Advertisements for medicines in leading medical journals in 18 countries: a 12-month survey of information content and standards

An investigation into the pharmaceutical advertising in Iranian medical journals

Background

Pharmaceutical advertising is not only considered a key factor in the successful launch of pharmaceutical products, but is also an important source of public health information with a significant impact on consumer choice and behavior. Nowadays, advertising has become the broadest dissemination channel for various products, including medicines, which may ultimately lead to the generalization of self-treatment or mistreatment. Improper drug promotion can exacerbate unhealthy outcomes by making false or misleading claims, using inferior references, and failing to meet international standards. This study aimed to examine the requirements for pharmaceutical advertising from regulatory perspective and the compliance of Iranian pharmaceutical advertisements to related standards and guidelines. It is limited to print advertisements in Iranian national medical journals and magazines.

Method

The present study is a descriptive–analytical study using bibliometric methods. As a first step, a comprehensive review of the national and international regulations on drug advertising was conducted and a comparison of different regulations was provided. In the second step, a checklist was created to evaluate the compliance of drug advertising with the extracted regulations.

Result

The results of the present study show that the claims made in Iranian drug advertisements are 29.10% valid, 27.67% exaggerated, 23.10% controversial, 12.62% misleading, and 6.8% invalid. In general, we found that most medical advertisements in Iranian journals and magazines comply with national laws and regulations. However, many international requirements are not met in these advertisements.

Conclusions

Although we found that printed medical advertisements in Iran are roughly compliant with national regulations, there is still a long way to achieve full compliance. Monitoring processes should be improved and clearly defined penalties should be set to avoid misleading claims and their likely health consequences. It is very important in Iran to update the existing rules and regulations for medical advertisements according to international guidelines. More careful monitoring of the content of advertising and the accuracy of claims are also needed.

Medicines Information and the Regulation of the Promotion of Pharmaceuticals

Many factors contribute to the inappropriate use of medicines, including not only a lack of information but also inaccurate and misleading promotional information. This review examines how the promotion of pharmaceuticals directly affects the prescribing and use of medicines. We define promotion broadly as all actions taken directly by pharmaceutical companies with the aim of enhancing product sales. We look in greater detail at promotion techniques aimed at prescribers, such as sales representatives, pharmaceutical advertisements in medical journals and use of key opinion leaders, along with the quality of information provided and the effects thereof. We also discuss promotion to the public, through direct-to-consumer advertising, and its effects. Finally, we consider initiatives to regulate promotion that come from industry, government and nongovernmental organizations.

One more case of the double standard: discrepancies between drug information provided to Brazilian and American physicians

Several factors have been identified as exerting influences upon the physician prescribing behaviour. Some studies on this issue emphasize the role played by the sources of information available to physicians. A number of reports have been published on the influence of marketing strategies upon these professionals. Such strategies include advertisements in medical journals, detail-men, free samples, distribution of folders, leaflets and gifts, as well as support to congresses and symposia. The impact of the 'special' relationships that manufacturers cultivate with health authorities and physicians and considered opinion-makers should also not be underestimated. This study aimed to evaluate the quality of information provided by a widely-used Brazilian prescribing guide, the Dicionário de Especialidades Farmacêuticas(DEF) on the 44 best-selling pharmaceutical products in Brazil. WHO criteria for drug information were used as parameters of which information is of such outstanding importance that it should be included in any informative material offered to physicians. The information in the DEF was compared with that available for the same products in the PDR (Physicians' Desk Reference) and USP-DI (Drug Information for the Health Care Professional) used by prescribers in USA. Results show the absence of important data from the Brazilian manual, including contraindications, adverse effects and drug interactions. These findings suggest that poor quality information may potentially contribute to the irrational use of drugs. Copyright (c) 2000 John Wiley & Sons, Ltd.

