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Pharmaceutical Direct-To-Consumer Advertising: Analyses of Policy Stakeholders and Supreme Court of Canada Interveners

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Pharmaceutical Direct-To-Consumer Advertising: Analyses of Policy Stakeholders and Supreme Court of Canada Interveners Western University Scholarship@Western Electronic Thesis and Dissertation Repository 6-22-2017 12:00 AM Pharmaceutical Direct-to-Consumer Advertising: Analyses of Policy Stakeholders and Supreme Court of Canada Interveners Tom T. Eldik The University of Western Ontario Supervisor Dr. Sandra Regan The University of Western Ontario Joint Supervisor Dr. Margaret Ann Wilkinson The University of Western Ontario Graduate Program in Health Information Science A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Health Information Science © Tom T. Eldik 2017 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Pharmacy Administration, Policy and Regulation Commons Recommended Citation Eldik, Tom T., "Pharmaceutical Direct-to-Consumer Advertising: Analyses of Policy Stakeholders and Supreme Court of Canada Interveners" (2017). Electronic Thesis and Dissertation Repository. 4633. https://ir.lib.uwo.ca/etd/4633 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. Abstract Background: Pharmaceutical direct-to-consumer advertising (DTCA) is a controversial form of advertising that markets prescription pharmaceuticals to patients and consumers. The positions, power, interests and influence of pharmaceutical DTCA stakeholders shape Canadian DTCA policies; however, no focused analysis of DTCA stakeholders has occurred. Methods: This study involved a two-pronged stakeholder analysis: First was a broad analysis of pharmaceutical DTCA stakeholders using Canadian publicly available documents and websites. The second analyzed interveners on pharmaceutical litigation at the Supreme Court of Canada, and the comparisons to a leading tobacco advertising case, RJR-MacDonald v Canada (A.G) and a pharmaceutical DTCA case CanWest Media Works Inc. v Canada (A.G). Results: There is a broad range of pharmaceutical DTCA stakeholders, with varying positions, power, interests and influence. Positions on DTCA policy ranged from supporting less regulation to maintaining current regulations. Stakeholders are often networked with each other through participation in self-regulatory groups or membership in associations; pharmaceutical industry stakeholders were most highly networked. All interveners identified in the second analysis are stakeholders identified in the first analysis. Pharmaceutical litigation interveners were either brand or generic pharmaceutical industry stakeholders. Public policy stakeholders were notably absent in pharmaceutical case litigation despite their participation in RJR-MacDonald and CanWest. Conclusion: Future pharmaceutical DTCA policy may be shaped by ‘high’ power stakeholders who favour maintaining the current regulations. Those same ‘high’ power stakeholders can be found participating in pharmaceutical litigation at the Supreme Court. Indications are that pharmaceutical industry stakeholders would be accepted to participate in Supreme Court pharmaceutical advertising litigation while public health stakeholders might apply as a coalition to participate. Keywords: Pharmaceutical Direct-to-Consumer Advertising, Stakeholders, Interveners, Policy Analysis, Legal Analysis i Acknowledgments First, I must thank Dr. Sandra Regan for her amazing and endless support as my thesis supervisor. Your patience and guidance throughout the many ups and downs of the past few years have been truly invaluable. You have inspired me to reach for the best possible version of myself, and for that I will always be thankful. To my co-supervisor, Dr. Margaret Ann Wilkinson, thank you for guiding me in a new and exciting field of study. I don’t think I will ever forget our coffee fueled meetings and white- board drawings. To my peers in Health Information Science, thank you for listening, for goofing off, and for the late nights out. This experience would not have been the same without you. Finally, I would like to thank my family and closest friends. If graduate school was a marathon, then it was your cheering from the sidelines that kept me going. Thank you for making sure that every beer was accompanied by plenty of laughs. Mom and Dad, your vocal and unwavering belief that I can accomplish whatever I set my sights to is both the reason I started and the reason I finished this thesis. ii Table of Contents Abstract ................................................................................................................................ i Acknowledgments............................................................................................................... ii Table of Contents ............................................................................................................... iii List of Tables .................................................................................................................... vii List of Figures .................................................................................................................... ix List of Appendices .............................................................................................................. x Chapter 1 : Introduction ...................................................................................................... 1 1.1 Introduction ............................................................................................................. 1 1.2 Pharmaceutical Direct-to-Consumer Advertising ................................................... 1 1.3 Policy and Stakeholders .......................................................................................... 2 1.4 Relevance to Health Information Sciences ............................................................. 4 1.5 Research Gap .......................................................................................................... 4 1.6 Problem Statement .................................................................................................. 5 1.7 Research Questions ................................................................................................. 5 1.8 Format ..................................................................................................................... 6 1.9 References ............................................................................................................... 8 2 Chapter Two: Analysis of Policy Stakeholders ........................................................... 11 2.1 Introduction ........................................................................................................... 11 2.2 Background ........................................................................................................... 13 2.2.1 Stakeholders and Stakeholder Analysis .................................................... 13 2.2.2 Pharmaceutical DTCA Legal Regulation ................................................. 15 2.2.3 Policy Context for Direct-to-Consumer Advertising ................................ 17 2.3 Literature Review.................................................................................................. 20 2.4 Research Aim ........................................................................................................ 22 iii 2.5 Methods................................................................................................................. 22 2.5.1 Study Design ............................................................................................. 22 2.5.2 Data Collection ......................................................................................... 23 2.6 Data Analysis ........................................................................................................ 27 2.6.1 Coding ....................................................................................................... 27 2.6.2 Criteria & Coding Definitions .................................................................. 27 2.6.3 Code Definitions ....................................................................................... 28 2.6.4 Position ..................................................................................................... 29 2.6.5 Power ........................................................................................................ 30 2.6.6 Interests ..................................................................................................... 31 2.6.7 Influence ................................................................................................... 32 2.6.8 Thematic Groupings.................................................................................. 33 2.7 Results ................................................................................................................... 33 2.7.1 Stakeholder Networks ............................................................................... 37 2.7.2 Stakeholder Positions ................................................................................ 40 2.7.3 Stakeholder Power .................................................................................... 42 2.7.4 Stakeholder Interests ................................................................................. 45 2.7.5 Stakeholder Influence ............................................................................... 47 2.8 Discussion
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