Canwest Set to Challenge Ban on DTCA

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NEWS CanWest set to challenge of the claim is that Health Canada regulations are contradictory to the Charter ban on DTCA of Rights and Freedoms. “In a nutshell really — because it’s anWest Global Communica- long and complicated — is that it’s tion’s bid to overturn Ottawa’s against freedom of expression,” Chaly C ban on direct-to-consumer ad- said. “From our perspective it’s some- vertising (DTCA) of prescription drugs thing that needs to be addressed espe- will face a stiff challenge after a court cially with Canadians viewing television ruling has allowed a coalition of Cana- and journals, etcetera, coming from the dian health and consumer groups and [United] States that do allow DTCA. It’s unions to intervene. just the environment — it’s time to The Nov. 5th decision by the Ontario look at this.” Superior Court means that CanWest Coalition members, however, main- will not only have to oppose Health tain that allowing DTCA would harm Canada, which currently forbids public both the physical and fiscal health of advertising of prescription drugs, but Canadians. Citing the report of a senior advocacy groups who fear that such ad- FDA official who estimated that 35 000 vertising will lead to unsafe drug use to 45 000 Americans died from heart at- and increased public health care costs. tacks due to the heavily-advertised and The case is scheduled to be heard in now withdrawn arthritic pain drug rofe- January or February, and will likely end coxib (Vioxx), they argue that the phar- up in the Supreme Court of Canada. maceutical industry is the last place to

It is estimated that the annual Cana- turn for reliable, unbiased and compre- Canapress dian drug advertising market is worth hensive information on medications CanWest Global, led by CEO Leonard about half a billion dollars. The court (Lancet 2005;365 [9458]:475-481). Asper (above), argues that the ban on decision means the coalition will be al- “Loosening the rules in any way will direct-to-consumer prescription drug lowed to introduce evidence against lift- not be good for public health,” says advertising contradicts Canada’s Char- ing of DTCA and to cross-examine wit- Women and Health Protection (WHP) ter of Rights and Freedoms. nesses. Coalition members include the Coordinator Anne Rochon Ford. “We Women and Health Protection, Cana- feel there is a particular case to be made dian Health Coalition, Medical Reform for the added impact on women, be- the biggest threat to public health in- Group of Ontario, Canadian Federation cause women are prescribed more surance programs in Canada — costs of Nurses Unions, Canadian Energy and drugs and because women are often the are completely out of control. Prescrib- Paperworkers Union, Canadian Union targets of the advertising, there are spe- ing practices are out of control and they of Public Employees, Drug Safety cific campaigns directed very pointedly will get worse by a factor of 10 if they Canada and Society of Diabetic Rights. at girls and young women for certain start saturation drug ads.” “It’s an important precedent in drugs.” The WHP group is urging peo- According to the Canadian Institute terms of an ad hoc coalition of groups ple to tell their elected representatives, for Health Information, drugs are the applying for standing like this,” said including the federal health minister, fastest growing category of health care the group’s lawyer Stephen Shrybman that they oppose legalizing DTCA. spending, with total expenditures esti- shortly after the November ruling. The coalition’s economic concern mated to have reached almost $25 bil- Last December CanWest, which focuses on research showing that lion in 2005, an increase of 11% over owns 11 of Canada’s major daily news- DTCA results in increased drug con- the previous year. papers including the National Post, a sumption particularly of newer, more Barbara Mintzes, researcher with major television channel and other me- expensive drugs (CMAJ 2003;169 the University of British Columbia’s dia outlets, launched a legal challenge [5]:405-12). That outcome, they say, Centre for Health Services and Policy to the federal law outlawing American- will drive up costs of health benefit Research, says she is stunned at the style prescription drug advertising, plans and threatens the sustainability timing of the CanWest challenge. claiming that the regulation discrimi- of publicly funded health care. “The key surprising aspect of this nates against its business interests. “DTCA will basically destroy case is that it comes at this point in time, Betsy Chaly, CanWest director of cor- Medicare,” says Mike McBane of the after the Vioxx disaster and also after the porate communications, said the basis Canadian Health Coalition. “Drugs are US industry association has brought in

