International Seminar on Drug Advertising

Canadian Experience

Brazilian Health Surveillance Agency and

Pan American Health Organization

Brasilia, Brazil April, 2005

Erwin Friesen, Pharm.D, FCSHP

efriesen@cha.ab.ca

Presentation Outline• Overview of Canada and Health Care System

• Arguments to Allow and Prohibit Direct to Consumer

(DTC) advertising of prescription drugs

• Current status of DTC advertising in Canada

• Reasons for Canadian decision

• Canadian challenges with advertising

• Difference in impact of advertising in Canada/US

• Questions

Canada Health Overview• Life expectancy 2004 (Source - WHO)

– Canada 79.8 years – USA 77.3 years

• All citizens are covered by the government for a wide range of services

(e.g. hospitals, physicians) regardless of financial status

• People have access to health care regardless where you happen to be or

live in Canada.

• Health care system is publicly administered through tax revenues not by

private business

• Provinces and territories administer their own publicly funded drug

programs

Clinical Arguments to Allow DTC Advertising of Prescription Drugs

• Lead to better health because public becomes educated• Under diagnosed e.g. high cholesterol

• Under treated e.g. erectile dysfunction (impotence)

• Increase discussion between patient and health care workers about drugs and medical conditions

• Better patient compliance with prescription drug treatment regimens

• New and better medications

Economic Argument to Allow DTC Advertising of Prescription Drugs

• Earlier management of more serious, costly conditions that consumers typically ignore, or chose not to treat when symptoms appear to be minor or non-acute

Clinical Arguments to Prohibit DTC Advertising of Prescription Drugs

DTC has emotional rather than educational content

Negative effect on relationships by creating conflicts between the

patient's desire and the caregivers more informed judgement

No discussion of “non drug” or non prescription treatments

Lead to “medicalisation” of normal human experiences in healthy

patient populations

No evidence of improvement in choices by physicians, patients or

public health

Economic Arguments to Prohibit DTCAdvertising of Prescription Drugs

Increases prescription expenditures

Usually only advertise new drugs which are

more expensive than older drugs

No good evidence of value for money

2004 Canadian Parliamentary Inquiry Recommended against Direct to Consumer

Advertising for Prescription Drugs

Reason 1

“DTC” advertising of prescription drugs could contribute to increased or inappropriate drug consumption.

Total Expenditure on Drugs and Health OECD 2001

Top 10 Pharmaceutical Markets in the worldin current US$ billion

Source: IMS Midas Customized Insights (October 2001)

Change in U.S Health Expenditures 1970 - 2002

Drug Expenditure - International Comparisons

2004 Canadian Parliamentary Inquiry Recommended against Direct to Consumer

Advertising for Prescription Drugs

Reason 2

“Drug advertisements could endanger rather than empower consumers by minimizing risk information and exaggerating benefits”

*Represents cost in millions of advertisingSource IMS Health 2002-2003

Leading 10 US Products in Dollars Spent on Advertising - 2002

However - Canada is not insulated against advertising!!!

• “Spillover” from American media– Television– Newsprint, magazines

• Canadian government has allowed two types of indirect advertising – Reminder advertisements– Help seeking advertisements

Three Forms of DTC Advertising to Public

1. Product-disease advertising that includes both the product name and specific therapeutic claims;

2. “Reminder” advertisements that provide the name of a product without stating its use;

3. “Help-seeking” advertisements, which tell consumers about a new but unspecified treatment option.

“Reminder” Advertising

• Birth control product that is now mainly indicated for treatment of severe acne

• Banned in several countries due to liver toxicity and possibly blood clots

• Why is second line second line drug in bus shelters?

“Help Seeking” Advertising

Comparison of DTC Advertising Effect in USA/Canada

City,Country

Patients have seenDTC advertisements

Patients requestedadvertised drug

Patients receivedadvertised drug

Sacremento,USA

95% 7.2% 78%

Vancouver,Canada

87% 3.3% 72%

Canadian Medical Association Journal 2003;169(5):405-12

Possible reasons that Canadians ask and spend less often for advertised drugs

• USA public has “constant” advertising

• Canadian “reminder” and “help seeking” advertising is not

as effective as product - disease advertising

• Payment expenditure increases hampered by public funding

mechanisms and public/government is more “cost

conscious”

• Canadians less inclined to see drug therapy as another

marketplace commodity

Closing• Currently Canada’s view is that direct to

consumer advertising for prescription drugs is not in the best interest of the patient or society

• However due to television, press and internet -- Canadian society is not isolated from US advertising