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Matthew Jones

Health Canada is warning doctors that they shouldn't be using their personal websites to promote drugs, medical procedures or other health products.

The department was prompted to take action after receiving complaints about physicians directly promoting prescription drugs to consumers online.

The advisory highlights the challenges of regulating such activities in an online world, where any doctor or health professional can communicate freely with the public.

"It's a complex issue and it's really only developing now," said Bill Pope, registrar and chief executive officer of the College of Physicians and Surgeons of Manitoba.

In Canada, the practice known as direct-to-consumer advertising of drugs is forbidden. That means drug companies or other parties are not allowed to run a commercialon air or in print or create a website that promotes a particular drug to treat a particular condition. Prescription drug advertisements are restricted in Canada to protect consumers.

While fewer restrictions are placed on advertising other health products, including non-prescription drugs, vaccines and natural health products, manufacturers can't make misleading or deceptive promises or claim to cure certain serious diseases, such as depression, asthma or cancer.

Health Canada's advisory, posted online last month, says that doctors must understand and respect the law when it comes to direct-to-consumer advertising.

The department said it has received complaints about cosmetic surgeons promoting drugs on their personal websites and that once it looked into the issue, "it was noted that this practice was widespread."

For instance, many cosmetic surgery clinics promote Botox, which is a drug, or Latisse, a prescription treatment that promises fuller, thicker eyelashes.

The department said it suspects many doctors and health professionals are simply unaware of the law when it comes to online drug promotion. It has issued letters to provincial colleges, which act as medical regulatory authorities, to put them on the alert.

But the issue raises important questions for health professionals across the spectrum, said Joel Lexchin, professor in the School of Health Policy and Management at York University in Toronto.

And he doesn't believe it's necessarily restricted to prescription drugs.

For instance, a number of naturopaths aggressively market a host of supplements, vitamins or other formulations on their websites, in many cases without mentioning possible side effects or potentially risky drug interactions. Other medical specialists may advertise procedures or treatments that could boost their profits.

"If you advertise on a website for physiotherapy as a good treatment for something and you happen to … have a share in a physiotherapy clinic, then even if people don't necessarily all go to the one you own, you're still likely to increase your business," he said.

The major issue at stake is the fact that while the Internet allows for much freer, open dialogue between health professionals and the public, the sheer volume of online communications isn't as easy to regulate as other traditional mediums, such as TV or print ads.

There are thousands of doctors across Canada, making any attempt by regulatory bodies to check for prohibited online activities nearly impossible, Dr. Lexchin said.

"Do they have the resources to monitor? How do you even know if doctors have got a website and what's on their website?" he said.

In Manitoba, Dr. Pope said "many physicians, not all, but many are developing their own websites" and that the new online era does pose questions for the health profession.

In some cases, they are questions that medical bodies aren't prepared to answer or feel they don't need to address. For instance, the College of Family Physicians Canada said they don't have a position regarding doctors and their online activities, while the Royal College of Physicians and Surgeons of Canada said the issue doesn't fall under its purview.

The apparent lack of discussion of this issue among some medical bodies and physicians on the ground may help explain why some doctors are simply unaware that what they say online could break the law or otherwise cause harm. For instance, doctors who dispense medical advice online could be vulnerable to lawsuits or other problems.

Dr. Pope said until he received the letter from Health Canada warning against promoting drugs online, he wasn't aware of the legality of the issue.

"I think certainly if there's a law against it or it's breaching some form of regulation, then it's important for our members to know this is something they have to be very careful about," he said. "I guess in the case of some, they weren't actually aware it's inappropriate."