self-regulatory guidelines to limit its 3 years. About 4000 Quebeckers who own advertising practices,” Mintzes used the drug between 1999 and 2004 stated an e-interview from Amsterdam. may be represented in the suit. “Secondly, the Institute of Medicine re- Merck may seek a motion to de-au- port on drug safety in the US drew a thorize the class action on the grounds strong link between safety concerns and that each plaintiff’s case is unique. DTCA. They recommended a morato- In the US, Merck is arguing each rium on any advertising to the public of case separately and faces more than 42 drugs within their first two years on the 000 lawsuits. So far, Merck has won 5 market, within a US context in which a Vioxx cases and lost 4. A class-action total ban was unlikely.” suit on behalf of unions, health plans DTCA is a live issue elsewhere as and over third-party payers who cov- well. In Europe, a proposal to weaken ered rofecoxib prescriptions has been the ban on advertising prescription- authorized in the state of New Jersey. only medicines was overwhelmingly re- Rofecoxib, a selective COX-2 in- Canapress jected by the European Parliament 2 hibitor, nonsteroidal anti-inflammatory Dion reaffirmed that access to health years ago. The European Commission drug (NSAID) gained Canadian ap- care shouldn’t be “determined by the recently stated that it regrets that deci- proval in 1999 for the treatment of acute thickness of the patient’s wallet.” sion and called for a reform of the Eu- and chronic symptoms of osteoarthri- ropean pharmaceutical legislation. tis, rheumatoid arthritis, acute pain and However, in New Zealand — the only menstrual pain. IMS Health Canada re- paign statement on health, Dion re-af- country other than the US that currently ports that rofecoxib was the number 10 firmed opinions expressed to the CMAJ allows DTCA — the government is ex- top-selling drug in Canada in 2003, to the effect that access to health care pected to ban DTCA after several reviews with 3.3 million prescriptions written shouldn’t be “determined by the thick- recommended rejecting it and the fact and retail sales totaling $194 million. ness of the patient’s wallet” but that that many doctors in New Zealand op- Merck is expecting a decision from more private sector delivery of services pose DTCA (Br J Gen Pract 2003;April: the US Food and Drug Administration shouldn’t be ruled out-of-hand. 342-5). — Alicia Priest, Victoria by April on its application for approval Dion said he also wants to improve of Arcoxia, its COX-2 inhibitor for peo- Aboriginal health, increase health re- DOI:10.1503/cmaj.061505 ple suffering from osteoarthritis. — search promote healthy lifestyles and Barbara Sibbald, CMAJ sports activities and strengthen the public health agency. “I want to have DOI:10.1503/cmaj.061600 the strongest regulations against pollu- Quebec allows Vioxx tants and against dangerous products. I want to put in place a better Canadian class-action suit drug approval process, and better inter- New Liberal leader national cooperation on dealing with he Quebec Superior Court has pandemics.” set a worldwide precedent in champions R&D boost During the campaign, Dion also T granting plaintiffs class-action vowed to use tax incentives to spur status in a suit against Merck Frosst cores of federal Liberals seemed higher research outlays within the pri- Canada Ltd., the Canadian manufac- to emerge from their leadership vate sector, and more commercializa- turer of rofecoxib (Vioxx). S convention expressing a meas- tion on federally funded research US parent Merck & Co. Inc., an- ure of incredulity about what they’d just through mechanisms like a fund that nounced Sept. 30, 2004, a voluntary done in selecting former cabinet minis- would allow government scientists “to worldwide withdrawal of rofecoxib ter Stéphane Dion to their party helm. compete for new long-term funding (Vioxx) after a study showed patients tak- It took several curious turns of events over and above their existing research ing the anti-inflammatory drug on a for the erstwhile defender of federalism budgets when undertaking projects in long-term basis face twice the risk of a within Quebec, who’d cast himself as an conjunction” with small and medium- heart attack compared with patients re- environmental crusader, to top frontrun- sized businesses. He also proposed de- ceiving placebo (CMAJ 2004;171:1027-8). ners Michael Ignatieff and Bob Rae. voting 5% of all federal research out- The Nov. 9 Quebec court decision Dion’s health policies were certainly lays to address the needs of developing marks the first personal injury class-ac- among the mysteries to Liberal dele- countries, particularly with regard to tion suit authorized in the swirl of litiga- gates. Although the 51-year-old sociolo- health and the environment. tion surrounding rofecoxib. The Cana- gist participated in the CMAJ’s survey of Dion also championed another fund dian class action was filed by 2 plaintiffs, Liberal leadership hopefuls (CMAJ to promote multidisciplinary environ- who allege that they suffered heart at- 2006;175:1189-90), he did not issue a mental research, as well as one to fund tacks after using rofecoxib for more than health policy paper. In his sole cam- research needs identified as national

CMAJ • January 2, 2007 • 176(1) | 20