“When you know more about what’s wrong, you can help make it right,” once claimed a television advertisement for Zoloft — a prescription medication used to treat depression.

According to a University of Toronto-affiliated review paper that studied New Zealand advertisements that was published in June 2019, advertisements for prescription drugs like this one, that target consumers directly, are frequently misinterpreted by consumers as “trusted public health messages.”

The United States and New Zealand are the only two countries where direct-to-consumer advertising (DTCA) is completely legal. In Canada, the legality of prescription drug advertisement is more complicated. While DTCA is prohibited, alternative methods of prescription drug advertisement are legal.

Background information on DTCA

To clarify Canada’s stance, The Varsity spoke to Dr. Joel Lexchin, co-author of the study and an associate professor at U of T’s Institute of Health Policy, Management and Evaluation. Dr. David Menkes, an associate professor at the University of Auckland, was the second co-author.

Health Canada — Canada’s national department of public health — allows firms to broadcast two types of advertisements for prescription drugs. One type, ‘reminder advertisements,’ can mention the name, price, and quantity of the advertised drug, but not its therapeutic application.

Lexchin gave the example of a Viagra advertisement that depicts a very active man dancing his way to work with a background chorus singing, “It’s great to stay up late.” As he puts it: “It doesn’t tell you what the [use of] Viagra is, but it gives you an idea.”

The second type of legal DTCA are help-seeking ads, which don’t mention the name of the drug, but discuss the disease. Lexchin explained, “You can’t say, ‘Take Penicillin if you have strep throat,’ but you can say, ‘Here is a new treatment available for strep throat. See your doctor.’”

Does DTCA have a negative impact on consumers in Canada?

In a study published in 2003, Lexchin collaborated with Dr. Barbara Mintzes, an assistant professor at the University of British Columbia, and other researchers to examine how DTCA affects the decisions that physicians in Vancouver, British Columbia and Sacramento, California make when prescribing drugs.

They found that physicians prescribed the advertised drug to 72 per cent of patients who requested the drug in Vancouver, as compared to 78 per cent in Sacramento. Furthermore, that patients in both cities who requested DTCA drugs were much more likely to receive a higher number of prescriptions than patients who did not request them. However, it is important to note that of the patients exposed to DTCA in Vancouver, only 3.3 per cent requested the drug. The effects were higher in Sacramento, at 7.2 per cent.

Different models of regulation

Canada’s government prohibits DTCA through regulation, but there is some body of research to suggest its ineffectiveness. In a separate 2014 review of the DTCA cases that Health Canada has regulated, Lexchin and Mintzes concluded that Health Canada’s response “is notable both for its lack of teeth and lack of accountability and transparency.”

There is another regulatory body independent from Health Canada called the Pharmaceutical Advertising Advisory Board (PAAB), which provides “preclearance service recognized by Health Canada for advertising directed to healthcare professionals and consumers.”

However, Lexchin notes that “it is not mandatory [for PAAB to] review any ads directed to consumers and they have no power to order any changes to the ad,” leaving its effectiveness in regulating DTCA questionable.

In an email to The Varsity, Patrick Massad, the PAAB commissioner, responded to this statement, writing that, “Preclearance provides confidence that an advertisement adheres to the pertinent regulations before dissemination.”

“Given that preclearance is largely voluntary, it is supplemented by a complaints resolution system and multi-agency proactive monitoring activities to identify advertising in the marketplace that contravenes the regulations,” he continued.

“In my experience, it is rare that an advertiser elects to ignore the preclearance agency ruling. However, in those instances, the matter is forwarded to Health Canada for enforcement. Ultimately, compliance with Federal regulations is not voluntary,” Massad wrote.

“It should be noted that DTCA disseminated over broadcast media is required to undergo preclearance by a recognized preclearance agency. Preclearance is now also required for healthcare professional advertising of opioid products. The PAAB would welcome further broadening of mandatory preclearance.”

DTCA is already prohibited in Canada — at least on paper. However, more legislative work may be required to increase the effectiveness of regulation.

The Varsity has reached out to Health Canada for comment.