I think one of the first thing that foreigners from other countries notice when they come to live in the United States is the prevalence of direct to consumer advertising for medicines. In Canada, where I am from, we get a lot of this indirectly due to the fact that we watch a lot of American television (~90% of Canadians live within 100 km of the US border) but it permeates everywhere in the US: magazines, newspapers, movies, even buses. Whether it should be allowed is a question of great debate. Only 2 developed countries formally allow it: the United States and New Zealand. Advocates argue that it provides more and better information to consumers whereas critics argue it leads to inappropriate use of medicines. But does it work? Part of the problem with research relating to information is that it is really hard to come up with a good control to investigate this research.

My good friend Mike Law, however, may have come up with one. As a fellow Canadian, he also was aware that Canadians get a lot of exposure to US DTC advertising but realized that not all Canadians process it the same way – namely that the French speaking populations get much less exposure (one they get less US channels, and they watch English language TV less frequently). He argues, this makes a good control group to investigate the effects. His analysis found that two of the three drugs he investigated show little or no increase in sales in English Canada over French Canada, while one of the drugs did. What these drugs show is less that it is effective but that it may really depend on some of the characteristics of the drugs themselves and perhaps the marketing efforts themselves. But the big finding is that is is certainly not a sure thing.

Is this really a good control? Perhaps. I really like the creativity of the research design. But it is also true that Canadians do not have the same levels of prescription drug coverage as Americans do, so it is not clear that they would behave the same down here. It is also not clear to me that French Canadians have less exposure to English language TV. I am sure they still watch Grey’s Anatomy, Desperate Housewives, and the rest like the rest of us – heck it seems people even in Africa watch these shows. But it certainly is a believable approach.

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