The five-year survival rate for white women diagnosed with invasive breast cancer is 88% while the five-year survival rate for black women diagnosed with invasive breast cancer is only 74%.
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Stop the Epidemic: The Newsletter of the Massachusetts Breast Cancer Coalition
Jun 01, 2002
"Now, predict your risk of breast cancer. And act on it. There is something you can do."
"Look at Diane now! The acne solution for women only."
"A LESSON in guys: never play hard to get. Be hard to get."
If you’ve turned on your TV, read a magazine or looked at a billboard in the past few years, chances are you’ve seen one or more of these slogans. You’ve probably also seen mysterious, sloganless ads, like the billboard of a couple in bed, with no explanation beyond, "Zyban? Ask your doctor." Whatever your reaction to the ads, you can’t ignore the startling images. An ad in Chatelaine for the cholesterol-lowering drug Lipitor shows a dead body on a mortuary slab and asks: "Which would you rather have, a cholesterol test or a final exam?"
Ads for prescription drugs are at the eye of a health policy storm. Members of every breast cancer group in this country need to understand this controversy, and not only because some of the ads involve breast cancer drugs. Patients’ organizations are influential players in a heated policy battle in which both sides are firing volleys across the thresholds of MP’s offices. Few people are neutral in this debate. Before joining the fray, patients’ groups need to air the issue carefully with their members and ask: "Which side are we on?" Before you read any further, a warning: understanding the DTCA debate is vital to your group’s health, but discussing these issues could be fatally divisive to your organization.
The jargon term for prescription ads is DTCA, short for "direct-to-consumer advertising." Every industrial country except the USA and New Zealand bans them, on the grounds that prescription drugs carry health risks that ordinary products don’t. In the present system, doctors are the designated gatekeepers. Their role is to prescribe a drug when professional judgment tells them that drug is the best available course for the patient. Until recently, ads to influence consumers were off-limits, although drug companies can target physicians, via office visits, ads in medical journals, and an array of other methods.
The policy shift that opened the floodgates began in the United States in 1997. The American drug regulator, the Federal Drug Administration (FDA), had previously allowed DTCA but with heavy restrictions. Under pressure from industry, the FDA finally loosened the constraints governing ads on radio and TV. Ads like the first one quoted above, promoting tamoxifen (Nolvadex) to women at high risk of breast cancer, began to swamp the American media.
In Canada, with "just-watch-me" defiance of the ban, drug companies have launched ad campaigns for drugs like Diane-35 and Alesse (see slogans above), Zyban, Lipitor and Viagra that they claim are legal – at least technically – under Health Canada’s regulations.
As part of its strategy in Canada, the pharmaceutical industry sought allies in influential sectors, including the media. Newspapers, magazines and TV channels will enjoy a financial bonanza if the laws are relaxed. In the US in 2001, drug companies spent $2.6 billion on DTC media ads. The drug industry has also identified patient advocates as highly desirable allies and has wooed groups to join their fight against government "paternalism" and "censorship." The industry claims prescription drug ads are essential educational materials for today’s informed health consumer – its members say we have a right to the ads.
Not all health consumer groups agree that the freedom to see ads for tamoxifen, Zyban or Lipitor is one of the great cornerstones of democracy. I belong to several coalitions whose members argue the opposite: that citizens have a right to unbiased information about prescription drugs; but ads, by definition, are inherently biased. Their purpose is to sell drugs. The drug companies’ insistence that advertising is education chillingly evokes George Orwell’s nightmare society, in which "War is Peace," "Ignorance is Strength" and "Freedom is Slavery." Pharmaceutical ad campaigns are so in-your-face and so well funded they overwhelm the modest capabilities of those who would truly educate the public about drugs. Because prescription drugs can have harmful or lethal effects, banning their promotion is no more paternalistic than banning child pornography or controlling the use of firearms.
Health advocates involved in breast cancer issues formed the coalition Prevention First,(1) in which I am active, because we were concerned about the promotion of tamoxifen to healthy women. The FDA approved tamoxifen for healthy women at high risk of breast cancer in October 1998 and this approval gave AstraZeneca, the drug’s manufacturer, the right under US law to mount a media campaign promoting tamoxifen to American women.
AstraZeneca launched its slick "Now, predict your risk of breast cancer. And act on it." campaign in early 1999. Our coalition analyzed the ads and concluded they violated FDA regulations. We filed complaints to the FDA, detailing the problems. The FDA concurred with our arguments and ordered AstraZeneca to stop the campaign. In its letter to AstraZeneca, the FDA said that the company had overstated the drug’s benefits and downplayed its risks.(2) By the time the ads were withdrawn, however, millions of women had been misinformed about tamoxifen’s risks and benefits. The company was not required to run corrective ads.
