Should Canada allow direct-to-consumer advertising of prescription drugs?

Drug or disease ads contribute to public health by increasing appropriate consultation for undiagnosed or untreated health conditions

Most studies agree that “disease awareness” or “drug awareness” ads lead to increases in consultations for targeted conditions.3 Critics complain that healthy patients seeking physician advice are a waste of health care resources4; however, there is scant evidence that these consultations are inappropriate.5

In a survey by the US Food and Drug Administration, physicians reported that the majority (88%) of patients asking about specific drugs after seeing advertisements did indeed have the conditions for which the drugs were intended.6 About one-fourth of patients whose visits were prompted by ads received new diagnoses, some for preventable conditions such as hypertension, diabetes, high cholesterol, and depression.7 And nearly three-fourths of physician respondents reported that the campaigns improved the quality of their discussions with patients. Overall, advertising can help redress the “health deficit” whereby serious conditions are underdiagnosed and undertreated.

Ads do not lead to patients getting inappropriate medications

Prescription drugs are among the few substances requiring approval of a learned intermediary, which tends to limit rather than promote access. While physicians report being asked by patients about advertised drugs, more than half of the physicians surveyed by the Boston Consulting Group said formularies had a major effect on their prescribing practices and one-third said they would not discuss treatments not covered by insurers.8

A longitudinal study comparing English-speaking Canadians exposed to (illicit) American ads about 3 drugs with French-speaking Canadians not exposed to such ads concluded that the ads did not affect prescribing rates for 2 of the drugs and led to only a short-term increase in the prescribing rates of the third.9

Similarly, the US Government Auditing Office concluded that only 27% of those who saw drug ads actually requested and received prescriptions for those drugs.10 Three-fourths of patients who sought physician advice after seeing a drug advertised reported that the doctors discussed health and lifestyle changes; more than half were prescribed a generic alternative, while 51% received suggestions about nonprescription treatments.

Direct-to-consumer information about pharmaceutical products serves an unmet patient need

Not only do most Canadians (68%) support direct-to-consumer prescription drug information, but most believe that DTCA is allowed.11

Similarly, the European Commission has been pressed by the public to allow pharmaceutical companies to provide information (not advertising) directly to consumers through public media, including broadcasting, print media, and the Internet.12 Most European cancer patient groups surveyed said they could not rely on their specialists to provide sufficient information and many felt doctors’ prescribing practices were governed by restrictive health authority budgets.13 In another survey, patient groups felt they should have the right to directly approach pharmaceutical companies for product information.14

Direct-to-consumer drug information must be balanced, screened, and monitored

In April 2008, the European Commission, while retaining the ban on advertising, proposed a framework supporting direct information on prescription drugs through public media and audiovisual and written material, subject to prescreening and monitoring by an independent body.15 Information could not be “misleading by omission” and required “balanced representation” of both benefits and risks so consumers could make informed decisions.

Health Canada’s guide for advertising nonprescription drugs recognizes that consumers should be provided with fair and balanced information about the benefits and risks associated with medications in order to make informed decisions. It acknowledges that the public is ignorant about package inserts or product monographs but does pay attention to product advertising. Therefore, balanced information to patients through advertising can promote appropriate use of drugs, with concomitant benefits to the health care system.16

I propose extending the same rationale and guidelines to prescription medicines. Information must be evidence-based and not exceed what has been approved for the product monographs. All substantive benefits and risks must be included and all communications pre-screened and approved. Inaccurate communications must be corrected or removed, and misleading information should lead to penalties.