US DTC Ads Create Dilemma in Canada


When is a brand-name medication not what the doctor ordered? When it’s prescribed in one country and delivered in another. Take the case of Americans and Canadians who need prescription refills when visiting across their common border. Although US and Canadian travelers have long coped with the fact that nearly a third of medications with the same name and manufacturer differ in their formulation, adverse effects or approved indications between the two countries, that confusion is aggravated when Canadians see DTC ads for US medications.

Freely crossing the border into Canada through cable TV and the Internet, those ads portray medications that Canadian consumers are hard-pressed to distinguish from their local counterparts. In fact, some US medications being advertised may lack approval for that indication in Canada or be unavailable there.

One solution to the problem could be DTC ads for Canadian prescription medications. Canadian consumers have said they want more information about their medicines. And Canadian manufacturers are pressuring their government to allow DTC advertising similar to that allowed in the United States.

Severe Restrictions

Unlike FDA, the Canadian government tightly controls DTC advertising of prescription medications: only a medication’s name, quantity and price may be mentioned.

The Canadian Pharmaceutical Association recently came out against DTC advertising, noting: “The underlying problem is a tension between optimal use of medication only if and when they are known to improve health, and the pressure companies are under to continuously expand product sales.” The association calls for federal leadership on the issue and supports joint efforts involving patient groups, government, manufacturers and health care providers to develop “appropriate measures” that will meet Canadians’ needs.

The question is, how long can the pressure for DTC advertising in Canada be resisted? Health Canada, the country’s health administration, is concerned that DTC advertising could increase physician visits and, therefore, costs to the healthcare system. However, non-compliance with medication regimens costs Canada more than $18 billion a year. Patient education that improves compliance could decrease those costs by 50-80 percent. DTC advertising that is developed from a patient education rather than a Madison Avenue point of view could play a key role in lowering health care costs in Canada – or in any country. Proponents hope that a Canadian DTC advertising campaign would do a better job of educating the public than it is doing in the United States and be a key component in the effort to lower Canadian healthcare costs.

Many consumers in both the United States and Canada want DTC advertising. However, Canadian decision-makers recognize the flaws associated with DTC promotion in the United States and want to avoid repeating them in Canada. They are not against providing quality educational information to consumers, but they do want to ensure that such materials are unbiased, of high quality, and written in language anyone can understand.

Their position has a strong message for DTC marketers in the United States. Regardless of where consumer promotion exists, an effective DTC program should

  • offer appropriate guidance to people who may need medical care. It should answer questions such as “Are my symptoms those of a minor headache or a migraine?”
  • reinforce the roles of physicians and pharmacists, and teach consumers to see a physician at the early stages of a problem when treatment is likely to be less expensive
  • help keep patients from dropping out of therapy. In the United States the cost of treating complications associated with noncompliance exceeds the total cost of prescription medications purchased every year.

Finally, it would be in the best interests of consumers – regardless of where they live – if DTC ads clearly conveyed a medication’s country of origin. Although that may seem like a problem affecting only Canadians, in the future, US consumers could be exposed to DTC messages from other countries, and they will need to know if that information is relevant to their condition. In an era of increasing globalization and consumer use of the Internet, DTC marketers must address that issue now.

Dr. Dorothy L. Smith is a consumer education expert and president of Consumer Health Information Corporation. The full-service company specializes in patient labeling, program development, and strategic planning for DTC campaigns.

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Published in Pharmaceutical Executive, July 2000. Copyrighted material; All rights reserved.