What is it about the words "diarrhea," "dizziness" and "death" voiced over images of people playing in a field of flowers that makes Canadians feel superior? Yes, drug ads on American channels can be a little like Saturday Night Live skits - especially compared to relatively discreet Canadian ones that say little more than the drug name. Why, then, are the quieter Canuck-style ads the ones coming under heaviest attack south of the border?
In a year marked by scandalous revelations about antidepressants and suicide, arthritis drugs and heart attacks, direct-to-consumer (DTC) drug ads have come under intense scrutiny in the U.S. Calls for moratoriums and full-out bans on consumer-directed ads made news right up to FDA hearings on the matter last month.
Meanwhile, Canada has considered itself above the fray. We already have a ban on the ads, and those we do allow say so little, you have to guess what the drug is used for. But some health advocates say these obscure sales pitches may in fact be worse for the consumer than the more detailed harangues on side effects you see on U.S. channels. Indeed, Big Pharma there has recently volunteered to yank all such advertising. Canada, however, has yet to budge.
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Technically, we shouldn't have a clue about why that couple is smirking in those Cialis ads, why the furniture is overturned on those Levitra billboards and why all those girls are so proud they're on Alesse. But you'd have to be pretty dim not to catch the over-the-top insinuations and nudge-nudge, wink-wink messaging going on in these "reminder ads," as they're called.
According to Barbara Mintzes, a researcher with UBC's Centre for Health Services and Policy Research who's been tracking drug ads, these ads are a clear violation of our Food And Drugs Act, but the agency responsible for enforcing it, Health Canada, isn't doing anything about it. "We shut our eyes and allow it to happen," says Mintzes.
Once upon a time, Canada prohibited all direct-to-consumer drug advertising. But Health Canada started doing some rejigging in the mid- to late 90s. An old clause in the Food and Drug Act originally designed to allow pharmacies to advertise drug names, prices and quantities was suddenly being used to justify an entirely different type of ad. Thanks to this quiet policy shift, the drug biz could suddenly hawk its wares on TV, billboards and in newspapers - as long as it never mentioned what a drug is used for.
Admittedly, a bunch of Charlie's Angels look-alikes running around announcing "I'm on Alesse" while conducting ambush wax jobs on hairy guys doesn't divulge much about the drug. But clever marketers tacked a picture of the birth control pills' 21-day blister pack onto their ads to give you a strong hint.
"[Coalition group] Women and Health Protection sent a complaint about the first Alesse ad campaign in early 2000, and Health Canada's response was very disappointing," says Mintzes. Health Canada said the ads in that instance were legal. The group was given the same answer after filing a complaint about an anti-obesity drug campaign earlier this year, as was Quebec's L'Union des Consummateurs when it complained about the Cialis ads in October.
Sure, Canada hasn't gone so far as to let erectile dysfunction drugs sponsor sporting events (as Cialis, Viagra and Levitra have in the U.S.), nor have they allowed acne drugs to lure teens with free downloads and coupons (as Differin recently did on MTV). But we're close. A "Meet the Alesse girls" campaign currently running on MuchMusic's website invites girls over 13 to take personality tests to find out "what kind of Alesse girl you most resemble," play online games with little pink dots (hmm, wonder what those are supposed to signify?) and win cute purses, watches and DVD players (no drug purchase necessary, of course). All the while, a pink pill pack sits in the corner of your screen reminding you what form of birth control the cool girls use.
Even an organization endorsed by Health Canada to advise drug companies on how to keep their ads on the right side of the law is frustrated with the feds' hazy interpretation of what's legal. "I've argued against Alesse ads that show the package," says Ray Chepesiuk, commissioner of the Pharmaceutical Advertising Advisory Board (PAAB). "I have no idea why Health Canada said that's okay. We would never accept that."
Health Canada's response? "A blister pack is not exclusively used for a certain category of products," says Ann Sztuke-Fournier, manager of the department's regulatory advertising branch. Even a 21-day pack?
While Sztuke-Fournier says anything that alludes to a drug's therapeutic use is not and has not been allowed, she won't name any instances when Health Canada came down on a company for "inferring" a drug's use. It seems that data isn't public.
She says even less about Health Canada's lack of action on drug advertising to 13-year-olds.
But as Canada fudges the lines around the legality of reminder ads, the pharmaceutical industry in the U.S. recently volunteered to put a stop to precisely this type of advertising. (The guidelines come into effect in January.) As if to reinforce those efforts, over 200 medical school profs issued a statement with a similar message a few days before the November 1 FDA hearings. At a minimum, direct-to-consumer prescription drug advertising should be banned unless it comes with a full FDA-approved label, complete with warnings, counter-indications and side effects. That means no reminder ads.
David Dunne, a U of T marketing prof teaching a health-care marketing course in January, isn't surprised. In some ways, restricted Canadian ads that can only mention the drug name have a marketing advantage over full product ads seen on American channels. "If you look at those American ads, there's just as much time spent talking about side effects as there is talking about the benefits of the drug. From an advertising point of view, it doesn't seem to be very effective."
Chepesiuk notes that full product ads have even been known to dampen the popularity of a drug. He says the campaign for anti-obesity drug Xenical was discontinued in the U.S. partly because ads mentioned unpalatable side effects like flatulence and anal leakage. Canadians missed out on all those nasty details (unless they spotted them in American mags). Instead, we saw black-and-white images of "Julie" trying to fit into an old wedding dress or talking about doing a striptease for her husband, and the caption "What would you do with a few pounds less? Ask your doctor about Julie's story."
Health Canada doesn't even call these "ads," but, rather, "help-seeking messages" for ailments like herpes or cholestorol awareness. They're said to be more educational than promotional since they don't mention the drug's name, although links to websites and 1-800 numbers often lead consumers right into industry hands.
For its part, Health Canada shows no signs of cracking down on iffy drug marketing, as the House of Commons Standing Committee on Health firmly recommended last year. No surprise, really, considering this is the agency that has let U.S. drug ads invade our airwaves for years without reining them in. Health Canada says it's a CRTC matter, while the CRTC tells NOW it's Health Canada's job.
Of course, leaving this in the hands of broadcasters and publishers is in itself problematic when they're considered a bigger lobby group for liberalized drug ad regulations than the drug industry itself.
And the chances of the Canadian pharmaceutical industry calling for equivalent curbs on DTCs to those we're seeing in the U.S. are perhaps next to nil. When asked for his thoughts on banning reminder ads, Russell Williams, president of Rx&D, the org representing Canada's research-based pharma companies, denies that what we have now even qualifies as advertising. "Unlike in the United States, DTC advertising is not permitted by law.... What pharmaceutical companies are permitted to do under current legislation is display the name of the prescription medicine."
Any further discussion of the issue he labels "a moot point."
Regardless, U of T's Dunne says Canadian marketers aren't suffering in the relatively restrictive ad climate. Indeed, according to a study by Mintzes published in the Canadian Medical Association Journal in 2003, when Canadians ask for advertised drugs by name, doctors give it to them 72 per cent of the time - even when half the doctors wouldn't have prescribed that drug otherwise.