CARP Action
With more U.S. pharma
ads flooding onto Canadian TVs,
John Lorinc discusses their impact
W
HEN LEA PREVEL
KATSANIS, a professor of marketing at
Concordia University’s
John Molson School of
Business, and co-author Joyce Sarkis
recently completed a study on the
impact of direct-to-consumer pharmaceutical advertising (DTCA),
they came to two stark conclusions
about drug promotion.
One was that younger people (1835) easily retain the risk alerts and
the other brand information, but
they don’t really care about the information because they feel they’ll live
forever. Older people, by contrast,
require more time to absorb health
warnings, but pay closer attention,
tend to have positive views about
these ads and are more likely to ask
for a prescription for the promot-
88 – MARCH 2014 everythingzoomer.com
ed brand. Mostly, though, older individuals are far more likely to defer
to their physicians when seeking advice about drugs they may have heard
about on television or in the print
media, Prevel Katsanis says of her
findings. “The power of DTCA is really limited because the doctor trumps
all.”
The debate over the effectiveness
of drug ads and the rules governing
them in Canada has been a thorny
one for more than a decade, and
Prevel Katsanis’s view is by no means
shared by all. With a few limited exceptions, Health Canada does not allow drug companies to advertise prescription pharmaceuticals unless the
ad includes only the brand name, the
price and the quantity in the package, which explains why there are no
prescription drug ads in Zoomer or
any other Canadian magazine.
Canada’s patent drug industry accepts the restriction. As Russell
Williams, president of Canada’s
Research-based Pharmaceutical
Companies, says, its members comply with the rules well and take the
position that “Canadians should
speak with their health-care professional when they have questions
about conditions or therapies that
are available to them.”
In the U.S., by contrast, the Food
and Drug Administration allows
DTCA, such as TV ads that often
feature healthy and frequently middle-aged people enjoying themselves
while a rapid voice-over enumerates
all the horrible potential side effects and contraindications of the
promoted medication. (The print
equivalent is the ad plus a page of fine
print medical information.)
But because so much American TV
advertising crosses the border, the
question of its role in shaping consumer attitudes has preoccupied
Canadian drug marketers, regulators and critics of the pharmaceutical industry. Further muddying the
picture is that drug companies are
allowed to run so-called “reminder” ads that illustrate a condition
and suggest that viewers “ask their
doctor” about potential but unspecified remedies. More problematically, some drugs that have received the
FDA’s so-called “black box” warnings (alerting patients to potential
life-threatening risks) continue to
be promoted here without such cautions because existing rules prevent
drug companies from including anything other than the brand name,
price and quantity in their ads.
According to Prevel Katsanis, who
worked as a pharmaceutical marketer before becoming an academic, the
existing Canadian policy regime is
well matched to the way older individuals seek information and then
make choices about prescription
drugs. “I really think Canada has it
right.” Only the U.S. and New Zealand
allow DTCA. There are three forms of
DTCA as described by the U.S. Food
and Drug Administration: full product ads, which state the name of the
product and its uses; reminder ads,
which state only the product name;
and disease-awareness ads. Since
2001, reminder ads have been allowed in Canada. Canada’s approach
is unique among countries that prohibit DTCA and, according to Barbara
Mintzes, an assistant professor of
population and public health at the
University of British Columbia, needs
“rethinking.” The reason: the risks of
over-prescribing – a problem particularly acute in older people.
In recent years, the most heavily advertised prescription medications,
apart from birth control pills and
drugs for smoking cessation, have addressed health concerns that mainly
afflict those who are middle-aged and
older, among them all the various impotence medications, Lipitor (statins
for high cholesterol), Celebrex and
Vioxx (non-steroidal anti-inflammatory medications).
In the U.S., drug companies spent
vast sums promoting these medications. Between 1995 and 2006, Canada
saw an increase in consumer-oriented
drug advertising with almost $300
million allocated for both unbranded
ads and branded reminder ads (e.g.,
a recent Celebrex campaign that playfully urged viewers to “act your inside
age”). Still, per capita ad spending in
the U.S. is more than 17 times higher.
Why? Well, there’s the old adage: it
pays to advertise. But aggressive promotion has also been shown to expand the diagnostic boundaries for
certain conditions (e.g., depression
or anxiety), leading to an increase
in unjustified prescriptions as physicians bow to pressure from patients
who have seen DTCA. In Canada, we
have seen ads featuring alarming images such as corpses with toe tags and
voice-overs about cholesterol levels.
Case in point: a Cornell/New York
University study published this year
in the Journal of Internal Medicine
found that DTCA “may promote overdiagnosis of high cholesterol and
over-treatment for populations where
risks of statin use may outweigh the
potential benefits.” Statins, according to several studies, are most effective for those who’ve had heart attacks or strokes, but high cholesterol
on its own is not the only predictor of
cardiac “events.” Smoking and being
overweight are much
stronger risk factors.
The authors note that
if Lipitor is prescribed
to people without previous heart disease,
treatment benefits are
small and may not outweigh harm. But the
authors found that increased advertising
for statins was linked
to increased prescriptions for those at low
risk of having a heart
attack or stroke.
Another
s t u d y,
published last year by the Medical
Journal of Australia, looked at how
regulators responded to complaints
about ad campaigns for testosterone replacement therapy in both
Australia and Canada. In both countries, Abbott and Bayer had promoted testosterone gels by running ads
asking viewers if they’d experienced
symptoms such as after-dinner sleepiness. Another asked, “Has he lost
that loving feeling?” Such “symptoms” may or may not have a medical basis and are, in any event, nonspecific, the study noted. Yet the ads
didn’t mention that the use of testosterone supplements can accelerate
certain types of prostate cancers and
cardiovascular conditions without
altering mood or libido. “These disease awareness campaigns are clas-
sic examples of disease mongering,”
the study concluded sharply. Mintzes,
a co-author, notes that regulators in
both countries failed to act effectively. Australian authorities fined Bayer
$10,000 and called the ads “alarmist.”
Health Canada, however, determined
that the Abbott ads were “balanced”
and noted that the Pharmaceutical
Advertising Advisory Board (PAAB,
of which CARP is a member) preapproved the campaign.
Prevel Katsanis, however, argues
that ads that suggest people consult
their physicians serve
a positive role because
they encourage dialogue. But Mintzes
says such advertising can actually drive
up health costs, noting a U.S. study showing that a heavily promoted acid reflux drug
prompted many patients to switch from
an equally effective but
lower-cost generic.
PAAB commissioner Ray Chepesiuk calls
drug ads “a double-edged sword” but
notes there’s little chance that the direct to consumer parts of the law will
change to allow more advertising. In
public consultations, Health Canada
has heard the pharmaceutical and
the broadcasting industries call for
loosening the laws, as well as criticisms from consumer and drug safety advocates.
But Chepesiuk, a former pharmacist who has spent years scrutinizing
drug ads, acknowledges that neither
the U.S. DTCAs nor Canada’s essentially content-free ads serve the consumer well. His suggestion: rules that
encourage advertisers to target the
population that would benefit from a
prescription medication. As he says
of Canada’s current system, a little information can be a dangerous thing,
especially if it comes in doses.
Studies
show that
aggressive
drug
promotion
can lead
to an
increase in
prescriptions
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