Healthy Skepticism Library item: 1654

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Errett B.
What does it do? Um ... ask your doctor
National Post Date uncertain 2002

Full text:

In a commercial currently in heavy rotation on Canadian television, a man leaves his house in the morning with a spring in his step. While upbeat music plays, he dances and bounces his way to work. The commercial ends as he enters the elevator, still grinning ear-to-ear. The logo for Viagra then flashes on the screen, accompanied only by the words, “Talk to your doctor.”

If not for the fact that everyone in the world knows what Viagra is, one could imagine hordes of Canadians of all ages stampeding into doctor’s offices across the nation to get what appears to be a miracle happy pill. The advertisement makes no actual claims, but the message is clear that this product will put a smile on your face and have you skipping gaily into the office.

The vagueness of the Viagra ad and others like it is quite deliberate. Under the complex regulations that control direct-to-consumer pharmaceutical advertising in Canada, ads may provide information about a disease or they can give you the name of a product, but they cannot do both. Vague campaigns are often the result as drug companies push the limits of the law.

The current Viagra campaign, for example, is part of a long-term, two-step strategy in which the condition was first described in the well-known television commercial featuring a man with erectile dysfunction who is unable to bring himself to tell his doctor about his problem. The name Viagra was never mentioned.

“Our first step was to talk about the disease itself, erectile dysfunction. I think there was a lot of taboos and misperception about the disease, so our role was to educate the public as to what the disease was about,” explains Sophie McCann, manager of corporate affairs at Pfizer Canada, the makers of Viagra. She stresses that the company wants to stay well within regulations and will not run the erectile dysfunction awareness campaign while the Viagra ads are running.

But if the company’s intent is to clear up confusion, how do they justify the current ads?

“We encourage people to go and get the real facts about the medication, which is as far as the law allows us to go,” McCann says, taking the opportunity to provide these facts. It’s apparent she is fluent in the language of the campaign as she describes the target audience as “men who are having difficulty attaining intimacy with their partners.”

The Viagra ad works because of the almost universal knowledge of the product. McCann explains that she was not concerned about confusion because Pfizer’s studies show that more than 95% of Canadians at least know the word Viagra. One and a half million prescriptions for the drug have been filled since its Canadian launch three years ago.

Other campaigns don’t have that advantage. Billboards for Zyban, a drug prescribed for smoking cessation, portray abstract situations in which smokers might be tempted to reach for a cigarette. One advertisement shows only a cup of coffee; another billboard features a smiling couple in bed, presumably happy that they are not longing for a post-coital nicotine fix.

These advertisements might confuse non-smokers, but the company behind them says they are effective at hitting the target market.

“We’ve received great feedback both from physicians and patients, especially patients, who are smokers and ex-smokers,” says Carlo Mastrangelo of GlaxoSmithKline. The campaign, which also features ads showing a plate after a meal and a party hat, is in its third year.

As with Pfizer’s representatives, Mastrangelo stresses the company’s message that the ad encourages discussion with medical professionals rather than outright clamouring for the drug. “The creative really speaks to smokers, particularly motivated-to-quit smokers. These are individuals who are thinking quite strongly about quitting smoking and thinking about approaching their physician to talk about which options are available to them.”

Opponents of the advertising aren’t so sure. The Canadian Medical Association has come out against direct-to-consumer advertising by drug companies, and patients’ lobby groups keep up the public fight.

“We don’t feel that the ads are educational, which is what the industry claims they are. The point of the ads is to sell a product. It isn’t to educate people about a disease or a health condition,” says Anne Rochon Ford, co-ordinator for Working Group on Women and Health Protection and an ardent opponent of direct-to-consumer drug advertising.

“The ads, for the most part, deal more with lifestyle issues than true medical problems. The industry panders to people’s desire to find a pill for ills that maybe don’t need pills.”

The current regulations are part of the amendments made to the Food and Drugs Act in 1978. Before that time, it was illegal to advertise prescription drugs at all. An amendment was made allowing advertisements for prescription drugs to include information about the name, price and quantity of a particular drug. It also opened the door to the other type of advertisement.

“Under that amendment, the reminder ads and help-seeking ads were permissible. However, they were not used until the mid-‘90s,” explains Ryan Baker, a spokesman for Health Canada.

Canada’s policy differs from the United States, which allows outright direct-to-consumer advertising. The only stipulations are that the ads must tell consumers where they can obtain further information and must identity doctors and pharmacists as primary sources.

In the rest of the world, only New Zealand has regulations as lax as those in the United States. And while similar battles are being fought over drug ads in Europe, the combination of Canada’s proximity to the U.S. market and the current regulations make this country the probable next place for change.

If Canada’s rules are confusing, the enforcement of them is often more so. For instance, a print advertisement for the oral contraceptive Alesse that shows the drug’s distinctive packaging as well as a message about young women being in control of their lives was approved by the government agency.

“I and others don’t understand that ruling,” says Ray Chepesiuk, commissioner of the Pharmaceutical Advertising Advisory Board, a group to which drug companies can voluntarily submit their ads for review. Though the board has no direct regulatory role, it can advise Health Canada on campaigns that may be in violation of the law.

“It looks to me like a violation, because they’re actually showing the oral contraceptive package. I know the target audience would recognize the package of colour-coded tablets in 21s,” Chepesiuk says. He uses the example of the Alesse ads as proof that Health Canada needs to reform the system and admits a bias in favour of more overt pharmaceutical advertising.

Representatives on both sides of the debate realize that if drug companies were serious about challenging the existing laws, they would have a strong case on the grounds of freedom of speech.

“Underneath this all, there is constitutional challenge potential on commercial free speech. What if a company did challenge them? Are they looking for chaos, or a court ruling that’s going to create problems and then they have to scramble to do something?” asks Chepesiuk. “I’ve heard lawyers’ opinions, and if they did take it to court, it wouldn’t stand up. Even in the industry, no one wants the American model right out. It’s not in society’s best interest to get these half-messages.”

Ford agrees change is coming, though she believes the American model isn’t necessarily inevitable.

“Whether we’ll win the battle in terms of getting Health Canada to tighten their regulations instead of loosen them, I honestly don’t know. I hear very mixed messages,” Ford says. “I know the industry thinks it’s a done deal but I don’t believe that.”

For the time being, the drug companies are content to stay within the bounds of the law, even if that means confusing the general public with mysterious ad campaigns. Pfizer’s representative takes care to stress that the Viagra ads follow the letter of the law.

“I think we’re well within Canadian regulations at this point,” McCann says. “We’ve been very careful in developing an ad that is responsible and tasteful and fell within Canadian regulations.”