Last December, the FDA required AstraZeneca to withdraw another ad promoting tamoxifen, this one aimed at women with breast cancer ("I reduced my chances for a recurrence of breast cancer significantly.") Again the company was found to have misled women by overstating tamoxifen’s benefits and understating the risks.(3)
The future of DTCA in Canada is uncertain. As of this writing, DTCA promoters hold one trump card: DTCA opponents lack hard evidence of "death by advertising" – proof that prescription drug ads actually cause harm to health. However, the price tag to the health care system, through increased drug costs, has been demonstrated (yes, we pay for those glossy ads). Industry has made freedom of speech its centerpiece argument, for good reason. Courts have typically defended free speech unless the messages in question have done demonstrable harm. So far the evidence of DTCA’s health harm is indirect.
A study by Barbara Mintzes, published in the British Medical Journal, moves the argument against DTCA closer to the goal post.(4) When physicians prescribed a heavily advertised drug requested by patients, Mintzes found that they were more likely to be uneasy about the appropriateness of the prescription than when they prescribed a drug the patient had not requested. Although evidence that advertising endangers health is still shy of proof, I believe bans on prescription drug ads must be maintained and enforced in Canada while more data is gathered.
Beyond the DTCA argument, this debate puts the question of industry partnerships squarely before the advocacy community. We now have in Canada two categories of patient groups: those that welcome pharmaceutical funds and partnerships, and those that reject corporate funding. Many groups have not yet formulated a policy on this question.
Partnerships between pharmaceutical companies and advocates from the patient community make me extremely uneasy. Physicians and medical researchers are finally confronting the corroding effects of conflicts of interest; patients engaged in influencing public policy must do the same. Groups receiving industry money may forfeit the freedom to critique the pharmaceutical industry. By contrast, health advocacy groups that refuse pharmaceutical company funds are free to advocate for the public interest, independent of powerful industry influences that could benefit from their advocacy. They maintain a credibility that groups receiving industry money sacrifice.
The DTCA controversy offers a concrete example groups can use to explore the pros and cons of industry funds with their membership. Some breast cancer groups have corporate funding policies posted on their websites,(5) and veteran health activist Anne Rochon Ford has written an excellent booklet to help groups navigate this potentially explosive discussion.(6)
References
1. Coalition members are the Boston Women’s Health Book Collective, Breast Cancer Action, DES Action, the Massachusetts Breast Cancer Coalition, The Centre for Medical Consumers, the National Women’s Health Network, the Women’s Community Cancer Project, and the Working Group on Women and Health Protection (Canada), represented by Breast Cancer Action Montreal. Web address - http://www.bcaction.org/Pages/LearnAboutUs/PreventionFirst.html
2. Web reference: http://www.fda.gov/cder/foi/appletter/1998/17970s40.pdf
3. Web reference: http://www.fda.gov/cder/warn/2001/10205.pdf
4. Mintzes, Barbara, et al. "Influence of direct to consumer pharmaceutical advertising and patients’ requests on prescribing decisions: two sites cross sectional survey", BMJ, Vol. 324, February 1, 2002, 278-279.
5. See, for example, Breast Cancer Action’s policy, at http://www.bcaction.org/Pages/LearnAboutUs/CorporateContributions.html and Breast Cancer Action Montreal’s at: http://www.bcam.qc.ca/news.htm.
6. Ford, Anne Rochon, A Different Prescription: Consideration for Women’s Health Groups contemplating Funding from the Pharmaceutical Industry, Toronto: National Network on Environments and Women’s Health (NNEWH). To access the booklet on the NNEWH website, go to http://www.yorku.ca/nnewh/english/nnewhind.html.
Sharon Batt is the author of Patient No More: the Politics of Breast Cancer and has been active in breast cancer advocacy since her diagnosis in 1988. She co-founded Breast Cancer Action Montreal who along with MBCC is a member of the Prevention First Coalition: A Coalition of Independent Health Organizations.
Text box to be inserted someplace in article:Please visit DES Action’s website at http://www.web.net/~desact/anglais/anglais.html to see their policy position on DTCA published by Vancouver researcher, Barbara Mintzes, called "Direct to Consumer Prescription Drug Advertising: When Public Health is No longer a Priority."
You, Your Breast Cancer Group and Prescription Drug Ads
Sharon BattStop the Epidemic: The Newsletter of the Massachusetts Breast Cancer Coalition
Jun 01, 2002
"Now, predict your risk of breast cancer. And act on it. There is something you can do."
"Look at Diane now! The acne solution for women only."
"A LESSON in guys: never play hard to get. Be hard to get."
