By Published On: February 1st, 20089 Comments

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.

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Originally published in Focus, February 2008.  Watch the video:

9 Comments

  1. steve hayes February 2, 2008 at 3:04 am

    Yes, that is all that Canada needs is more unrestricted drug advertising. Right, we need to have more people addicted not to street drugs but prescription drugs.

    Are these drugs safe? Ask the undertakers.

    As the director of Novus Medical Detox, we see many people addicted to OxyContin, legal heroin, who just did what they were told by their doctors. This is one reason that Purdue Pharma paid fines of $600+ million for falsely promoting OxyContin.

    Some people’s DNA and metabolism does make them more susceptible to dependence and addiction and either way the withdrawal is painful. We now have protocols that make it much more comfortable but the real problem is treating the symptoms and not the cause. I was told in the 1980’s that I would be on pain killers but I found other solutions and have not taken them.

    Steve Hayes
    http://www.novusdetox.com

  2. Rob Wipond February 2, 2008 at 3:18 am

    Thanks a lot for your comments, Steve.

    By the way, do you see much in the way of people addicted to Ativan and those types of prescription sedatives? I’m seeing a lot of that myself. Doctors and pharmacists seem to dish them out without regard to the warnings about long term use. I’ve heard that class of drugs is the hardest of all to come off of, and often has the worst long term effects. In your experience, is that accurate?

    For anyone interested in my own previous writing on prescription drug addiction, see here.

  3. Rob Wipond February 9, 2008 at 12:58 am

    This comment from UBC researcher Barbara Mintzes was forwarded to me by Women and Health Protection, and I thought it was a helpful clarification to repost here:

    Just a quick note to say that it’s great to see this article, very well argued and explains the context to what is going on now with the CanWest
    case — very important to have this type of information out publicly. There is only one inaccuracy that I felt I needed to point out, however.
    When the US FDA sends out a regulatory letter, these are not toothless letters that are ignored. Companies do withdraw the offending
    advertisements as soon as they get the letter. The letters are also posted on the FDA’s website which means they are publicly available —
    important that it is possible to know what the company did and what the FDA thought about it. The problem is that the companies are not fined and there usually are no other sanctions, so nothing to prevent repeat violations; also that there is a much longer delay than previously in terms of the the timing of letters — around 4 months between when the ad starts to show on average and when the letter goes out. The timing was around 2 weeks to get a letter out before internal administrative procedures were brought in by Daniel Troy, a Bush administration appointee, requiring letters to be screened through the FDA’s legal office before they could be sent out. Troy had represented pharmaceutical companies in cases against the FDA before his appointment. He is no longer the FDA’s general legal counsel, but unfortunately this administrative policy lives on.

    I wanted to note this correction because the FDA does have a regulatory process in place that is publicly accountable. They can’t deal with the
    increasing volume (only review one third of TV ads, down from 2/3 a few years ago). However, compare it to the Canadian situation:
    1) no active monitoring requirements (the FDA requires companies to submit all ads when they first run);
    2) when a person or group does complain about advertising they suspect is illegal, they may or may not hear what happens, and generally only 6 months later (once recently 2 years later with no information provided).
    3) no publicly accountable complaint procedures
    4) no publication of # of complaints, reasons, results
    5) no fines, sanctions or other sequelae for the companies.
    Barbara Mintzes

  4. See link above for the video I’ve made about this topic.

  5. BERNEredfeathers October 12, 2008 at 3:17 am

    We are finding out now what deregulation can do to the banking industry in the U.S. and how it affects all of us. I resent the interference by CanWest Global in attacking Canadian Drug Ad Laws.

  6. BERNEredfeathers December 7, 2008 at 5:15 pm

    Rob, I drop in to say hello and Merry Christmas. I try to follow you as often as I can and enjoy your reporting.
    When one reads anything on the internet he really has to sift through a lot of information to try to make any kind of decision and if one tries too choose a book on a given topic, well some of the information is so incredulous that you wonder if this is the same world that I live in. Such a book that I am currently reading about “economic hit men”, if read as literature makes exciting reading but if it is a true “confession”, is pretty scary. In the context, of reality, with what is happening in Washington or the world then it becomes sadly truthful. Surreal.
    I believe you are trying to make difference, thanks.

  7. Rob Wipond December 7, 2008 at 7:20 pm

    Thanks for your encouragement and support!

