Ann Rochon Ford talks with HCE about “The Push to Prescribe: Women and Canadian Drug Policy”

by Shana Thornton-Morris

Contributing Editor

Anne Rochon Ford discusses the collection of essays in the book The Push to Prescribe: Women & Canadian Drug Policy, which is a timely and complete look at a major North American health care crossroads. Editors Anne Rochon Ford and Diane Saibil worked with the Steering Committee of Women and Health Protection in order to present investigative writings with a straightforward message about pharmaceuticals and public health care policy. The Push to Prescribe details the impact of pharmaceuticals on our bodies, social interactions, environments and economics.

While Ford et al focus on the Canadian health care system, they also present a comparison to the U.S. system of approval for drugs from the Food and Drug Administration (FDA), policies of the U.S. National Institutes of Health and sometimes standards in Europe—this is not a text that should be overlooked by American women and the international community in general.

“One of the main objectives is to point out the way in which pharmaceuticals specifically have an impact on women differential from that of men,” Ford said. “So that was one issue laced throughout the book. Another is that the commercialization of this aspect of medicine and the very dominant role that the pharmaceutical industry has in influencing not just promotion but regulation is deeply disturbing. We wanted to… outline how this is happening, …point out why this is problematic and …why it’s particularly problematic for women.”

The authors of The Push to Prescribe point out that neomedicalization has led to the consumption of drugs for questionable conditions like restless leg syndrome, overactive bladder and premenstrual dysphoric disorder (PMDD). They also discuss that many women underestimate the impact of drugs like birth control pills, vaccines for the Human Papillomavirus (HPV), and statins with their limited benefits and increased impact on the environment. The effects of these drugs and medical treatments as well as Vioxx and the selective serotonin reuptake inhibitors (SSRIs) class of anti-depressants, to name a few, are also analyzed in the book. The authors also discuss the limitations of past and present clinical trials prior to drug approval as well as the reporting of adverse drug reactions (ADRs). They give the reader an especially close analysis of how these drugs and the policies surrounding the drugs affect women.

“There are a lot of parallels with what’s going on in the States,” Ford said. “In fact, our regulatory programs are not that different. The Canadian system learns from and borrows from ways in which things have been done by the FDA. We consume the same drugs. We see your drug ads. There’s kind of a seamless border when it comes to these issues between Canada and the United States. Obviously, we’re at slightly different places regarding some of these issues. (…) While there are some distinctions between our two countries, I think there are way more similarities. There are many parallels in women’s health generally between the US and Canada.”

One of the distinctions mentioned by Ford is direct-to-consumer advertising. In Canada, direct-to-consumer advertising from drug companies is not exactly legal, though the authors of The Push to Prescribe show the leaks in the system. They discuss the standards of regulation concerning direct-to-consumer advertising in the US and Canada, and show a greater tolerance of US policies in Canada.

“In many cases,” Ford said, “it’s been shown that far too often what it (direct-to-consumer advertising) results in is people thinking that they need a drug when other more helpful solutions might have been the best bet to start with, but because people have been seduced by the messages in direct-to-consumer advertising they can often be quite insistent when they walk into a doctor’s office. Doctors have stated over and over in research… that they often feel like they’re pressured to prescribe now that people know more about drugs and think that they want them or need them. The other thing that’s important to realize is that the drugs that get advertised for the most part are not the drugs for life-threatening situations. They (the drugs in advertisements) are mostly drugs for things for which there are other, more helpful solutions. The other thing that’s happening slowly over time in the clinical setting between doctor and patient is that the patient comes in with this new knowledge because they have learned it from the advertising or they’ve gone onto the internet and the doctor doesn’t have a head start on suggesting changes in a person’s diet and lifestyle.”

At a time when American women are awaiting the votes of Congress to decide how health care will shift, the authors provide research and documents in order to examine pharmaceuticals and Canadian public health policy as they directly affect women and their families. In both Canada and the United States, women specifically are more affected by health care policies. The authors point out that women go to the doctor more frequently than men, women use more medications than men possibly due to living longer lives, and women make more medical decisions about other family members, especially children and seniors.