If you’ve turned on your TV, read a magazine or looked at a billboard in the past few years, chances are you’ve seen one or more of these slogans. You’ve probably also seen mysterious, sloganless ads, like the billboard of a couple in bed, with no explanation beyond, "Zyban? Ask your doctor." Whatever your reaction to the ads, you can’t ignore the startling images. An ad in Chatelaine for the cholesterol-lowering drug Lipitor shows a dead body on a mortuary slab and asks: "Which would you rather have, a cholesterol test or a final exam?"
Ads for prescription drugs are at the eye of a health policy storm. Members of every breast cancer group in this country need to understand this controversy, and not only because some of the ads involve breast cancer drugs. Patients’ organizations are influential players in a heated policy battle in which both sides are firing volleys across the thresholds of MP’s offices. Few people are neutral in this debate. Before joining the fray, patients’ groups need to air the issue carefully with their members and ask: "Which side are we on?" Before you read any further, a warning: understanding the DTCA debate is vital to your group’s health, but discussing these issues could be fatally divisive to your organization.
The jargon term for prescription ads is DTCA, short for "direct-to-consumer advertising." Every industrial country except the USA and New Zealand bans them, on the grounds that prescription drugs carry health risks that ordinary products don’t. In the present system, doctors are the designated gatekeepers. Their role is to prescribe a drug when professional judgment tells them that drug is the best available course for the patient. Until recently, ads to influence consumers were off-limits, although drug companies can target physicians, via office visits, ads in medical journals, and an array of other methods.
The policy shift that opened the floodgates began in the United States in 1997. The American drug regulator, the Federal Drug Administration (FDA), had previously allowed DTCA but with heavy restrictions. Under pressure from industry, the FDA finally loosened the constraints governing ads on radio and TV. Ads like the first one quoted above, promoting tamoxifen (Nolvadex) to women at high risk of breast cancer, began to swamp the American media.
In Canada, with "just-watch-me" defiance of the ban, drug companies have launched ad campaigns for drugs like Diane-35 and Alesse (see slogans above), Zyban, Lipitor and Viagra that they claim are legal – at least technically – under Health Canada’s regulations.
As part of its strategy in Canada, the pharmaceutical industry sought allies in influential sectors, including the media. Newspapers, magazines and TV channels will enjoy a financial bonanza if the laws are relaxed. In the US in 2001, drug companies spent $2.6 billion on DTC media ads. The drug industry has also identified patient advocates as highly desirable allies and has wooed groups to join their fight against government "paternalism" and "censorship." The industry claims prescription drug ads are essential educational materials for today’s informed health consumer – its members say we have a right to the ads.
Not all health consumer groups agree that the freedom to see ads for tamoxifen, Zyban or Lipitor is one of the great cornerstones of democracy. I belong to several coalitions whose members argue the opposite: that citizens have a right to unbiased information about prescription drugs; but ads, by definition, are inherently biased. Their purpose is to sell drugs. The drug companies’ insistence that advertising is education chillingly evokes George Orwell’s nightmare society, in which "War is Peace," "Ignorance is Strength" and "Freedom is Slavery." Pharmaceutical ad campaigns are so in-your-face and so well funded they overwhelm the modest capabilities of those who would truly educate the public about drugs. Because prescription drugs can have harmful or lethal effects, banning their promotion is no more paternalistic than banning child pornography or controlling the use of firearms.
Health advocates involved in breast cancer issues formed the coalition Prevention First,(1) in which I am active, because we were concerned about the promotion of tamoxifen to healthy women. The FDA approved tamoxifen for healthy women at high risk of breast cancer in October 1998 and this approval gave AstraZeneca, the drug’s manufacturer, the right under US law to mount a media campaign promoting tamoxifen to American women.
AstraZeneca launched its slick "Now, predict your risk of breast cancer. And act on it." campaign in early 1999. Our coalition analyzed the ads and concluded they violated FDA regulations. We filed complaints to the FDA, detailing the problems. The FDA concurred with our arguments and ordered AstraZeneca to stop the campaign. In its letter to AstraZeneca, the FDA said that the company had overstated the drug’s benefits and downplayed its risks.(2) By the time the ads were withdrawn, however, millions of women had been misinformed about tamoxifen’s risks and benefits. The company was not required to run corrective ads.
Last December, the FDA required AstraZeneca to withdraw another ad promoting tamoxifen, this one aimed at women with breast cancer ("I reduced my chances for a recurrence of breast cancer significantly.") Again the company was found to have misled women by overstating tamoxifen’s benefits and understating the risks.(3)
The future of DTCA in Canada is uncertain. As of this writing, DTCA promoters hold one trump card: DTCA opponents lack hard evidence of "death by advertising" – proof that prescription drug ads actually cause harm to health. However, the price tag to the health care system, through increased drug costs, has been demonstrated (yes, we pay for those glossy ads). Industry has made freedom of speech its centerpiece argument, for good reason. Courts have typically defended free speech unless the messages in question have done demonstrable harm. So far the evidence of DTCA’s health harm is indirect.
