Review: The Push To Prescribe — Women and Canadian Drug Policy Edited by Anne Rochon Ford and Diane Saibil

By Ann Pappert

In 1992, when I first moved back to the U.S. after living in Canada for more than 20 years, I would stare in amazement at the endless parade of prescription drug commercials that appeared nightly across my TV screen. Direct-to-consumer ads for prescription drugs weren’t permitted in Canada. But here in the States, the ads were everywhere.

Since then, a globalized pharmaceutical industry has turned the parade of advertising into a tsunami of new medications and accompanying ads. As The Push To Prescribe — one of the most important books published yet on the growing influence of pharmaceuticals and the pharmaceutical industry — makes clear, the issue has particular urgency for women.

The sub-title, Women and Canadian Drug Policy, should not mislead potential readers into believing that it has limited value to American readers. Editors Anne Rochon Ford, director of the Canadian working group Women and Health Protection, and  freelance editor Diane Saibil have assembled a collection of superbly researched essays written by prominent feminist health activists and academics which provide a feminist perspective on issues ranging from direct-to-consumer advertising (that, by its nature, focuses on the U.S.) to regulatory agencies, the environmental impact of prescription drugs, clinical trials, and industry funding of consumer groups that focus on women and drug policy. This makes The Push To Prescribe unique among books about Big Pharma that have been published in the last few years. It is an invaluable resource for anyone concerned with the impact of drug policy on women.

Women have been the primary market since the birth of the modern pharmaceutical era in the 1940’s. While many drugs have unquestionably had a beneficial result, for millions of women, they have been nothing short of a disaster. Four decades ago, the women’s health movement was founded by women concerned with the safety of many drugs and devices aimed at women: DES, the Dalkon Shield, and the birth control pill, to name just a few.

As The Push to Prescribe details, women remain the most important market for the worldwide drug industry — and with good reason. Women are the primary users of medical services. We see doctors more frequently than men, and use more prescription drugs. Because women live longer, we have more chroic health problems, many of which are treated with prescription drugs. Even when we are not the direct consumers of medical services, we are often the family medical gatekeeper, usually the first person to suggest that a family member visit a doctor or take a drug.

All of this has not escaped the pharmaceutical industry’s notice. Much of the push to prescribe more drugs and expand indications for drug use has been aimed squarely at women.

Drug advertising, discussed in the book’s first chapter, is particularly critical for Americans because the U.S. and New Zealand (where drug ads are more limited), remain the only two countries where direct to consumer drug advertising is allowed. U.S. advertising is the lynchpin to creating global demand for a drug. And, many of the most visible ads are aimed squarely at women.

Today’s drug ads feature feminist language co-opted into clever cleavmarketing that plays on feminist principles of control, empowerment, and choice. The ads suggest that taking a prescription med is another step toward women’s self-determination, where we have the power to “ask our doctor” if a “drug is right for us.”

Women were the first to be targeted by so-called lifestyle drugs that turned natural events like menstruation, pregnancy, and menopause into medical conditions. And for the new and ever-growing market for what I call “aspirational drugs” — drugs that claim to “enhance” our lives by helping women to grow longer eyelashes or smooth wrinkles — plays into long entrenched gender stereotypes.

More troubling, as the book details, is how this new pharmaceutical universe has altered the regulatory landscape, Here, as in other countries, the agency charged with approving and monitoring drugs, the Food and Drug Administration (FDA) is increasingly aligned with industry.

With the globalization of Big Phama has come an industry push for regulatory standardization from country to country. The two most important changes have been in what industry calls “smaller regulation”, code for less regulation, and “risk management”, less pre-market safety evaluation with a shift to post-market surveillance, which most regulatory agencies, including the FDA are ill-equipped to handle. Health activists are increasingly concerned that these new policies compromise drug safety and point to the large number of new drugs that have recently been withdrawn from the market after safety issues surfaced.  As Ford points out, consumers have been turned into participants in what amounts to vast clinical trials, without either their consent or the necessary safety information. Because women are the biggest users of prescription drugs, any weakening of drug regulations put women at greater risk.

As The Push To Prescribe makes vividly clear, women have a critical role to play in the shaping of future drug policy. And any policy that fails to include not just what’s right for pharma, but what’s truly right for us does far more harm than good.

The Push To Prescribe is available from The Women’s Press (www.womenspress.ca) and, soon, from Amazon.

Ann Pappert is a freelance writer and journalist specializing in women's health and healthcare policy. Her work has appeared in major media in the U.S. and Canada and she has been a consultant on women's health to the World Health Organization and the Canadian government. She is based in New York City.