‘Two-legged bundles of diagnoses.’ That is what John Hoey, editor of the Canadian Medical Association Journal, in a strongly worded editorial, termed consumers who are hit with an onslaught of pharmaceutical direct-to-consumer advertising (DTCA). The editorial, published in the Sept. 2 issue of the journal, went on to say that drug-makers shouldn’t advertise, as it elevates prescription drugs to commodity status.

The editorial was accompanied by a study which found that patients who see drug advertising are likely to ask their doctors to prescribe marketed drugs to them more often; 7.2% of participating patients in Sacramento, Calif. (where DTCA is legal) requested advertised drugs, versus 3.2% of Vancouver patients (where it’s not). This finding may have actually bolstered the arguments of both the pro and the con side of the debate on allowing DTCA in Canada. On the one hand, DTCA encourages dialogue between doctor and patient, and on the other, such a dialogue may put undue pressure on said doctor.

In Canada, restrictions haven’t been amended since 1953, but there’s a light at the end of the tunnel for pharmaceutical marketers: a review by Health Canada has begun and public consultations on the issue are imminent.

‘These regulations should have been reformed years ago,’ says Cynthia Hastings-James, director of healthcare communications company Medicus Group in Toronto. ‘With access to U.S. television stations and with the unrestricted nature of the Web, Canadians are exposed to a confusing, incomplete picture of treatment options.’

Don Sancton, director of corporate affairs for Pfizer Canada, which has run campaigns for Viagra and the Alzheimer’s drug Aricept, isn’t celebrating just yet, but he believes the time is right for change. ‘With our understanding of so much about health and aging, and with the kind of tools and treatments that are available, much of health care is really an optional thing that patients have to take charge of themselves. [Patients] need to be armed with the knowledge of what sort of treatments and options are available for them to be able to age in the healthiest way possible.’

But if DTCA regulations are loosened, how should major players like Pfizer respond? Strategy sought the opinions of three experts.

Mehbs Remtulla, CEO, EURO RSCG Life, Toronto

At one extreme is the status quo – and the U.S. model is at the other, which I do not subscribe to 100%. In the U.S., they’ve taken the pharmacists out of the picture, which has been a big mistake. Pharmacists are increasingly influential – people visit a pharmacy more often than a doctor.

I see a Canadian model where you can have DTCA that allows the patient to talk to the doctor or pharmacist with the objective to inform them of something new in the category or reinforcing compliance to a certain therapy.

[Pharmaceutical companies should] make sure health-care professionals are well-informed. The last thing you want is a patient walking in asking for something and the doctor says, ‘I don’t know anything about it.’ Never put the physician in a compromising position.

One thing we don’t do in this industry is try things on a small scale. For some reason we feel we have to blow $50 million to see if a program will be successful or not. Testing things, measuring them, and then moving forward is a wonderful model to follow. The consumer agencies do that, but in pharma, somehow we’ve lost the basics of marketing when it comes to DTCA.

The U.S. seems to feel that DTCA equals television. In my opinion, that’s wrong. There are many more targeted, controllable, affordable media one can use, such as the Internet, and print (especially small-space ads). Say you’re doing a DTCA on an anti-obesity drug – going on TV, you’re going mass media. A certain proportion of the population is obese but not 100%, so why are you wasting a mass media avenue to target 25% of the consumers?

Focus your objective on making the consumer more educated, rather than being promoted to. Consumers are savvy – they know when they’re being promoted to and when they’re being informed.

Karl Moore, associate professor, faculty of management, McGill University, Montreal

What we’ve seen broadly is that 10 years ago, we were patients, now we’re consumers. It’s been a real shift of Canadians’ approach towards health care and where 10 years ago we would just do what our physicians said, we’re now looking for more than one opinion, and [who] we’re turning to may be a second physician, it may be someone who is not as qualified – it might be a naturopath.

We’re also increasingly turning to the Internet; most people, when they find out there’s something wrong, they’ll do an Internet search. And then the issue is: what’s the quality of the information you’re getting? There are those Web sites that are affiliated with medical associations which provide good, sound information. There are other Web sites, which are, in worst cases, run by quacks. Given that change in reality – that we’re no longer patients, but consumers – it’s helpful to provide more information.

[DTCA is] an area where you’ve got to take considerable care – it’s an area which is a bit of a minefield. But the pharmaceutical companies must continue to press forward because of the considerable change we’re seeing in terms of the information that is available to people. Through all the noise, the pharmaceutical companies have got to make sure they communicate some clear messages both to physicians and to consumers. They can hardly roll over; they need to be proactive.

Calls they make on physicians are becoming less efficient – there are just so many people out there chasing very little physician time, so we’re seeing the pharmaceutical companies looking for alternative channels such as the Internet, seminars and getting papers published in academic journals as a way of influencing the physician and consumer community.

Ken Stallman, EVP/managing director, Cundari Integrated Advertising, Toronto

DTCA is a continuation of the messaging that pharmaceutical companies are giving to the physician.

[If the restrictions are loosened], we would suggest to our clients that they have a really good support program for the patients, so they have all the necessary information about the disease, about the treatment, about how our drug can best help them. [This way, they can] have a dialogue with that patient through the tools that we develop.

We would also be [in favour of] a pre-clearance mechanism – whatever is put in advertising would have been cleared by a third party.

We have to stop the confusion of spillover in Canada because some of those drugs that are advertised in the U.S. are not known by that name in our country, or if they are, they may have a different indication in Canada. I think that’s only going to cause more harm to the safety of the consumer than help.

Spillover is not just on TV, but also in print. Sometimes People magazine looks like a magazine for drugs.

[The U.S. model] must be working to some degree because of the results published in the Canadian Medical Association Journal that showed it got patients to talk to their doctor.

Would I go the same route? I would do some fine-tuning – dealing with different stakeholders, physicians, end users to find the best balance to get the information across, and working with patient advocacy groups as well. They in turn want the information out.

The model needs refinement to make it more applicable to concerns raised by Canadians.