Tom: This is exactly the kind of commentary we should be publishing in Health Promotion in Canada! If you were willing to submit it as a letter to the editor, as chair of the editorial advisory committee, I would be happy to recommend to the publisher that it be published in the next issue. I would also encourage others who have controversial or critical things to say to send them in. Now that the magazine is no longer a Health Canada publication, it is free to take a more critical stance than it may have in the past.

Irv Rootman

At 02:23 AM 9/17/98 -0400, you wrote:
>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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