It seems that even when we do know history, we’re destined to repeat it.

In 1948, diethylstilbestrol (DES) was advertised as the “wonder drug”recommended for all pregnancies. The smiling face of a cherubic infantpeered out from the pages of medical journals next to the caption“Really? Yes, desPLEX to prevent abortion, miscarriage and prematurelabour…bigger and stronger babies too.”

Advertising works. It worked for DES, which was prescribed to anestimated 200,000 to 400,000 pregnant women in Canada between 1941 and1971. Despite scientific evidence from 1952 that proved DES did notprevent miscarriage, this harmful drug was advertised and prescribed for18 more years.

Only after it was linked to cancer in the daughters ofwomen prescribed DES was it finally restricted for use in pregnancy.Those exposed to DES continue to face the effects of infertility,reproductive abnormalities and cancer decades after initial exposure.

But that was over 30 years ago. Surely we’ve learned thatprescription drug advertising needs careful regulation. Apparently not.

We only have to look at the recent news surrounding the arthritis drugVioxx that is credited with causing thousands of extra heart attackdeaths. During its five years on the market, its manufacturer, Merck,spent around US $500 million advertising the drug to the U.S. public.Vioxx was no more effective than other similar drugs to treat arthritissymptoms, it was a lot more expensive, and turned out to be much lesssafe.

We’ve just observed DES Awareness Week — June 20 to 26. It’s time to remember the DESlegacy, including the lesson that prescription drug marketing cannotcontinue to upstage science.

Back in the ’50s and ’60s, doctors were the target for most drugadvertising. Direct-to-consumer advertising of prescription drugswasn’t permitted in any form in Canada. We can only imagine how manymore people would have been exposed to DES if it had been promoted ontelevision, billboards, bus shelters, newspapers and magazines asprescription drugs are today.

What many people don’t realize is that direct-to-consumer advertising isstill illegal in Canada, as it is in almost all industrialized countriesof the world, with the exception of the United States and New Zealand.The reason we are bombarded with drug advertising in this country isthat Health Canada isn’t adequately enforcing the law and companies haverushed to take advantage of this situation.

Most of us have seen the ads that slip past the border in Americanmagazines and on cable television. But prescription drug ads createdfor a Canadian audience are slightly different. A 1978 amendment to theFood and Drugs Act was introduced to allow consumers to compare drugprices. Advertisers were permitted to post the drug’s name, price andquantity as long as they made “no other representations.”

However, inNovember 2000, citing the 1978 price advertising clause, Health Canadapublished a policy paper saying that companies could advertiseprescription drugs as long as they didn’t include the drug’s name andinformation on its intended use in the same ad. The law hadn’t changedâe” just its interpretation. Needless to say, drug companies are takingadvantage of this legal loophole to introduce more and moredirect-to-consumer advertising. And Health Canada is letting it happen.

So we see “help-seeking ads” that encourage the public to call a 1-800number if they’re suffering from obesity, high blood pressure, highcholesterol, erectile dysfunction, etc. Or branded ads that name a drugbut don’t refer directly to the condition it treats — such as thenot-so-subtle Viagra ads which feature its recognizable brand coupledwith a heavy dose of sexual innuendo. Neither type of ad fits with theintent of the Food and Drugs Act.

In April 2004 in the report Opening the Medicine Cabinet, the StandingCommittee on Health admonished Health Canada for a lack of enforcementand vigilance. Among other recommendations to increase transparency andimprove post-market surveillance of prescription drugs, the Committeestated that Health Canada should enforce The Food and Drugs Act byenforcing the ban on direct-to-consumer drug advertising.

Yet, as part of the current legislative renewal process at HealthCanada, the department is proposing the exact opposite — legalization ofdirect-to-consumer advertising of prescription drugs as a form of public“information.”

Advertising is an effective business tool. It sells products. That’swhy companies spend billions of dollars each year on drug marketingbudgets — a lot more than is spent on drug research and development.But advertising does not provide reliable public information.Prescription drug ads are often misleading. They downplay the risks,exaggerate benefits and imply that drugs may be used to treat a widerrange of conditions than they are approved to treat.

The ads also focusmainly on the newest drugs available — drugs that are usually moreexpensive and not necessarily the most effective or safest choice. TheVioxx example proves the point once again. With celebrity endorsements,free trial offers, and emotive imagery suggesting complete relief, wasthe public really being “informed” or “educated”?

Let’s call a spade a shovel and quit heaping illegal advertising downthe throats of Canadians who are simply looking for reliable druginformation. Let’s learn from the mistakes of the past and take our cuefrom most other industrialized nations of the world wheredirect-to-consumer advertising continues to be illegal. Look to theEuropean Parliament where an attempt to introduce direct-to-consumeradvertising in 2002 was soundly rejected in the name of public health.

Parliamentarians voted overwhelmingly against legalizingdirect-to-consumer advertising and stated that the pharmaceuticalindustry was “incapable of providing impartial information on itsmedicines.” When will Health Canada come to the same logicalconclusion? It’s time to stop this drive to legalize direct-to-consumeradvertising of prescription drugs in Canada — before it’s a done deal.