The pharmaceutical industry is making a joke of Canada's prescription drug advertising laws, health professionals say.
In a new Viagra spot, the drug itself is the punchline.
The ad for Pfizer Canada Inc.'s erectile dysfunction drug depicts a fortyish businessman dancing all the way to work. As he slam-dunks a basketball and vaults over a newspaper box, a cheery song called Good Morning declares suggestively, "It's great to stay up late."
It doesn't say why he stayed up late - ads aren't allowed to link a drug with the medical condition it treats - but it doesn't take Dr. Ruth Westheimer to figure it out.
A Pfizer spokeswoman said the ad, which closes with the message "Viagra, talk to your doctor," is meant to convey the man's "relief" at overcoming his erectile problem.
Officially, Canada isn't supposed to allow the sort of one-sided, product-glorifying drug advertising one sees for soft drinks or toothpaste. But the Viagra commercial illustrates how, with a wink and a nudge, pharmaceutical companies are getting around restrictions and promoting their brands to the masses.
Viagra has plenty of company. Similar tactics have been used to pitch a medicine chest full of prescription drugs including anti-smoking aids, acne medications and birth control pills. In a bid to stand out, campaigns are getting more aggressive, observers say.
"It's very clear that the industry has been pushing the limits" of the law, said Barbara Mintzes, a researcher with the Centre for Health Services and Policy Research at the University of British Columbia. She accuses Health Canada of failing to keep drug companies in line.
"I would call it a commitment to non-enforcement of the law."
Dr. Henry Haddad, president of the Canadian Medical Association, sees a dangerous trend. The Viagra ad, in particular, ignores the drug's many side effects and contraindications and "makes light of the serious nature of prescription medicine in Canada," he said.
Health Canada, which is facing a co-ordinated drug and media industry effort to loosen drug advertising rules, said the Viagra ad is not breaking any laws. "It is in complete compliance with the regulations," said Heather McGregor, senior policy analyst with Health Canada.
That wouldn't always have been the case, however.
Until 1978, Canada banned all prescription drug ads aimed at consumers. The law was amended that year to allow ads that mention only the name, price and quantity of a drug. The purpose was to allow pharmacists to display prices so consumers could comparison shop.
But Health Canada has adopted a far more liberal interpretation of the amendment in recent years, critics charge. It now allows two types of ads - "reminder ads," which mention a drug but not a disease, and "help-seeking ads," which discuss a disease but not a drug. Ads usually encourage consumers to call a toll-free number or visit a doctor for more information.
In other words, companies are free to name a drug and talk about the condition it treats - just not in the same ad. The result is a game in which companies run slick branding campaigns laced with hints about a drug's purpose - a far cry from merely posting prices at the pharmacy.
Take Zyban, the smoking-cessation aid produced by GlaxoSmithKline Inc. Billboards identify the drug by name and depict situations that trigger cravings in smokers - a coffee cup, an empty dinner plate, a couple nuzzling in bed presumably after sharing an intimate moment. None of the ads says what Zyban is for, but smokers figure it out.
Another tactic is to run both help-seeking and reminder ads in the same campaign. Wyeth-Ayerst Canada Inc., for instance, aired two types of ads for its birth control pill, Alesse. One mentioned Alesse by name but did not say what it was for. The other, which featured similar music, actors and style, discussed birth control but did not name the drug.
In that case, Health Canada ruled the campaign violated its regulations because consumers could link the spots. But by then the ads had already aired. Health Canada advised the company "that the basis for Health Canada's decision must be considered when developing future advertisements," according to a November, 2000, policy statement.
More prescription drug ads could be on the way.
The pharmaceutical industry is lobbying Ottawa to allow direct-to-consumer (DTC) ads that discuss both the drug and medical condition, similar to spots that have been airing in the United States - and spilling over into Canada - since U.S. rules were relaxed in 1997.
"We would like to be able to tell people a lot more," said Murray Elston, president of Canada's Research-Based Pharmaceutical Companies and a former health minister in Ontario. Permitting DTC ads would allow consumers to be better informed about treatment options, he said.
Also pushing for DTC ads is a coalition of media organizations calling itself the Alliance for Access to Medical Information (AAMI), which includes the Canadian Association of Broadcasters, the Canadian Newspaper Association, Magazines Canada and the Institute of Canadian Advertising. The group has met with more than 70 MPs to press its case.
The stakes are enormous. AAMI members expect an estimated $400-million annual revenue windfall from the drug industry if DTC ads are allowed, said Glenn O'Farrell, president of the Canadian Association of Broadcasters. That represents about 5 per cent of the roughly $8-billion spent by all advertisers combined in major Canadian media last year.
Groups opposed to DTC advertising include the Canadian Medical Association, the Consumers Association of Canada and drug insurance plans, who warn DTC ads will only boost demand for drugs and push up health care costs but do little to improve the health of consumers.
In fact, allowing more ads could make consumers' health worse, critics say. Heavily advertised drugs tend to be new and their side effects less well known than those of older medicines. Diabetes drug Rezulin, for instance, was pulled from the U.S. market in 2000 after it was linked to 63 liver-failure deaths since it was introduced in 1997.
Canada isn't the only jurisdiction facing pressure to open its marketplace to more drug ads. Pharmaceutical companies are pressing to liberalize advertising laws in the European Union as well. Currently, only two countries - the United States and New Zealand - allow DTC ads.
The economics of the drug industry are driving the trend, analysts say. To grow and avoid being swallowed by competitors, companies are under intense pressure to expand markets and sell more blockbuster drugs. That, in turn, requires ads aimed at the mass market - such as the Viagra commercial now playing in living rooms across Canada.
"It's not about health," said Charles Medawar, director of British health research group Social Audit Ltd., who in December submitted a scathing report on DTC advertising to the European Parliament.
"It's overwhelmingly about money."
John Heinzl