Drugs aren't commodities to be hustled like cars and cookies

[Guest guest]

Drugs aren't commodities to be hustled like cars and cookies

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20050224/HPICARD2\

4/TPHealth/

 

By ANDRÉ PICARD

PUBLIC HEALTH REPORTER

Thursday, February 24, 2005 - Page A21

 

One of the most important and overlooked recommendations of the U.S.

advisory committee that held public hearings on the safety of Vioxx and

other cox-2 inhibitors is a call to ban all advertising of the popular

painkillers.

 

It is clear to the panel members that advertising played a central role in

this debacle.

 

Vioxx and Celebrex were among the most heavily advertised drugs in

history. Their main claim to fame, touted in slick ads, was that they were

safer than cheaper painkillers such as ibuprofen when, in reality, they

increased the risk of heart attack and stroke. Advertising, in no small

measure, led to the gross overprescription of these drugs to people with

arthritis and other painful conditions.

 

And it is telling that, when questions began to be raised about the safety

of Vioxx, its maker, Merck & Co., responded by bolstering the ad campaign

for the drug, not by commissioning research to investigate scientists'

concerns.

 

Vioxx was more heavily advertised than Pepsi and Budweiser, and that is a

perversity.

 

The advisory panel served up an important reminder that advertising

prescription drugs is a privilege, a lucrative privilege that, in the name

of safety, can be denied.

 

Currently, only two countries allow direct-to-consumer advertising of

prescription drugs, the United States and New Zealand.

 

The Canadian Food and Drugs Act explicitly prohibits such advertising. A

few years ago, however, Health Canada " reinterpreted " the act and related

regulations and concluded, in the words of then-health minister Allan

Rock, that " two types of prescription-drug ads may be disseminated to the

consumers under the existing regulatory provisions: 1) reminder ads --

where the name of a prescription drug is mentioned, but no reference to a

disease state appears in the ad; or 2) help-seeking ads -- where a disease

state is discussed, but no reference is made to a specific

prescription-drug product. "

 

That is why ads featuring a man dancing out of the house, sashaying down

the street and leaping over the newspaper box, followed by the single

word, Viagra, have become ubiquitous. It is why, in the pages of

newspapers, including The Globe and Mail, you have been bombarded with ads

urging you to ask your doctor about " Julie's story " -- Julie being a slim,

attractive woman who apparently thinks she's overweight.

 

This mystery ad is promoting the weight-loss drug Xenical. But the reason

it works is because there are no restrictions on advertising to doctors

and, in recent months, doctors, too, have been assailed with Julie ads,

along with information about Xenical.

 

Critics of Canada's law argue that it is hopelessly outdated, that

consumers would be well-served by advertising because it encourages

dialogue between patients and physicians and provides accessible health

information.

 

Opponents of direct-to-consumer advertising, however, argue that there is

no evidence that advertising prescription drugs has ever resulted in

better health care or more responsible decision-making by consumers.

 

There is plenty of evidence that there is a direct and disturbing

correlation between promotion and prescription -- and unnecessary

prescription in particular.

 

Research conducted by Barbara Mintzes of the University of British

Columbia showed that patients who specifically ask for a drug are nine

times more likely to leave the doctor's office with a prescription.

 

Advertising can be a powerful influence. The makers of Claritin, an

allergy pill, found that for every $1 spent, their sales increased by

$3.50.

 

Widespread direct-to-consumer advertising would increase the cost to

individuals, to employee insurance plans and to government drug plans. It

would also, without much doubt, increase adverse events related to drugs.

 

According to the Canadian Medical Association Journal, prescription drug

sales would increase $1.2-billion in Canada if U.S.-style advertising were

allowed. (And we already spend $16-billion a year on prescriptions.)

 

The only beneficiaries of advertising would be pharmaceutical companies

and the media. The CMAJ (which can already run drug ads because it's

primary readership is physicians and not the general public ) estimates

that mainstream media would rake in $360-million in revenues annually from

prescription drug ads.

 

The public -- and the public-health system - would not benefit from

prescription drug advertising in the mainstream media. On the contrary,

the evidence suggests it would be bad for their health.

 

That is why Health Canada should drop the notion of relaxing restrictions

and turn its attention to enforcing the laws that currently exist, even

extending them to non-prescription drugs and supplements (where all manner

of quackery is currently tolerated), and to advertising to physicians (an

area rife with conflicts of interest.)

 

One of the key responsibilities of the regulator, Health Canada, is to

ensure that the drugs on the Canadian market are safe. That must include

ensuring that the prescription-drug information conveyed to consumers is

accurate and balanced.

 

The Vioxx saga has, among other things, reminded us that drugs are not

just another commodity to be flogged like cars and cookies. Vioxx

contributed to the death of as many as 61,000 Americans (and another 4,000

to 7,000 Canadians) during the five years it was on the market -- and

those numbers were made worse by massive marketing campaigns.

 

Consumers want good, no-nonsense information about drugs. Right now, there

is a terrible informational void, but the last thing we need is to have

that void filled by an orgy of drug advertising.