Transcript No Slide Title

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
[email protected]
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
– USA
79.8 years
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 DTC
Advertising 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 world
in 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”
Leading 10 US Products in Dollars
Spent on Advertising - 2002
*Represents cost in millions of advertising
Source IMS Health 2002-2003
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 seen Patients requested Patients received
DTC advertisements advertised drug
advertised 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