Currently, drug companies are spending in excess of $200 million annually on promoting their products to Canadian physicians. Although the industry has adopted a voluntary code of advertising practice, this has not prevented gross excesses in all forms of pharmaceutical promotion: drug-company sponsored continuing medical education, and promotion through the public media, detailers, direct mail, sampling, and journal advertising. Not only does advertising add to the cost of drugs, but physicians' reliance on information conveyed through advertising leads to poor prescribing and consequently to significant adverse health effects for patients. Reforms of promotional practices are possible, but the initiative is unlikely to come from either the medical profession or the government. Pressure applied through an emerging grass-roots movement is the best hope for change.
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