Canadian medical care will be corrupted and the country's political system will be polluted if a legal bid to strike down Canada's ban on direct-to-consumer advertising of prescription drugs is successful, warns prominent academic Dr. John Abramson.
The Harvard Medical School clinical instructor issued the warning at a public talk on Mar. 4, 2008, after a day of being cross-examined on an affidavit he submitted on behalf of a coalition of public interest and union groups that was granted intervenor status in a case involving the highly publicized Canwest Global Communications challenge to the federal government's ban on direct-to-consumer advertising. Lawyers will argue that case in June in Ontario Superior Court.
Canwest spokespersons said company officials were unavailable for comment, but the firm contends the ban is a breach of the Canadian Charter of Rights and Freedoms. Among arguments presented in the Canwest affidavits is one that “evidence suggests that DTCA [direct-to-consumer advertising] is used for a subset of drugs with few competitors that treat a range of conditions, many of which are undertreated.”
But the public interest, and the health of patients, is sidelined when the emphasis is on sales, argued Abramson, the author of Overdo$ed America: The Broken Promise of American Medicine (2004), who spent 20 years as a family doctor before accepting a faculty position at Harvard.
Direct-to-consumer advertising is extremely lucrative for both pharmaceutical companies and the media outlets that carry the advertisements. It is legal only in the United States and New Zealand, though since 2000 Canada has experienced an increase in so-called “reminder ads” in which the name of the drug, and the condition it treats, can be mentioned — but not in the same advertisement. Critics argue that by allowing these ads, Health Canada is not enforcing its own legislation.
Research indicates doctors typically acquiesce to patients who request drugs that they have seen advertised. (CMAJ 2003;169[5]:405-12). Yet, some of the most heavily advertised drugs include those where evidence of harm, or lack of benefit, has been established — arthritis drugs such as refocoxib (Vioxx) and celecoxib (Celebrex), and some classes of antidepressants, Abramson said.
In other cases, advertising is very successful for drugs with no clear benefit over existing treatments but come at much higher cost, Abramson added, citing the example of esomeprazole (Nexium), the most heavily marketed drug ever — a drug to treat acid related stomach disorders that costs about 8 times more than its over-the-counter off-patent equivalent.
From 2002 to 2006, Astra Zeneca spent $1.08 million on direct-to-consumer advertising of Nexium, according to a 2007 estimate by Medical Marketing and Media.
Medical care is an area where more is not better, Abramson argued, noting that on a per capita basis, the United States boasts 3 times as many angioplasties, 2 times as many statin prescriptions and 3 times as many bypass operations as the Organisation for Economic Co-operation and Development average, yet ranks 17th among among industrialized nations for death rates from heart disease.
Abramson argued that, if approved, direct-to-consumer advertising would increase drug use and drug prices in Canada, leading to more drug industry money in the country — much of which would be spent, as is the case south of the border, to influence the political process. In that country, pharmaceutical companies hiked their spending to lobby government by 25% in 2007 to over $22 million, he noted, and there is a revolving door between government and industry.
Abramson told the more than 100 people attending his talk, held at the University of Toronto, that he wasn't looking for trouble when he took a year off from teaching at Harvard Medical School to write a book for medical students about how interpersonal relationships with patients are as important as science. But the subject of his book changed after he began analyzing clinical trial data for Vioxx, Celebrex and statin drugs, and compared this to articles about the drugs published in medical journal articles, the recommendations of US Food and Drug Administration reviewers, and the content of direct to consumer advertising.
Canwest has argued that full-fledged drug advertisements are preferable to the Canadian reminder ads since the former mention risks. But Abramson countered that while reminder ads are a problem, the mention of risks is a “decoy” — “there are words about risk” but the appeal is emotional and aimed at expanding sales, Abramson said. — Ann Silversides, Toronto, Ont.
Figure. Public interest, and the health of patients, is sidelined when the emphasis is on sales, argues Harvard academic Dr. John Abramson. Image by: Barbara Sibbald
Footnotes
Affidavits for all the parties to the court challenge can be found at the website of Women and Health Protection, part of the coalition that received intervenor status. (http://www.whp-apsf.ca/en/documents/doc_index2.html#charter)