I agree with Debbie Bang that the presence of corporate image advertising
for pharmaceutical companies in HPinC doesn't compel the reader to buy
drugs. Nor does such a presence  _necessarily_ impinge on editorial
decisions. I also accept that drug manufacturers have a legitimate
commercial interest in persuading people that they are 'good guys'. I'm sure
in many respects they are.

Taken in context, though, the article in Vol. 34, no. 2 about partnerships
("Partnerships: Government's New Math") was a bit too in-your-face to be
ignored. That article, to put it mildly, was not a balanced discussion of
the risks and benefits of partnerships or a discussion of alternatives. To
put it more strongly, it was a rah, rah, puff piece full of "unsupported
claims", "promotional prose" and "prominant brand names" (to use just three
of the "items containing promotional characteristics" identified by Daniel
Stryer and Lisa Bero in their evaluation of the appropriateness of
educational materials distributed by drug companies to physicians). By
comparison, the pharmaceutical company ads were tasteful.

The context that I'm referring to is not just the editorial context of the
magazine, but the political-budgetary context of events elsewhere in Health
Canada and elsewhere in the Federal health budget:
 - the gutting of the scientific capability of the Health Protection Branch
 - the lack of transparency of the drug approval process in Canada
 - the extension of pharmaceutical patent protection
 - the repeal of the Canada Assistance Plan Act
 - substantial cuts since 1995 in federal health care budgets

In _that_ context, it's hard for me to say whether happy talk about
partnerships sounds more Orwellian or Kafkaesque. And, given the unique
characteristics of the market for prescription drugs, it's hardly surprising
that pharmaceutical companies and the association were the first eager
partners out on the dance floor. Prescription drugs are unique in that the
person who traditionally makes the purchase decision is neither the one who
consumes them nor the one who pays for them. Also, traditionally direct to
consumer advertising of prescription drugs has been restricted. As a result
of those two factors, the drug industry has become adept at indirect
marketing approaches.

It's hard to avoid mentioning the parallel between the kind of partnership
marketing that drug companies do and the sponsorship of sporting and
cultural events by tobacco companies. No one is forced to smoke cigarettes,
either, just because they go to a du Maurier Jazz Festival. But it does kind
of blur the boundaries about what is "free speech", what is "support for the
arts" and what is simply the tobacco companies calling the shots because
they have all the bucks.

As Barbara Mintzes has pointed out: "There is an enormous imbalance in the
financial resources available to produce commercial, promotional information
on drugs as opposed to the limited resources available for comparative,
independent information and assessments" (Blurring the Boundaries: New
Trends in Drug Promotion, Amsterdam, Health Action International, 1998)

The pharmaceutical industry is also very active in framing the issue of
consumer health information about drugs as being primarily an issue of
patient _compliance_. Critics of that view, however, would maintain that the
quality and independence of information are paramount. According to those
critics, it is often inappropriate prescribing by doctors -- rather than
inappropriate compliance by patients -- that results in adverse health
consequences and/or unnecessary health care system costs.


Regards,

Tom Walker
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