Direct-to-consumer advertising and expenditures on prescription drugs: a comparison of experiences in the United States and Canada

O VER THE PAST QUARTER-CENTURY, PRESCRIPTION drug manufacturers in the United States have increasingly invested in direct-to-consumer advertising (DTCA) designed to build brand recognition and to foster patients' belief in the quality of their products. Policy-makers in Canada, where limited DTCA is permitted, and in countries that do not permit DTCA are under increasing pressure to allow such marketing activities. In this article I will review recent trends in DTCA and expenditures on prescription drugs in the United States to illustrate the significant impact that brand-oriented, consumer-targeted marketing activities could have on the Canadian health care system. There are essentially 3 types of DTCA. The first type consists of disease-awareness advertisements, which provide information about a medical condition and encourage people to talk to their physician about available treatments. Such advertisements are permitted in both Canada and the United States. The second type of DTCA consists of reminder advertisements, which may state the name of a product and may provide information about strength, dosage, form and price but may not mention the product's indication or make claims about effectiveness. With relatively few exceptions, reminder advertisements are also permitted in both countries. Product-claim advertisements are the third type of DTCA. These advertisements combine the brand name with claims about indication and effectiveness. This form of DTCA is permitted in the United States but not in Canada. For-profit pharmaceutical manufacturers invest in DTCA to generate profits. 1 Product-claim advertising is important to manufacturers because it allows them to associate claims with their particular brands. Disease-awareness advertising, in contrast, may prompt consumers to talk to their physicians about treatment but may not result in an expression of brand preferences. The distinction between these 2 types of DTCA is important because, as with other types of products, the ability to build brand loyalty is a potentially valuable means by which drug manufacturers can increase market share. 2 Competing firms may capture some of the demand induced by brand-specific advertisements, but the intent of investing in the advertisements is unquestionably to generate a financial return. 3 The first US product-claim DTCA was a series of print campaigns that began in 1982 and 1983. Among the first products advertised (in outlets such as Readers Digest and the Washington Post) were Oraflex (benoxaprofen), Pneumovax (pneumococcal vaccine) and Zorvirax (acyclovir). These DTCA advertisements were permitted under US law provided that product labelling information was presented with the advertisement. …