A study by Barbara Mintzes, published in the British Medical Journal, moves the argument against DTCA closer to the goal post.(4) When physicians prescribed a heavily advertised drug requested by patients, Mintzes found that they were more likely to be uneasy about the appropriateness of the prescription than when they prescribed a drug the patient had not requested. Although evidence that advertising endangers health is still shy of proof, I believe bans on prescription drug ads must be maintained and enforced in Canada while more data is gathered.
Beyond the DTCA argument, this debate puts the question of industry partnerships squarely before the advocacy community. We now have in Canada two categories of patient groups: those that welcome pharmaceutical funds and partnerships, and those that reject corporate funding. Many groups have not yet formulated a policy on this question.
Partnerships between pharmaceutical companies and advocates from the patient community make me extremely uneasy. Physicians and medical researchers are finally confronting the corroding effects of conflicts of interest; patients engaged in influencing public policy must do the same. Groups receiving industry money may forfeit the freedom to critique the pharmaceutical industry. By contrast, health advocacy groups that refuse pharmaceutical company funds are free to advocate for the public interest, independent of powerful industry influences that could benefit from their advocacy. They maintain a credibility that groups receiving industry money sacrifice.
The DTCA controversy offers a concrete example groups can use to explore the pros and cons of industry funds with their membership. Some breast cancer groups have corporate funding policies posted on their websites,(5) and veteran health activist Anne Rochon Ford has written an excellent booklet to help groups navigate this potentially explosive discussion.(6)
References
1. Coalition members are the Boston Women’s Health Book Collective, Breast Cancer Action, DES Action, the Massachusetts Breast Cancer Coalition, The Centre for Medical Consumers, the National Women’s Health Network, the Women’s Community Cancer Project, and the Working Group on Women and Health Protection (Canada), represented by Breast Cancer Action Montreal. Web address - http://www.bcaction.org/Pages/LearnAboutUs/PreventionFirst.html
2. Web reference: http://www.fda.gov/cder/foi/appletter/1998/17970s40.pdf
3. Web reference: http://www.fda.gov/cder/warn/2001/10205.pdf
4. Mintzes, Barbara, et al. "Influence of direct to consumer pharmaceutical advertising and patients’ requests on prescribing decisions: two sites cross sectional survey", BMJ, Vol. 324, February 1, 2002, 278-279.
5. See, for example, Breast Cancer Action’s policy, at http://www.bcaction.org/Pages/LearnAboutUs/CorporateContributions.html and Breast Cancer Action Montreal’s at: http://www.bcam.qc.ca/news.htm.
6. Ford, Anne Rochon, A Different Prescription: Consideration for Women’s Health Groups contemplating Funding from the Pharmaceutical Industry, Toronto: National Network on Environments and Women’s Health (NNEWH). To access the booklet on the NNEWH website, go to http://www.yorku.ca/nnewh/english/nnewhind.html.
Sharon Batt is the author of Patient No More: the Politics of Breast Cancer and has been active in breast cancer advocacy since her diagnosis in 1988. She co-founded Breast Cancer Action Montreal who along with MBCC is a member of the Prevention First Coalition: A Coalition of Independent Health Organizations.
Text box to be inserted someplace in article:Please visit DES Action’s website at http://www.web.net/~desact/anglais/anglais.html to see their policy position on DTCA published by Vancouver researcher, Barbara Mintzes, called "Direct to Consumer Prescription Drug Advertising: When Public Health is No longer a Priority."
Published by Stop the Epidemic!
The Newsletter of the Massachusetts Breast Cancer Coalition
http://mbcc.org
To view our newsletter archives, please go to:
http://mbcc.org/acatalog.php?id=1
The Newsletter of the Massachusetts Breast Cancer Coalition
http://mbcc.org
To view our newsletter archives, please go to:
http://mbcc.org/acatalog.php?id=1
Massachusetts Breast Cancer Coalition
1419 Hancock Street, Suite 202, Quincy, MA 02169 • Ph.(617) 376-6222 • Fx.(617) 376-6221 • toll free: 1-800-649-6222
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MISSION STATEMENT: "Defining breast cancer as a political issue, the Massachusetts Breast Cancer Coalition challenges all obstacles to the eradication of this disease."
MISSION STATEMENT: "Defining breast cancer as a political issue, the Massachusetts Breast Cancer Coalition challenges all obstacles to the eradication of this disease."
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