Quality of pharmaceutical advertising and gender bias in medical journals (1998-2008): a review of the scientific literature

OBJECTIVE

To review the scientific literature on pharmaceutical advertising aimed at health professionals in order to determine whether gender bias has decreased and the quality of information in pharmaceutical advertising has improved over time.

METHODS

We performed a content analysis of original articles dealing with medical drug promotion (1998-2008), according to quality criteria such as (a) the number, validity and accessibility of bibliographic references provided in pharmaceutical advertising and (b) the extent to which gender representations were consistent with the prevalence of the diseases. Databases: PUBMED, Medline, Scopus, Sociological Abstract, Eric and LILACS.

RESULTS

We reviewed 31 articles that analyzed advertising in medical journals from 1975-2005 and were published between 1998 and 2008. We found that the number of references used to support pharmaceutical advertising claims increased from 1975 but that 50% of these references were not valid. There was a tendency to depict men in paid productive roles, while women appeared inside the home or in non-occupational social contexts. Advertisements for psychotropic and cardiovascular drugs overrepresented women and men respectively.

CONCLUSIONS

The use of bibliographic references increased between 1998 and 2008. However, representation of traditional male-female roles was similar in 1975 and 2005. Pharmaceutical advertisements may contribute to reinforcing the perception that certain diseases are associated with the most frequently portrayed sex.

Drug advertisements published in Indian Medical Journals: Are they ethical?

CONTEXT

It is observed in studies done for western medical journals that insufficient information related to drug is usually provided in the drug advertisements published in them.

AIMS

As data for advertisements published in Indian Medical Journals were lacking, this study was designed with the aim of evaluating drug advertisements published in Indian Medical Journals for adequacy of information on drug and references given to support the claim made in the advertisements.

SETTINGS AND DESIGN

Cross-sectional survey.

METHODS AND MATERIALS

All medical journals related to clinical practice subscribed by the Central Library of Government Medical College, Surat, (Indian Journal of Pediatrics [IJP], Indian Pediatrics [IP], Journal of the Association of Physicians of India [JAPI], Journal of Indian Medical Association [JIMA], Indian Journal of Critical Care Medicine [IJCCM], Indian Journal of Medical and Pediatric Oncology [IJMPO], Indian Journal of Gastroenterology [IJG], Indian Journal of Ophthalmology [IJO], and Journal of Obstetrics and Gynecology of India [JOGI] were evaluated for adequacy of reporting of various parameters in drug advertisements published in these journals on the basis of "World Heath Organization (WHO)" criteria. References mentioned to support claims were also evaluated.

STATISTICAL ANALYSIS USED

Descriptive statistics was used to describe data as frequencies, percentages, and 95% confidence interval around the percentage.

RESULTS

Generic name was mentioned in 90% advertisements. Indications were mentioned in 84% advertisements. Dose, precautions, and contraindications were mentioned in 24%, 17%, and 16% advertisements, respectively. Adverse effects and postal address of pharmaceutical company was mentioned in 19% and 74% advertisements, respectively. Price was mentioned in only 5% advertisements. Only 28% claims were supported by references. Most common references were Journal articles (75%).

CONCLUSION

Drug advertisements published in Indian Medical Journals are poor in reporting various parameters according to WHO criteria.

[The influence of the advertising in the medication use in a group of elderly attended in a primary health care unit in Aracaju (Sergipe, Brasil)]

The growth of the Brazilian elderly people has led to a trend to an increase in the medication use. The inadequate use of drugs can be induced by some factors, like advertisement, with the risk of damaging the user's health. The objective of the study was to evaluate the advertisement influence in medication use in a group of elderly patients in a primary health care unit in Aracaju, Sergipe, Brazil. 230 elderly aging over 60 years with both genders had been interviewed from April to June of 2007. The majority of the interviewees (73%) has at least a chronic health condition and 73.9% consumed regularly at least one medication. 17.8% of the sample informed to use medication motivated by publicity influence; 2.2% had considered that the medication never cause damages and 6.5% believed that always it makes well. In this study, correlations have been made and demonstrated that those who presented a higher level of consumption influenced by advertising also think that drugs used are always beneficial and vice versa (p= 0.04). The data showed that part of elderly suffered influence of advertisement to medication use, and are not conscious of risks involved.

