DTCA that reaches Canada from the United States is currently unregulated in Canada, so the Canadian population can access American advertisements and, often, are unaware that these advertisements contain material that is not permitted in Canadian advertisements. Canadians often have access to these advertisements through international websites and social media sites. Consequently, Canadian patients, consumers, and physicians are increasingly being exposed to American advertisements that fail to provide information that would allow these individuals to make informed health and prescribing choices.
Consumers are increasingly turning to the internet as the primary source for information on and evidence for drug safety and efficacy. Cross-border access to online DTCA has become the state-of-the-art of electronic medical knowledge transfer method that is accessible to all populations. DTCA and online drug marketing are often masked as educational information. Types of websites on which clinical evidence-based information is published include "medical sites" such as WebMD, pharmaceutical company websites, medical journals, and social media sites.
Proponents of DTCA argue that banning DTCA denies Canadians the right to access health information and that DTCA may improve health and save lives by encouraging consumers to recognize symptoms and seek medical care at early stages of illness.
Opponents of DTCA argue that harm is caused to the public by companies promoting unnecessary and inappropriate prescription drug use. Additionally, DTCA is unequivocally biased towards the sponsoring company and, as such, fails to provide balanced, objective appraisals of available treatments and therapies in the marketing schemes.
Health Canada is responsible for only Canada-based advertisements, and so has no jurisdiction over American DTCA, even when the Canadian population has access to said advertisements. Currently, Health Canada is responsible for the interpretation and enforcement of drug advertising regulations. Health Canada does this by establishing policies that regulate marketed health products and issuing guidelines for the interpretation of regulations. Health Canada does not directly review DTCA materials for compliance with regulations. Furthermore, the approval of DTCA information is a self-regulatory voluntary system through the Food and Drugs Act and the Controlled Drugs and Substances Act.
The internet and social media has not been included in any Health Canada regulation documentation largely because technology advances faster than regulation can be updated or legislation can be mandated. The 2004 House of Commons Standing Committee on Health released a report called Opening the Medicine Cabinet, which highlighted concerns that Health Canada is too passive in the enforcement of DTCA regulation online and called for Health Canada to "dedicate specific resources to Health Products and Food Branch Inspectorate for vigorous enforcement of the DTCA regulations on prescription drugs."
Health Canada has assigned the Advertising Standards Canada (ASC) and Pharmaceutical Advertising Advisory Board (PAAB) agencies with the responsibility of reviewing and approving eDTCA information. The ASC has released a checklist intended to facilitate the development of ethically-driven prescription drug advertisements. The PAAC provides advisory opinions on messages directed to consumers of prescription medications, but companies are not obligated to comply with the suggestions of either the ASC or PAAB, which also allow unacceptable advertisements to be released in Canada. There are no sanctions for noncompliance with any agency-based regulations concerning eDTCA materials and Health Canada has not issued any guidance specific to social media and online marketing information that has the potential to influence evidence-based decision making of both patients and physicians. There is, therefore, the potential for eDTCA materials to be released online without any type of review and industry remains self-regulating in the area of eDTCA.
Direct-to-Consumer Advertising of Prescription Drugs
House of Commons Canada: Opening the Medicine Cabinet: First Report on Health Products of Prescription Drugs
Direct-to-Consumer Advertising in the Digital Age: The Impact of the Internet and Social Media in the Promotion of Prescription Drugs in Canada
Pharmaceutical Promotion in Canada: Convince Them or Confuse Them
How Does Direct-to-Consumer Advertising Affect Prescribing? A Survey in Primary Care Environments With and Without Legal DTCA
Should Canada Allow Direct-to-Consumer Advertising of Prescription Drugs? NO.