# \[e-drug\] DTCA and Canada 1

**URL:** <https://talk.edrugplus.org/t/e-drug-dtca-and-canada-1/17577>\
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**Created:** [September 4, 2003, 5:11am UTC](https://talk.edrugplus.org/t/e-drug-dtca-and-canada-1/17577 "2003-09-04T05:11:48Z")\
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**Post date:** [September 4, 2003, 5:11am UTC](https://talk.edrugplus.org/t/e-drug-dtca-and-canada-1/17577/1 "2003-09-04T05:11:48Z")

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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](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&gt;http://www.cmaj.ca/cgi/content/full/169/5/381?etoc](http://www.cmaj.ca/cgi/content/full/169/5/381?etoc&gt;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](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.

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