Myth Busted December 2004
Busted Again September 2007
Turn on your TV set or open a magazine and it may seem that drug ads are everywhere. But the fact is, the rules governing prescription drug advertising in this country are far more restrictive than the direct-to-consumer ads allowed in the U.S. By law, Canadian advertisers are able to mention only the drug name, price and quantity. In recent years, though, manufacturers have become increasingly creative with these rules, running so-called "reminder ads." These ads promote only the drug's name to consumers. However, instead of the product's price and quantity, we hear Sinatra songs, and alongside the brand names, the tagline, "ask your doctor." i- iii The combined effect of these more creative ads in Canada and spillover advertising from American media is that some may believe that anything goes in drug advertising in this country.
Drug companies and their supporters defend these ads citing their educational value. The national association representing Canada's research-based pharmaceutical companies, Rx&D, argues that "advertising can raise awareness of effective new therapies and improve overall health of the nation by helping Canadians recognize early symptoms and informing them about potential treatment options." iv The idea is that informed patients will be prompted to talk to their doctors about symptoms they might otherwise ignore, leading to treatment sooner and preventing expensive hospitalizations later.
Education or exaggeration?
Only eight percent of patented drugs introduced in Canada between 2001 and 2006 are considered "breakthrough" or important new contributions to therapy. v Therefore, one concern about direct-to-consumer advertising is that it stimulates sales of new drugs, which are more expensive than older treatments but often no better. Most major advertising campaigns begin within the first year a medicine is introduced onto the market, before the drug is in broader circulation and harmful side effects become apparent. vi
Those opposed to drug ads say that manufacturers use emotion rather than information to promote drugs. Take the 2003 Pfizer campaign that asked, "Which would you rather have, a cholesterol test or a final exam?" vii The campaign was launched by the manufacturer of the cholesterol-lowering drug, Lipitor, which is also the world's best-selling prescription medication. viii In its Canadian print ads, where neither the manufacturer's nor a drug's name were given, the campaign relied on the image of a tagged-toe corpse to get its message across. The television ads, also silent on the manufacturer's name and any specific drug, used the story of a healthy, young man who died unexpectedly of a heart attack, leaving his family grief-stricken. The message viewers might take is that cholesterol tests and subsequent drug treatment could prevent premature death from heart attacks in healthy people. The problem is the message contradicts existing research evidence. A 2003 meta-analysis of studies of cholesterol-lowering drugs in people without previous heart disease found no difference in mortality between those taking the drug and those on a placebo. ix A 2007 content analysis of American television drug ads suggests using emotion to sell these products is now a widespread practice. For example, it found many drug ads featured characters whose social, emotional or physical wellbeing were compromised without benefit of the advertised medications; after taking the medicine, they regained control and social approval. x
Researchers have also found that some ads promote unnecessary medicalization of normal life. xi Examples include promoting drug treatment for baldness, pre-menstrual syndrome, shyness or occasional sexual problems. And then there are ads for drugs with serious side-effects, such as the arthritis drug Vioxx. In the fall of 2004, Vioxx was pulled off the market because of risks of heart attacks and strokes. xii Up to that point, Vioxx had been among the top five most heavily advertised drugs in the U.S., with Merck spending more on advertising Vioxx than Pepsi-Cola spent on Pepsi. xiii A year before it was pulled, the drug had become the 10th-best-selling drug in Canada. xiv
Other research evidence suggests prescription drug ads exaggerate benefits and downplay risks. It also finds that they don't discuss non-drug treatments that may be available, prevalence of the illness or the success rate of the drug compared to a test group that took a placebo. By law, American ads must include information about a drug's side effects, who should and shouldn't take the medicine, and overdoses. However, that information is usually in small type in print ads, and TV ads often present the information too quickly to digest. xv- xviii
Ask your doctor
Drug companies and their supporters argue that direct-to-consumer ads start a conversation between patients and their doctors. Indeed, they do. And many of those patients who ask their doctor walk away with a prescription. The authors of a 2005 randomized trial in the U.S. found "standardized patients" - trained actors pretending to be patients - who asked for an advertised drug were likely to get a prescription for it, whether they showed symptoms of the illness the drug treated or not. xix Meanwhile, doctors worry about spending their limited time "re-educating" patients, explaining why a certain drug isn't appropriate for them or why a non-drug treatment may be better. xv, xviii
Worth the cost?
