straightening. But how?
Most medical professionals, independent non-profits, academics and the knowledgeable public support toughening and enforcing our laws.
CanWest claims the laws restrict freedom of expression and should be thrown out. Mind you, this same company fires journalists for suggesting $53 is too much for a cup of tea (see my article in Focus, Sept. 2006), and sues non-profits for writing clever newspaper satires (see here and here). So one might reasonably suspect an ulterior motive other than bolstering freedom of expression.
In fact, nobody questions CanWest Global’s right to say whatever it wants about drugs, so this case has nothing to do with freedom of expression. It’s about getting advertising money from pharmaceutical companies eager to run U.S.-style ads here, a pot estimated to be worth a half-billion dollars annually. Through their industry associations, major Canadian media have been lobbying regulators for years to gut the ad restrictions. Therefore, it’s noticeably fishy that the story is getting little coverage, even though CanWest’s case hits court soon and has far-reaching health care implications.
An alliance including the Canadian Health Coalition, Federation of Nurses Unions, and Women and Health Protection has intervenor status, and the latter has posted affidavits from all sides on its website. These highlight key concerns.
Does DTCA increase objective consumer knowledge, or effectively decrease it through clever manipulation? Does DTCA increase diagnoses of ineffable “diseases” like “depression”, “hyperactivity” and “anxiety disorder”? With drug costs already gobbling nearly 20% of health care budgets, double 1985’s percentage, can we risk letting lifestyle drugs become the next iPods?
CanWest’s position is well summarized in one (and seemingly the only) commentary that’s appeared in their media outlets. Long-time National Post columnist Peter Foster dismisses concerns DTCA will do anything but improve public access to accurate information.
“[W]hy in the name of heavens would anybody but a snake-oil salesman… go around making deliberately false claims if he wanted to stay in business…?” asks Foster rhetorically.
In fact, the U.S. FDA continually issues innumerable reprimands to major drug firms for false and misleading advertising. But ad laws are flimsy, and the toothless letters are essentially ignored. (See the comment from UBC researcher Barbara Mintzes below for clarification on this point.) Our government’s own DTCA-case affidavit describes several ongoing examples where Health Canada has issued repeated reprimands to companies who have continued illegally marketing potentially-lethal drugs to teenagers for years, often for unapproved, trivial uses like treating mild acne.
Worse, as Dr. John Abramson’s affidavit details, DTCA is but one part of a massive public manipulation offensive. There’s a pharmaceutical rep for every 4.5 office-based doctors. Many health care “non-profits” are corporate fronts. Drug lobbyists become government regulators. Two-thirds of academic institutions accept drug research contracts that don’t allow their own researchers to change the study design; half sign contracts that relegate the researchers to being mere advisors to company PR ghostwriters. When Abramson provides a summary quote describing our scientists as bozos “seduced” by cash and “frightened” to defy “gag orders” in a “race to the ethical bottom”, it sounds like a rant from a drunk Focus columnist–it’s actually an American Medical Association Journal editor. (Our physician organizations, the Canadian Medical Association and BCMA, both have publicly available policies against DTCA, but have been noticeably quiet about this case.)
Which highlights my own biggest concern: DTCA’s effect on media.
Illustratively, Foster mocks Canada’s laws by observing that Viagra’s Canadian ads would be inscrutable “if you did not know what Viagra was”. Which raises the question: Why DO we all know? We know because journalists have long been eager patsies replaying the latest magic-pill propaganda, and the social impacts have been dramatic. For example, PR News reported that media references to “social anxiety disorder” increased from 50 in 1998 to one billion in 1999, following PR efforts by Paxil’s manufacturer. SAD promptly changed from what medical texts called an “extremely rare” disorder into a multi-billion dollar industry.
How much more insidious will all this become when pharmaceutical giants are major advertising clients, and when there’s hefty ad money to be lost if journalists question drug claims?
DTCA would deeply undermine public access to accurate health information. It’s criminal that CanWest Global is acting so irresponsibly.
Originally published in Focus, February 2008. Watch the video: