February 18, 2009

Debating Direct-to-Consumer Pharmaceutical Advertising

This month’s issue of the journal Canadian Family Physician features a debate on direct-to-consumer advertising (DTCA) of prescription drugs, with arguments for and against allowing DTCA in Canada (where it is currently prohibited).

In putting forth her case for DTCA, Durhane Wong-Rieger says that such ads “contribute to public health by increasing appropriate consultation for undiagnosed or untreated health conditions.” This is a fairly common selling point from the drug companies themselves, who argue that prescription drug advertising is a form of education and a service for the public.

Dr. Barbara Mintzes, however, argues that “Any benefits could be better achieved through public health campaigns,” and expresses concern about increased prescribing of potentially dangerous drugs before the harmful effects are fully understood. Mintzes offers the following example, of a drug campaign targeted at women:

“The 2006 tegaserod ad for irritable bowel syndrome is emblematic of the hazards of prescription drug advertising. The eye-catching ad featured women baring their bellies to reveal slogans. Closing shots panned women of many different ages and races, suggesting widespread use. Relief of vague symptoms along with a comparison to fibre and laxatives implied use for mild problems. But key information on safety concerns, limited effectiveness, and the limited appropriate patient population was lacking. In 2007, the drug was withdrawn from the market because of cardiovascular risks. The first Food and Drug Administration safety warning, on risks of ischemic colitis, dated back to 2004. Tegaserod prescriptions rose by 56% in a US Medicaid population and 42% in English speaking Canada following exposure to US DTCA campaigns.”

Minztes also argues that advertisements may exaggerate benefits and target people with mild problems who are unlikely to benefit (perhaps such as in the YAZ example we discussed recently), and could lead to higher health care costs through “substitution of new, expensive drugs without treatment advantages.”

For related discussion, see this OBOS companion content. Time magazine also recently covered this topic, including whether a two-year moratorium on advertising new drugs may be achieved in the new administration, and Consumer Reports Health has critiqued the “stealth advertising” of Pfizer’s Chantix.


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