The pharmaceutical advertising code should be updated
A recent study comparing general medicine journals in Canada, the United Kingdom and the United States found five times the volume of pharmaceutical advertising in the two Canadian journals – Canadian Medical Association Journal and Canadian Family Physician – compared with their counterparts. Information quality in the ads was not compared, but older analyses of Canadian ads have raised concerns about their content.
For the past 40 years, Health Canada has turned over control of the drug ads that doctors see in medical journals to an organization called the Pharmaceutical Advertising Advisory Board (PAAB). On its website, the PAAB is described as an “independent review agency whose primary role is to ensure that healthcare product communication for prescription, non-prescription, biological and natural health products is accurate, balanced and evidence-based.” The PAAB sets out rules for what is and is not allowed in journal ads and the organization prescreens the ads before they appear to make sure that they comply with the code. Pharmaceutical companies that are members of Innovative Medicines Canada, the organization representing brand-name companies, have all agreed to respect the provisions of the Code. All of the major medical publications in Canada only accept ads if they have the PAAB logo on them.
In our view, the code has serious weaknesses. Although it requires a “fair balance of risk to benefit,” in practice, information about side effects is given less prominence than information about the benefits, as can be seen by the smaller font sizes used for discussion of harms. The generic name does not have to be used each time that the brand name is stated, nor does the generic name have to be afforded the same font size as the brand name. In contrast, in the United Kingdom, the industry code governing advertising requires the type size of the generic name to occupy a total area no less than that taken up by the brand name. Use of generic names is recommended as a means to promote better prescribing, as generic names for drugs in the same therapeutic class all have similar endings, and this helps doctors to understand similarities and differences in the actions of drugs.
We know based on US studies that journal advertising does affect prescribing. For every dollar spent on ads for products with large sales, companies get back on average $12.20. We suspect a similar effect is noticed in Canada.
The PAAB’s website says its code ensures ads “[reflect] current and best practices.” So here’s a challenge to the PAAB. To prove that its Code is indeed effective, the agency should engage independent experts to design a methodologically sound study to understand the effects of pharmaceutical ads in Canadian publications, as currently regulated by the PAAB. Are the ads associated with prescribing more expensive products, poor quality prescribing, better prescribing, prescribing more frequently, or do they have any effect at all? Such a study would be a start to understanding how the PAAB can be updated to best protect Canadians.
Joel Lexchin teaches health policy at York University and works as an emergency physician at the University Health Network. Barbara Mintzes is a senior lecturer at the Charles Perkins Centre and Faculty of Pharmacy at the University of Sydney.