In a social-media video, an elephant stands in the sunshine with its head raised to the sky. As the animal swings its heavy trunk in vigorous circles, text on the screen reads: “My husband after taking Viagra from Rocky.”
This ad, from online pharmacy service Rocky Health Inc., began running on online platforms Facebook and Instagram last October. But while its prurient humour may be distasteful to some, there is a deeper issue with this promotion: By promising customers that Viagra will allow them to “say goodbye to ED,” or erectile dysfunction, Rocky is running afoul of Canadian laws about drug advertising.
A number of the ads focused on a booming category of prescription medications: GLP-1s, which can help manage type 2 diabetes or aid in weight loss.Supplied
These kinds of direct-to-consumer messages are common in the United States. But in Canada they are restricted: Ads that feature the name of a prescription drug cannot say what it does, and vice versa. For example, an ad encouraging someone to talk to their doctor about erectile dysfunction cannot also name that little blue pill.
Rocky is far from the only company skirting these rules. With the proliferation of telehealth services in Canada in recent years, some in-demand medications – including blockbuster GLP-1 drugs that are revolutionizing the weight-loss industry – are being advertised more frequently and aggressively than ever, with the promise of discreet shipping to people’s homes.
The Globe and Mail reviewed the advertising library of Meta Platforms Inc., which owns Facebook and Instagram, and found dozens of examples of ads that appeared to contravene Canadian regulations from online prescription services and virtual pharmacies – including from Rocky Health Inc., Pocketpills and its subsidiary DooÜ Health Ltd., Felix Health Inc., Essential Clinic, Kinro Health Inc., Jack & Jill Health Inc. and Phoenix Digital Health Inc., which owns services under the Phoenix and Raven brands.
An ad for Pocketpills shows an image of an Ozempic injection pen with the caption, 'Lose weight with confidence!' next to a strong-arm emoji.Supplied
In many cases, the companies removed the ads after receiving questions about them from The Globe.
In a statement, Health Canada spokesperson Joshua Coke wrote that the department has “taken action on several online pharmacies that were engaged in non-compliant advertising of prescription drugs,” including examples identified by The Globe.
Preventing advertisers from saying what a drug is meant to treat may seem like an odd technicality to some – after all, the effects of drugs such as Ozempic have been widely publicized. But experts say such Canadian rules are a crucial bulwark against a deluge of marketing messages that do not put patient safety first.
“Of course, the public should have access to information on prescription-only medicines,” said Barbara Mintzes, a professor in pharmacy at The University of Sydney’s Faculty of Medicine and Health. Prof. Mintzes, who is Canadian, studies pharmaceutical policy and how advertising affects the prescribing and use of medications. “But you hope that people are able to access sources of information that are evidence-based and neutral – that are not trying to sell them a product, but are trying to give them an overview of: What do we know about what this product does in the human body?”
The advertisements The Globe reviewed frequently promoted prescription medications as solutions for various health concerns.
Experts say Canadian rules are a crucial bulwark against a deluge of marketing messages that do not put patient safety first.Cole Burston/The Canadian Press
For example, an ad published by Phoenix Canada promised users could “say goodbye to stubborn weight! Get prescribed Mounjaro online by a licensed doctor.” The promoted post began running in January but has since disappeared from the Meta ad library.
In a statement, Phoenix wrote that it regularly reviews ads before and after launch, and that it removed one of the examples cited by The Globe before any external inquiry.
Supplied
Another, from Felix, showed an image of a drug identified as Finasteride, and urged potential customers “to prevent further hair loss before it is too late!” An ad from Jill Health promised longer eyelashes. “Book your online consult and see if Latisse is right for you,” it said.
Felix chief executive officer Kyle Zien wrote in a statement to The Globe that the ad was “published in error” and that its removal demonstrated “the efficacy of our review and audit processes.”
Ahmad Elkalza, CEO of Jill’s parent company, said his team reviewed the Latisse ad and paused it. “Our goal is always to provide accessible health care while maintaining the highest standards of regulatory compliance,” Mr. Elkalza wrote to The Globe.
