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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 efriesen@cha.ab.ca. Presentation Outline. Overview of Canada and Health Care System
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International Seminar on Drug AdvertisingCanadian Experience Brazilian Health Surveillance Agency and Pan American Health Organization Brasilia, Brazil April, 2005 Erwin Friesen, Pharm.D, FCSHP efriesen@cha.ab.ca
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 79.8 years • USA 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 AllowDTC 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 DTCAdvertising 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.
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
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?
Comparison of DTC Advertising Effect in USA/Canada 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