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Direct-to-consumer prescription drug advertising in Canada: permission by default?

https://arctichealth.org/en/permalink/ahliterature183814
Source
CMAJ. 2003 Sep 2;169(5):425-7
Publication Type
Article
Date
Sep-2-2003
Author
David M Gardner
Barbara Mintzes
Aleck Ostry
Author Affiliation
Department of Psychiatry and the College of Pharmacy, Dalhousie University, Halifax, NS. david.gardner@dal.ca
Source
CMAJ. 2003 Sep 2;169(5):425-7
Date
Sep-2-2003
Language
English
Publication Type
Article
Keywords
Advertising as Topic - legislation & jurisprudence - methods
Canada
Consumer Participation
Drug Industry - economics
Drug Prescriptions
Humans
Notes
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Cites: Prescrire Int. 2001 Apr;10(52):52-411718161
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Cites: BMJ. 2002 Feb 2;324(7332):278-911823361
PubMed ID
12952804 View in PubMed
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How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA.

https://arctichealth.org/en/permalink/ahliterature183815
Source
CMAJ. 2003 Sep 2;169(5):405-12
Publication Type
Article
Date
Sep-2-2003
Author
Barbara Mintzes
Morris L Barer
Richard L Kravitz
Ken Bassett
Joel Lexchin
Arminée Kazanjian
Robert G Evans
Richard Pan
Stephen A Marion
Author Affiliation
Centre for Health Services and Policy Research, and the Department of Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC. bmintzes@chspr.ubc.ca
Source
CMAJ. 2003 Sep 2;169(5):405-12
Date
Sep-2-2003
Language
English
Publication Type
Article
Keywords
Adult
Advertising as Topic - methods
British Columbia
California
Consumer Participation
Drug Industry - trends
Drug Prescriptions
Female
Humans
Linear Models
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Questionnaires
Abstract
Direct-to-consumer advertising (DTCA) of prescription drugs has increased rapidly in the United States during the last decade, yet little is known about its effects on prescribing decisions in primary care. We compared prescribing decisions in a US setting with legal DTCA and a Canadian setting where DTCA of prescription drugs is illegal, but some cross-border exposure occurs.
We recruited primary care physicians working in Sacramento, California, and Vancouver, British Columbia, and their group practice partners to participate in the study. On pre- selected days, patients aged 18 years or more completed a questionnaire before seeing their physician. We asked these patients' physicians to complete a brief questionnaire immediately following the selected patient visit. By pairing individual patient and physician responses, we determined how many patients had been exposed to some form of DTCA, the frequency of patients' requests for prescriptions for advertised medicines and the frequency of prescriptions that were stimulated by the patients' requests. We measured physicians' confidence in treatment choice for each new prescription by asking them whether they would prescribe this drug to a patient with the same condition.
Seventy-eight physicians (Sacramento n = 38, Vancouver n = 40) and 1431 adult patients (Sacramento n = 683, Vancouver n = 748), or 61% of patients who consulted participating physicians on pre-set days, participated in the survey. Exposure to DTCA was higher in Sacramento, although 87.4% of Vancouver patients had seen prescription drug advertisements. Of the Sacramento patients, 7.2% requested advertised drugs as opposed to 3.3% in Vancouver (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.2-4.1). Patients with higher self- reported exposure to advertising, conditions that were potentially treatable by advertised drugs, and/or greater reliance on advertising requested more advertised medicines. Physicians fulfilled most requests for DTCA drugs (for 72% of patients in Vancouver and 78% in Sacramento); this difference was not statistically significant. Patients who requested DTCA drugs were much more likely to receive 1 or more new prescriptions (for requested drugs or alternatives) than those who did not request DTCA drugs (OR 16.9, 95% CI 7.5-38.2). Physicians judged 50.0% of new prescriptions for requested DTCA drugs to be only "possible" or "unlikely" choices for other similar patients, as compared with 12.4% of new prescriptions not requested by patients (p
Notes
Cites: West J Med. 2000 Oct;173(4):221-211017964
Cites: J Fam Pract. 2000 Dec;49(12):1092-811132058
Cites: CMAJ. 2001 May 15;164(10):1449-5111387918
Cites: CMAJ. 2001 Aug 21;165(4):46211531059
Cites: BMJ. 2002 Feb 2;324(7332):278-911823361
Cites: JAMA. 1999 Jan 27;281(4):380-29929095
Cites: JAMA. 2003 Feb 19;289(7):827-812588246
Cites: Adv Data. 2002 Jun 5;(328):1-3212661586
Cites: Health Aff (Millwood). 2003 Jan-Jun;Suppl Web Exclusives:W3-82-9514527237
Cites: Health Aff (Millwood). 2003 Jan-Jun;Suppl Web Exclusives:W3-112-514527241
Cites: J Health Serv Res Policy. 2003 Oct;8(4):237-4414596759
Cites: N Engl J Med. 2002 Feb 14;346(7):498-50511844852
Comment In: CMAJ. 2004 Mar 2;170(5):768-70; author reply 770-114993155
Comment In: CMAJ. 2004 Mar 2;170(5):768 ,770; author reply 770-114993157
PubMed ID
12952801 View in PubMed
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Twelve years' experience with direct-to-consumer advertising of prescription drugs in Canada: a cautionary tale.

https://arctichealth.org/en/permalink/ahliterature150697
Source
PLoS One. 2009;4(5):e5699
Publication Type
Article
Date
2009
Author
Barbara Mintzes
Steve Morgan
James M Wright
Author Affiliation
Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada. Barbara Mintzes bmintzes@chspr.ubc.ca
Source
PLoS One. 2009;4(5):e5699
Date
2009
Language
English
Publication Type
Article
Keywords
Advertising as Topic - economics
Canada
Consumer Participation - economics
Drug-Related Side Effects and Adverse Reactions
Humans
Inflation, Economic
Legislation, Drug - economics
Marketing of Health Services - economics
Mass Media
Prescription Drugs - economics
United States
Abstract
Direct-to-consumer advertising (DTCA) of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow 'reminder' advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. 'Reminder' advertising is prohibited in the US for drugs that have 'black box' warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising.
Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib), which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings.
Branded 'reminder' advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for compromise solutions to industry pressure for expanded advertising, Canada's experience stands as a stark warning.
Notes
Cites: J Fam Pract. 2000 Dec;49(12):1092-811132058
Cites: BMJ. 2008;337:a105518765444
Cites: N Engl J Med. 2002 Feb 14;346(7):498-50511844852
Cites: CMAJ. 2003 Sep 2;169(5):405-1212952801
Cites: CMAJ. 2003 Sep 2;169(5):425-712952804
Cites: N Engl J Med. 2004 Oct 21;351(17):1707-915470193
Cites: Lancet. 2005 Feb 5-11;365(9458):475-8115705456
Cites: J Health Commun. 2004 Nov-Dec;9(6):491-715764448
Cites: CMAJ. 2005 May 10;172(10):129915833921
Cites: J Health Commun. 2005 Oct-Nov;10(7):609-1916278198
Cites: CMAJ. 2005 Nov 22;173(11):1313-516301694
Cites: Ann Fam Med. 2007 Jan-Feb;5(1):6-1317261859
Cites: N Engl J Med. 2007 Aug 16;357(7):673-8117699817
Cites: Health Aff (Millwood). 2007 Sep-Oct;26(5):1392-817848450
Cites: Lancet. 2001 Oct 6;358(9288):1141-611597668
PubMed ID
19479084 View in PubMed
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