One, Two, or One Too Many?

(Version française)

Opinion

You may have noticed a couple of advertising campaigns out in our community recently.

The "One Life" campaign is a very interesting and well put together campaign to encourage people to get tested for HIV. Taken alone, the "One Life" campaign is very positive, and the goal of encouraging people to get tested is something that we can only be in favour of. Have a look at the web site for One Life here.

The "Juste une fois" campaign ("One With U" in the English version) is a promotion for the once daily HIV treatment Atripla. Atripla is a combination of Sustiva, Tenofovir and FTC in a single pill. This is not in itself a bad thing either: dosing simplification can be very helpful to treatment adherence and this combination can be very effective in treating HIV, although it is not for everyone.

The big problem I have had with the "Juste une fois" campaign is that it is an advertising campaign for prescription medication. The law in Canada places some serious limits on direct to consumer advertising of prescription medications. This is why you won't see either the name of the company or the name of the medication on any of the promotional materials. It would be naïve to think that people can't figure out what drug is being advertised, as there is only one combination available in the format of one pill once per day, so this campaign is treading rather close to the line.

Add to this that the campaign placement has been ubiquitous in areas likely to reach potential customers (outside HIV clinics, almost everywhere in the Village…) and you have a violation of the spirit of the ban on direct to consumer advertising.

The Canadian Treatment Action Council, of which ACCM is a member, has done some thinking about this issue and has written a position paper on direct to consumer advertising (DTCA). You can see the paper in its entirety here. In brief, the points covered by this paper include the following:
• There is no proof of the health benefit of DTCA, so the only reason for it must be to increase the profits of the companies responsible for it.
• The amount of money spent on DTCA in the United States, where it is allowed, leads directly to the possibility that the costs of this activity will be recovered in the price of the drug being advertised.
• Most doctors found that DTCA was not helpful with respect to the quality of care they could offer their patients, both in terms of patient expectations and doctors' prescribing patterns.
• There is no evidence that DTCA leads to better informed patients, as it advocates for a single product rather than presenting a balanced view of available options to inform choice.
• DTCA can have a negative impact on the doctor-patient relationship, as doctors may find themselves pressured into prescribing a product which might not be appropriate for the individual, or may have to spend time they don't usually have to re-educate patients with more balanced information.

In general, there are better, more balanced sources of treatment information that ought to be relied on; advertising tends to paint an unrealistically positive portrait of the product that does not serve to inform treatment decisions.

So what does one of these have to do with the other?

This was the sight that greeted me on my way to Ça Marche in the Beaudry Métro: the One Life and the One Pill campaigns next to each other throughout the station. In case there was any doubt about a link between them, it was the same advertising firm and the same pharmaceutical company, and the two campaigns ran side by side in a very public way.

The excellent campaign to encourage HIV testing has been tainted by its association with the objectionable direct to consumer advertising campaign. That is why I will encourage ACCM to refrain from associating with either of these campaigns.

What do you think? (Comments encouraged.)

Ken Monteith

Executive Director