International Seminar on Drug Advertising Canadian Experience

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International Seminar on Drug
AdvertisingCanadian Experience

• Brazilian Health Surveillance Agency and
• Pan American Health Organization
• Brasilia, Brazil
• April, 2005
• Erwin Friesen, Pharm.D, FCSHP
• efriesen_at_cha.ab.ca

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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

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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

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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

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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

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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

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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

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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.

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Total Expenditure on Drugs and Health OECD 2001
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Top 10 Pharmaceutical Markets in the world in
current US billion
Source IMS Midas Customized Insights (October
2001)
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Change in U.S Health Expenditures 1970 - 2002
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Drug Expenditure - International Comparisons
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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

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Leading 10 US Products in Dollars Spent on
Advertising - 2002
Represents cost in millions of
advertising Source IMS Health 2002-2003
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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

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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.

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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?

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Help Seeking Advertising
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Comparison of DTC Advertising Effect in
USA/Canada
Canadian Medical Association Journal
2003169(5)405-12
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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

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Closing

• Currently Canadas 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