Residents of Quebec have unwittingly become the subjects of a recent medical-research experiment conducted by a team of international researchers. If your thoughts suddenly turned to the CIA/MKULTRA with LSD and brainwashing at McGill, don't worry: this year's experiment is nothing so nefarious.
In a , published online September 2 in the British Medical Journal, a team of Harvard and University of Alberta researchers studying direct-to-consumer advertising (DTC) realized that Quebec is the ideal place to compare the effects of DTC advertising on drug sales.
Why Quebec? The English-French divide -- Hugh MacLennan's two solitudes -- represents a unique situation. The entire population of Quebec lives in very close proximity to the United States, where DTC drug advertising is legal, but a portion of the population (the anglophones) are much more likely to see those ads than the other portion (the francophones) who would tend to stick to French-language and therefore Canadian television channels, radio stations and magazines produced in Canada, where DTC ads are illegal.
Harvard Medical School's Michael Law, the lead author, explained in :
“It’s not an absolutely perfect control group... There’s obviously a small percentage of Quebec residents who are exposed to English language media. But as control groups go for this sort of observational study, it’s about as good as you get."The researchers chose three drugs to look at: etanercept, mometasone and tegaserod. They compared sales among anglophone Quebecers to sales among francophone Quebecers, both before DTC ads began and after they started.
The results are rather surprising: the only significant difference between the two populations' sales were for tegaserod, but even that drug's sales eventually leveled out.
The conclusion to draw from this research -- though it contradicts what seemed before like common wisdom -- is that DTC advertising doesn't really work very well.
DTC IN CANADA?
The BMJ study comes at a time when DTC advertising is a hot topic in Canada.
Canadian research has shown that introducing DTC advertising increases government health spending on pharmaceuticals; , which did an admirable job comparing the notoriously difficult-to-compare American and Canadian situations, was published last year by a respected University of British Columbia epidemiologist, Steven Morgan, in the journal Open Medicine.
CanWest, the owner of dozens of newspapers and televison channels across the country, filed a lawsuit in 2005 challenging the Canadian government's ban on DTC advertising. Their lawsuit, which is being dealt with in Ontario Superior Court, has not reached trial yet.
A separate CanWest lawsuit, filed in federal court against the Minister of Health and the Attorney General, claimed that the Canadian government was obliged to enforce its ban on DTC advertising even in American magazines that could be purchased in Canada. That suit was in July 2007. CanWest appealed, but in the Federal Court of Appeals refused to reverse the lower court's decision. (CanWest has not yet commented on whether they will attempted to appeal that decision further; check back here for Canadian Medicine follow-up in the next few days with CanWest's response.)
The Canadian Health Coalition, which is staunchly opposed to the introduction of DTC advertising in Canada, has put together a good-sized -- albeit selective -- collection of articles and resources on the topic , including the text of affidavits filed in the CanWest challenge in Ontario.