“One of the messages that needs a lot of attention is the extent to which we need to be educating children about drugs (pharmaceuticals),” Ford said. “Children learn in their homes and in their schools and sometimes they’re mimicking the behavior of their parents who automatically reach for an aspirin if they have a headache or just think that if they’ve been irritated that maybe they need an anti-depressant or sleeping pill or whatever. What’s happening with children is really where we need to be putting a lot more attention, not just in terms of reigning in the appalling degree of over-prescription to children which is finally starting to get some attention. I’m talking about going right down to toddlers being given anti-psychotics. There’s also a huge… need to be educating, to be infusing into our educational system the importance of healthy alternatives to drugs, to convey a very strong message that prescription drugs are not benign. They’re not candy. They’re not vitamins. They are controlled by a gatekeeper who is the physician for a reason. To think that we can continue to take them at the rate that we’re consuming them in our society is only going to lead to more problems. Kids need to hear the real story behind some of the movie stars who’ve overdosed lately and what’s going on there, just how many prescription drugs were those folks taking, whatever it takes to get the message through to kids that these are not benign substances and there are other ways of dealing with our health problems.”

Ford counsels women and parental guardians to step back and look at who is funding campaigns within schools to suggest diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD) and other behavioral issues. She says that the information may look like it’s coming from the Boards of Education, but she says that almost always there is involvement from industry or from physicians and/or retired psychiatrists who have been hired by industry to come in and work with boards to try and complete testing on children. Ford says while some children need drugs, so many others just need to have their energy channeled in another way whether that’s through creative endeavors, sports, diet changes, talk therapy or other healthy, lifestyle changes. Ford suggests that many parents should try other alternatives first, instead of initially relying on prescriptions drugs.

Another concern mentioned by Ford is how many substances might combine to produce a long-term effect. She uses the example of a child taking anti-depressants for decades as well as the toxins present in the environment and the radiation emissions from cell phones and other gadgets. Most studies examine isolated effects of one drug on a person or radiation emissions, not both as well as other environmental substances. Ford calls for more caution in regard to administering drugs due to the uncertainty of the combined interactions of substances; moreover, she suggests the need for more studies on the combined effects of drugs and technology over the long-term.

“In terms of personal choice, look beyond the information that is produced by industry, i.e. information that will be somewhat biased because their main aim is to sell their product,” Ford said. “Look beyond those places for guidance when you’re making a decision about not just whether to take a drug but whether you need treatment for something in the first place. One of the issues that we bring out in two places in the book is the extent to which normal behavior, the everyday sadnesses of life, all kinds of things have become medicalized. I think we owe that to the pharmaceutical industry, so I think we have to be wary of information that is produced by them. Some of it is good… but we have to remember what their bottom line is, which is they want to sell their product and they need to satisfy their shareholders.”

Many women may struggle with knowing how to make this information more accessible to other women and even themselves. With hectic lives, women often lack the time to read such extensive and in depth information; yet it is crucial to women who are in control of their health care and the health care of their families. No doubt women are interested in health care practices and legislation that will affect their future decisions. However, women are more bombarded by advertisements that are sponsored in part or completely by pharmaceutical companies. Whether women see pharmaceutical advertisements on television, a magazine, the back of a bathroom door, announced over the radio or some other medium, they are acquiring information from drug companies. The authors evaluate advertisements and show that drugs like Viagra which are specific to men’s health are often marketed toward women. The authors also point out that even health-related and disease-related non-profit organizations are often sponsored and funded by drug companies.

