Healthy Skepticism Library item: 2194

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

Silversides A.
Looser ad rules a headache for drug plans
The Globe and Mail 2001 Sep 18

Full text:

Company drug-plan costs will climb even higher if the federal government yields to lobbying and eases restrictions on mass-media advertising of prescription drugs, warns a spokesman for the Employers Committee on Health Care — Ontario.
Such a move would “compound an already serious problem in runaway drug-plan costs,” says Barry Noble, national director of managed care for Manulife Financial Corp. of Toronto and a member of ECHCO, an organization of 20 large employers.

Canada’s Food and Drug Act, which prohibits direct-to-consumer advertising (DTCA) of prescription drugs, is scheduled to be updated under a process called “legislative renewal.” DTCA has emerged as one of the most controversial areas in the act, and debate is polarized, says Ross Duncan, a Health Canada policy adviser.

In Canada, company drug-plan costs are rising at a rate of about 15 per cent a year, but in the United States, it’s even higher — about 20 per cent, Mr. Noble says.

DTCA is legal and widespread in the United States, and its impact accounts for part of the difference in rates, he argues.

The stakes are high. In the United States, the pharmaceutical industry spent $2.5-billion (U.S.) to advertise to consumers last year, up from $1.8-billion just a year earlier. “In many respects, this proliferation of consumer promotion has changed the health-care landscape,” says a briefing document by IMS Health Inc., which tracks drug spending.

General Motors Corp., with 1.2 million employees and retirees in the United States, is the largest private purchaser of health care in that country. In 2000, it spent more than $1.1-billion on drugs and expects that to rise 20 per cent this year, says Rob Minton, manager of health-care communications for GM in Detroit. The company has been sounding alarms about DTCA. “There are a number of things driving up drug utilization, but DTCA is certainly one.”

The past spring, the U.S. Food and Drug Administration commissioned studies into the impact of DTCA, examining issues such as “inappropriate prescribing,” the IMS document notes. “That is, are consumers asking for and getting drugs they should not be on?” And concern about rising costs has led to the introduction of almost 60 bills on DTCA issues in U.S. state legislatures, according to market-research firm Scott-Levin. The bills seek to promote programs aimed at changing doctors’ prescribing habits and to force financial disclosure on drug advertising and promotional expenses.

If DTCA were legal in Canada, Mr. Noble estimates it would lead to, at a minimum, an extra percentage-point rise in drug costs, “and that is a huge expenditure.” (Canadians spent $10-billion (Canadian) on drugs last year, and patented drugs accounted for 63 per cent of sales, according to the Patented Medicine Prices Review Board. It is patented drugs that are heavily advertised in the United States.)

Mass-media advertising of prescription drugs is legal only in the United States and New Zealand, but pharmaceutical companies, as well as the media and advertising firms that stand to benefit, have been lobbying hard to ease restrictions in Canada and Europe.

The pharmaceutical industry argues that advertising “can raise awareness of effective new therapies and improve the overall health of the nation by helping Canadians recognize early symptoms and informing them about potential treatment options,” according to a policy statement from Rx and D Canada, an Ottawa-based association that represents Canada’s trade-name pharmaceutical companies. With DTCA, “Canadians would be empowered to take charge of their health like never before,” the organization contends.

But groups such as the Canadian Medical Association, the Canadian Pharmacists Association and the Consumers Association of Canada are on record as opposing any change in restrictions.

Critics say the industry has provided no data linking drug advertising to improved health, and that valuable treatment information can be communicated in other ways.

“I feel comfortable that there are other ways to deliver the valuable [educational] component, without creating the opportunity to flog drugs. . . . And you notice that it is not new cancer treatment that the industry promotes, but rather [drugs like] Propecia [for baldness],” Mr. Noble says.

Indeed, the seven top drugs in the United States in 1999, ranked in terms of spending on mass-media ads, were: an oral antihistamine, a drug for ulcers, an antiobesity drug, a drug for baldness, another antihistamine, a cholesterol reducer and a drug for smoking cessation, according to a report on DTCA by the U.S. National Institute for Health Care Management. (Oral antihistamines are over-the-counter drugs in Canada, but prescription-only in the United States.)

Canada is, of course, already affected by cross-border advertising. As well, in the past couple of years, drug companies here have been using creative ad techniques in a bid to skirt Canadian restrictions.

Because DTCA is at least technically illegal in Canada, there is no agency mandated to oversee or approve the advertising, says Ray Chepesiuk, commissioner for the Pharmaceutical Advertising Advisory Board (PAAB), which acts as a watchdog for drug advertising aimed at doctors. Drug companies sometimes turn to PAAB for help with DTCA. “We tell them how to make it not advertising,” Mr. Chepesiuk says.

When U.S. restrictions on DTCA were eased in 1997, spending on mass-media advertising of prescription drugs there began to soar. In 1996, pharmaceutical companies paid $600,000 (U.S.) to advertise to the public, according to IMS Health. Of the $2.5-billion spent in 2000, $1.6-million was spent on television advertisements alone.

“Opponents argue that these ads have materially damaged the patient-physician relationship, impairing the physician’s ability to make independent treatment recommendations,” an IMS document notes. Numerous studies show that when they are asked to prescribe a particular drug, doctors typically prescribe them, Mr. Minton notes.

“DTCA can create inappropriate expectations on the part of general consumers,” says Gery Barry, president of health insurer Liberty Health. “These are medically complex products. People become so used to taking a pill, they don’t pay attention to side-effects and possible drug interactions. . . . The thinking that if something is new it’s better is a dangerous fallacy. We know a lot less about new things.”

Indeed, it is often newer, more expensive drugs that are most heavily promoted, speeding the uptake of these drugs compared with the time before DTCA. This is a concern to doctors such as Joel Lexchin, a professor at York University in Toronto who is also an emergency-room physician and drug-company watchdog. Dr. Lexchin notes that new drugs are tested on, at most, 3,000 to 5,000 people. That means “any adverse reaction in less than one in 1,500 won’t be seen” before the drug goes to market.”

Studies have shown that rising drug costs are the result of a combination of patients taking more drugs, and taking newer, more expensive drugs. GM hired pharmacists to look at what was actually happening in its drug plan, and it found some surprises. Prilosec is an ulcer medicine that is heavily advertised in the United States by manufacturer AstraZeneca PLC of Britain. In 1999, Prilosec ranked second in terms of advertising spending, with $79.4-million spent on promoting it, according to the NIHCM report. The GM pharmacists found that, over the past three years, 92 per cent of the GM plan members who received prescriptions for Prilosec had never before received a prescription, or even visited a doctor, for gastro-intestinal problems. “So the first therapy they get is the most expensive and the most heavily advertised. . . . Maybe some portion of them did need it, but not all of them,” Mr. Minton says. Last year, GM spent $52-million on Prilosec.

Mr. Noble notes that the private sector now pays for more than half of the prescription drugs used in Canada, a recent change; the main purchaser used to be the public sector.

Mr. Minton notes that GM has been the most vocal U.S. company about drug costs and the impact of DTCA because of its size. “But when we talk to the major drug companies, we talk not just for ourselves, but also for Ford, DaimlerChrysler and the UAW (United Auto Workers),” he said.