A 2007 study that compared spending on pharmaceutical drugs in the U.S. and Canada estimates that if Canada had followed the American lead in allowing these ads, it would be spending $10 billion more per year on prescription medicines than it currently does. xx
This study, combined with a 2005 systematic review that found no evidence that direct-to-consumer advertising leads to health benefits, xxi suggests the costs of opening the door to these less restrictive ads - both in dollars and risks - is not worth the possible benefits, unless they profiled appropriate and cost-effective treatments. xx
Manufacturers have put their faith in direct-to-consumer advertising, spending $4.8 billion in the U.S. last year alone. xxii Direct-to-consumer advertising has proven effective in selling medicines and boosting profits, xxiii but not educating the public. To promote safe, effective and efficient medicine use, policy makers may be well-advised to maintain restrictions on direct-to-consumer advertising and to invest in publicly sponsored campaigns - independent of manufacturers - that deliver reliable and comparative health information to the public. xxiv
i. Brown B. 2004. "Opening the medicine cabinet: first report on health aspects of prescription drugs." Report of the standing committee on health. http://cmte.parl.gc.ca/cmte/CommitteePublication.aspx?COM=8791&Lang=1&SourceId=76297
ii. Gardner DM, Mintzes B, and Ostry A. 2003. "Direct-to-consumer prescription drug advertising in Canada: Permission by default?" Canadian Medical Association Journal; 169(5): 425-427.
iii. Health Canada. 2000 (updated 2005). "Advertising campaigns of branded and unbranded messages." Policy Statement. www.hc-sc.gc.ca/dhp-mps/alt_formats/
iv. Canada's Research-Based Pharmaceutical Companies. 2007. "Position papers
- Advertising prescription medicine in Canada: Why it makes sense."
www.canadapharma.org/Media/Papers/dtca_e.html (accessed March 3, 2007)
v. Patented Medicine Prices Review Board. 2007. "Annual report."
vi. Donahue JM et al. 2007. "A decade of direct-to-consumer advertising of prescription drugs." New England Journal of Medicine; 357: 673-681.
vii. Mintzes B. 2006. "Disease mongering in drug promotion: Do governments have a regulatory role?" PLoS Medicine; 3(4): 0461-0465 (e198).
viii. CBC. 2006. Canadian court halts generic Lipitor launch: Pfizer. www.cbc.ca/money/story/2006/12/08/pfizer.html
ix. Therapeutics Initiative. 2003. "Do statins have a role in primary prevention?"
Therapeutics Letter #48. www.ti.ubc.ca/PDF/48.pdf
x. Frosch DL et al. 2007. "Creating demand for prescription drugs: A content analysis of television direct-to-consumer advertising." Annals of Family Medicine; 5(1): 6-13.
xi. Woloshin S and Scwartz LM. 2006. "Giving legs to restless legs: A case study of how the media helps make people sick." PLoS Medicine; 3(4): 0452-0455 (e170).
xii. Merck & Co. 2004. "Merck announces voluntary worldwide withdrawal of Vioxx." Press Release. www.vioxx.com/vioxx/documents/english/vioxx_press_release.pdf
xiii. Mintzes B. 2006. "What are the public health implications? Direct-to-consumer advertising of prescription drugs in Canada." www.healthcouncilcanada.ca/docs/papers/2006/hcc_dtc-advertising_200601_e_v6.pdf
xiv. IMS Health Canada. 2003. Compuscript.
xv. Roth MS. 1996. "Patterns in direct-to-consumer prescription drug print advertising and their public policy implications." Journal of Public Policy and Marketing; 15(1): 63-75.
xvi. Woloshin S et al. 2001. "Direct-to-consumer advertisements for prescription drugs: what are Americans being sold?" The Lancet; 358(9288): 1141-1146.
xvii. Bell RA, Wilkes MS, and Kravitz RL. 2000. "The educational value of consumer-targeted prescription drug print advertising." Journal of Family Practice; 49(12): 1092-1098.
xviii. Lexchin J and Mintzes B. 2002. "Direct-to-consumer advertising of prescription drugs: the evidence says no." Journal of Public Policy and Marketing; 21(2): 194-201.
xix. Kravitz RL et al. 2005. "Influence of patients' requests for direct-to-consumer advertised antidepressants: A randomized controlled trial." Journal of the American Medical Association; 293(16): 1995-2002.
xx. Morgan SG. 2007. "Direct-to-consumer advertising and expenditures on prescription drugs: A comparison of experiences in the United States and Canada." Open Medicine; 1(1): e37-45.
xxi. Gilbody S, Wilson P, and Watt I. 2005. "Benefits and harms of direct to consumer advertising: A systematic review." Quality and Safety in Healthcare; 14(4): 246-250.
xxii. Flood C and Zimmerman M. 2006. "Direct-to-consumer advertising: CanWest's Charter Challenge." In IHSPR Research Spotlight Pharmaceutical Research and Policy. www.cihr-irsc.gc.ca/e/32055.html
xxiii. The Kaiser Family Foundation. 2003. "Impact of Direct-to-Consumer Advertising on Prescription Drug Spending." www.kff.org/rxdrugs/upload/Impact-of-Direct-to-Consumer-
xxiv. Joint Declaration of HAI Europe, ISDB, AIM, BEUC, Medicines in Europe Forum.
2006. "Relevant health information for empowered citizens." www.haiweb.org/01102006/PatientInformationDeclaration.pdf
Mythbusters are prepared by staff at the Canadian Health Services Research Foundation and published only after review by experts on the topic. The Foundation is an independent, not-for-profit corporation. Interests and views expressed by those who distribute this document may not reflect those of the Foundation.