A number of the ads focused on a booming category of prescription medications: GLP-1s, which can help manage type 2 diabetes or aid in weight loss.
For example, an ad for Pocketpills showed an image of an Ozempic injection pen with the caption, “Lose weight with confidence!” next to a strong-arm emoji. Ads for its subsidiary DooÜ Health included similar images with messages such as “55% OFF your weight loss assessment” and “Dad Bod to God Bod.” An ad for Raven showed a video of Meghan Trainor talking about her health, saying the pop star was sharing her experience with Mounjaro and encouraging viewers to “find weight loss treatments” on its website.
In many cases, companies removed certain ads after receiving questions about them from The Globe.Supplied
But the drugs’ exact use is important. For example, medications Zepbound and Wegovy are indicated for weight loss on their label, while Ozempic is approved primarily for diabetes. Health Canada prohibits companies from promoting other so-called off-label uses.
Advertising a drug’s name and a use that is off-label is “a double whammy,” said Patrick Massad, commissioner of the Pharmaceutical Advertising Advisory Board (PAAB), an organization that is independent from Health Canada and that reviews drug advertising to ensure compliance.
Traditionally, PAAB has focused on ads from drug manufacturers – who fund the organization and who, in the past, have been the primary source of medication advertising. But as new telehealth companies promote their services, PAAB has alerted Health Canada to ads that seem to cross the line.
By promising customers that Viagra will allow them to 'say goodbye to ED,' or erectile dysfunction, Rocky is running afoul of Canadian laws about drug advertising.Supplied
“We’ve learned that the problem is much bigger than the one or two that we hear about – because when you reach out to one entity, it’s like, ‘Why am I being singled out?’” Mr. Massad said.
Companies can face fines and other penalties if found guilty in court for violations of the law, but Health Canada cannot itself issue monetary penalties. Typically, the government’s approach has been to work with companies to address non-compliance.
Mr. Massad supports that collaborative approach, but he said PAAB has told Health Canada that a greater variety of enforcement options would motivate companies to follow the rules. “So that there’s something between ‘Stop doing this,’ and someone going to jail,” Mr. Massad said.
“The department expects regulated parties to comply with legislative and regulatory requirements and take timely and appropriate action to address any non-compliance,” Health Canada’s Mr. Coke wrote.
Some online health companies seem to be following the rules. Online services hims & hers, Juniper and MedExpress all had ads in the Meta library that appeared to comply with Canadian regulations.
While most Canadians still prefer to visit a pharmacy in person, use of virtual platforms is growing. According to a survey conducted last spring by the Canadian Pharmacists Association (CPhA), one-third of Canadians now use online pharmacy services.
Felix chief executive officer Kyle Zien wrote in a statement to The Globe that this ad was 'published in error.'Supplied
“COVID was the time when people really saw how telehealth can actually be used,” said Sadaf Faisal, CPhA’s acting vice-president of public and professional affairs. “And then we saw these platforms, right after COVID, they started surging.”
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Some people in the industry say Canada’s regulations need to evolve.
“These rules are out of date,” said Raj Gulia, CEO of Pocketpills, who believes it is “insane” that ads cannot say what a drug does. “Information should be available.”
Health Canada has told his company to restrict information on its website about conditions that certain drugs treat, even though American websites are not similarly limited, and anyone can find information with a quick Google search or from an AI assistant.
“We’re not a random guy or a TikToker putting information out there about a medication,” said Mr. Gulia, who is a registered pharmacist.
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But Prof. Mintzes argues advertising is not the same as the kind of balanced information patients would usually receive from a health care professional – which covers the drawbacks and advantages of prescription medications.
“You get the impression that you are ordering a consumer product,” she said, after reviewing an example of an ad for Mounjaro published by Phoenix Canada. “There’s no sense that this is a medicine; that there might be a potential to suffer harm from it; and that certainly there are groups of people for whom it should not be used.
“All of that is missing from this picture.”