    Are you reading “Confessions of an Economic Hit Man”? I have little doubt it’s true. I used to do a lot of research and writing on Latin America, so many of his stories coincided with other things I’d learned about. Also, one of my favourite investigative journalists, http://www.gregpalast.com as I recall either wrote the intro to that book or in one of his own books discusses meeting that author during one of his ‘missions’. Reading Palast’s writing, too, provides a savage indictment of North American mainstream media for ignoring such stories despite overwhelming evidence.

  8. quiact December 17, 2008 at 12:20 am

    DTC Advertising

    Not long ago, usually on television, one viewing will often at times see an advertisement for some type of medication- usually it is a drug involved with the treatment in a large market disease state. Such commercials are sponsored by large pharmaceutical corporations for particular networks on television. This is called direct to consumer advertising, and both doctors and citizens largely prefer that they do not exist.
    Since 1997, when the FDA relaxed regulations regarding this form of DTC advertising for the pharmaceutical industry, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry has spent around 5 billion annually on this media source. The industry ranks number two on their spending of media campaigns- next to automobiles, I believe. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns typically associated or possible with newer medications, as history has shown.
    The purpose of DTC ads are not to educate and inform the viewers, in my opinion, as others have claimed. Any advertising of any type shares the same objective- which is to increase sales and grow their market for a particular product and, in this case, for a particular perceived medical condition or disease state that may or may not exist, as a television is not by definition a health care provider for the viewer. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment soon for what may be an unconfirmed medical condition or disease suggested with such DTC advertisements. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads before they are presented to the public, in relation to their accuracy and clarity, as well as possibly their effect on the health care system, as the FDA allows the DTC advertising to continue, yet now it is becoming more restricted, I understand.
    DTC advertising is also a catalyst for and similar to disease mongering.
    Disease mongering is the creation of what some believe should be medical flaws, and illustrated by the creators through exaggeration and embellishments through such media sources as an avenue for what appears to be propaganda often, as is often seen with DTC advertising. The content of the advertisements appear to be medically absent, yet realistically they are in fact corporate creations of these questionable human ailments that do not or may not require treatment, possibly, and may be attempts by the makers of certain drugs to develop or embellish a particular medical condition to acquire additional profit. One of my favorite DTC advertisements is the new concept for the use of an anti-depressant for a social disorder. Social disorders appear to be another phrase for what are known as introverts- a term created by Dr. Carl Yung. And it is a personality trait, not a medical disease, many believe. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators of these commercials again wish to grow the market for a particular, and possibly fictional, disease state. Then there is also baldness treatments advertised, as another example by the advertisers who attempt to create a need for treatment. Lifestyle medications are not treatment options for illnesses, and should not be portrayed as such in certain direct to consumer advertisements. Then there are the Viagra commercials with the happy man who is fully energetic on the advertisement for this drug is not your typical man who has erectile dysfunction. So DTC advertisements are intentionally deceiving to grow the markets for the benefits of the makers of the drugs advertised.
    Also, DTC ads discuss only one treatment option normally, so it seems, when likely there are several treatment options that exist for authentic medical disorders. The options for treatment should be left to the discretion of the health care provider, as they are the ones who assess your health, not your television or another media source. That’s why most of the world does not allow DTC advertising, with the exception of our country and New Zealand.
    Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional remains largely unregulated, yet apparently effective for the creators of direct to consumer advertising. People are prone to believe what they see and hear, regardless of whether or not it is actually true. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome if not awkward for the health care provider chosen by the viewer of a DTC ad for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads require a prescription. Also, in some situations, the sponsor will speak and acquire a dormant/inactive actor, perhaps, or a former athletic celebrity, to fuel their intent.
    Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world utilizing media outlets such as television. Perhaps this will save some over-prescribing of expensive medications that progressively has been occurring recently, which will benefit everyone in the long term. And the Health Care System can regain control of their purpose, which should be far from financial prosperity. This elimination of DTC advertising would only be a start to achieve control in the U.S. Health Care System as it exists today.
    “Ignorance is not innocence but sin.” — Robert Browning
    Dan Abshear
    Author’s note: What has been written was based on information and belief
    Published on http://www.brainblogger.com

  9. Fiametta January 27, 2009 at 9:36 am

    Nice work! I’ll have to do a cross post on this one ;)

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