“On the issue of how the average woman can make a difference, joining up with organizations who are trying to fight this in our respective countries—lending support, solidarity and letters—all of that helps,” Ford said. “We need to reach the people who are in decision-making places to say, ‘there are some real concerns here and there are a lot of us out here who have been harmed by drugs because our regulatory systems are not stringent enough.’ There are others out here who have been needlessly put on medication that is not doing them any good and in fact possibly doing them harm. We’re taking money away from more health-enhancing treatment options in order to put more money into treatment options that may not always be the best solution. That isn’t to say that drugs aren’t sometimes the best solution. Sometimes they are, but… our thinking about this has gotten skewed away from options that are more health promoting.”

Some women want to know how to obtain information produced by health and disease-related non-profit organizations that aren’t funded by corporate entities and pharmaceutical companies, but women often have trouble in locating grassroots organizations. According to the book, some non-profit organizations have developed guidelines for working with a corporate sponsor. Ford offered advice to women who want to support an organization that is not controlled by a pharmaceutical company’s agenda. “You can start by asking, ‘how are you funded?’” Ford said. “And if they are in any way cagey about their response, I would be concerned. Also, the internet allows us so much ability to find out that kind of information. For most websites, if you dig around long enough, you’ll find out who’s sponsoring them. They have an annual report. They have to say in there who funds them.”

Throughout the book, transparency is a concept taken up by the authors of The Push to Prescribe. They have not only called for greater transparency within the Canadian health care system in regard to drug policy, but they have also asked for heightened transparency concerning the overall environmental impact of drugs. The findings in the book question the medical ethics of current and past pharmaceutical practices, especially when the public has been mislead regarding the safety and efficacy of drugs.

“There’s certainly a lot more heat on about this issue around what the environmental impact is of pharmaceuticals in water, soil and so on. There’s a big issue that is getting worse because drug consumption is increasing in that drugs get into our water system first and foremost through how we secrete them through urine. People pour drugs down the toilet. Drugs get into landfills through garbage and leach out into the soil. So there are a number of ways in which pharmaceuticals are getting out there and getting back into us.” Ford calls that only problem number one. Ford says that problem number two concerns the available treatment systems for environmental damage.

“For example,” Ford said, “if they detect that there are high amounts of SSRI anti-depressants and anti-cholesterol drugs in a given water system and they use their standard treatments of treating bacteria in the water, the impact is not what we would like to see. In fact, what’s being created are these bi-products from where those two chemicals meet, so where the drug meets the chlorine or whatever the treatment is. The outcome of that is also problematic. The bi-products are called disinfectant bi-products, so the bi-products are themselves creating health problems. We’ve got a huge mess here and it’s only beginning to see the light of day. What Sharon (Batt) argues at the end of her chapter (9) and how we conclude that section of the book is that if we don’t start looking upstream, (…) our attention is going to be misguided. (…) We would argue that the treatment solutions have to include decreasing drug consumption.”

In Chapter four, “Who Pays the Piper?”, Sharon Batt writes that the purpose of her analysis “is not to demonize the actors but to bring to light underlying conditions that could be modified through improved understanding and policies.” While the authors would like to be heard by their health care system in Canada, they have suggestions for all women who make health care decisions. Batt writes again in chapter four, “No health care system, whether publicly or privately insured, can give every sick person everything he or she wants. A public health care system implies sharing resources, spreading available funds across many services and prioritizing on the basis of need and evidence.” Ford and the other authors of The Push to Prescribe ask for greater transparency, actions as well as discussions, decreased drug consumption and an overall evaluation and modification of pharmaceuticals and their place in health care.

According to Ford, Women and Health Protection has worked with a number of grassroots organizations in the United States. Women and Health Protection has existed for about ten years. Their sister organization The Canadian Women’s Health Network also has worked on a number of joint campaigns with American groups. Some US groups the Canadian organizations have worked with are the National Women’s Health Network and the Boston Health Collective. Ford said that Women and Health Protection has also done some work around drugs used in and associated with breast cancer with the group Breast Cancer Action in San Francisco.

The Push to Prescribe: Women and Canadian Drug Policy
ed. Anne Rochon Ford and Diane Saibil
Women’s Press, 2010