Truth and direct-to-consumer advertising in Canada of DUKORAL for traveler’s diarrhea prevention

The ability to practise as a primary care physician in a nonconflicted, evidence-based manner can be challenging within a practice environment full of questionable online information bombarding not only patients but also providers. Unfamiliar with specific interventions, physicians might rely too heavily on easily accessible messages created and tailored by the corporate world to put the private interests of shareholders ahead of the public interest. One understudied area of concern is the effect of direct-to-consumer advertising (DTCA) on physicians and other health providers,1 both directly and through manufactured demand from patients for drugs and vaccines that might not be medically necessary.2 While Canada has weakly prohibited the DTCA of prescription drugs,3 it has not prohibited DTCA for immunizing agents.4 While leakage of DTCA enters the Canadian market through American sources using cable television and the Internet, vaccines uniquely approved in our country but not in the United States provide a natural experiment on the outcome of domestic DTCA’s effect on Canadian physicians, nurses, and pharmacists. The purpose of this article is to historically review a travel-related vaccine (ie, DUKORAL) that is currently being overprescribed by primary care physicians in Canada despite long-standing evidence-based guidelines demonstrating its lack of efficacy