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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
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.
Top 10 Pharmaceutical Markets in the worldin current US$ billion
Source: IMS Midas Customized Insights (October 2001)
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?
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