Quality of pharmaceutical advertisements in medical journals: a systematic review

Background

Journal advertising is one of the main sources of medicines information to doctors. Despite the availability of regulations and controls of drug promotion worldwide, information on medicines provided in journal advertising has been criticized in several studies for being of poor quality. However, no attempt has been made to systematically summarise this body of research. We designed this systematic review to assess all studies that have examined the quality of pharmaceutical advertisements for prescription products in medical and pharmacy journals.

Methods and Findings

Studies were identified via searching electronic databases, web library, search engine and reviewing citations (1950 – February 2006). Only articles published in English and examined the quality of information included in pharmaceutical advertisements for prescription products in medical or pharmacy journals were included. For each eligible article, a researcher independently extracted the data on the study methodology and outcomes. The data were then reviewed by a second researcher. Any disagreements were resolved by consensus. The data were analysed descriptively. The final analysis included 24 articles. The studies reviewed advertisements from 26 countries. The number of journals surveyed in each study ranged from four to 24 journals. Several outcome measures were examined including references and claims provided in advertisements, availability of product information, adherence to codes or guidelines and presentation of risk results. The majority of studies employed a convenience-sampling method. Brand name, generic name and indications were usually provided. Journal articles were commonly cited to support pharmaceutical claims. Less than 67% of the claims were supported by a systematic review, a meta-analysis or a randomised control trial. Studies that assessed misleading claims had at least one advertisement with a misleading claim. Two studies found that less than 28% of claims were unambiguous clinical claims. Most advertisements with quantitative information provided risk results as relative risk reduction. Studies were conducted in 26 countries only and then the generalizability of the results is limited.

Conclusions

Evidence from this review indicates that low quality of journal advertising is a global issue. As information provided in journal advertising has the potential to change doctors' prescribing behaviour, ongoing efforts to increase education about drug promotion are crucial. The results from our review suggest the need for a global pro-active and effective regulatory system to ensure that information provided in medical journal advertising is supporting the quality use of medicines.

Accuracy of drug advertisements in medical journals under new law regulating the marketing of pharmaceutical products in Switzerland

Background

New legal regulations for the marketing of pharmaceutical products were introduced in 2002 in Switzerland. We investigated whether claims in drug advertisements citing published scientific studies were justified by these studies after the introduction of these new regulations.

Methods

In this cross-sectional study, two independent reviewers screened all issues of six major Swiss medical journals published in the year 2005 to identify all drug advertisements for analgesic, gastrointestinal and psychopharmacologic drugs and evaluated all drug advertisements referring to at least one publication. The pharmaceutical claim was rated as being supported, being based on a potentially biased study or not to be supported by the cited study according to pre-specified criteria. We also explored factors likely to be associated with supported advertisement claims.

Results

Of 2068 advertisements 577 (28%) promoted analgesic, psychopharmacologic or gastrointestinal drugs. Among them were 323 (56%) advertisements citing at least one reference. After excluding multiple publications of the same drug advertisement and advertisements with non-informative references, there remained 29 unique advertisements with at least one reference to a scientific study. These 29 advertisements contained 78 distinct pairs of claims of analgesic, gastrointestinal and psychopharmacologic drugs and referenced studies. Thirty-seven (47%) claims were supported, 16 (21%) claims were not supported by the corresponding reference, and 25 (32%) claims were based on potentially biased evidence, with no relevant differences between drug groups. Studies with conflict of interest and studies stating industry funding were more likely to support the corresponding claim (RR 1.52, 95% CI 1.07–2.17 and RR 1.50, 95% CI 0.98–2.28) than studies without identified conflict of interest and studies without information on type of funding.

Conclusion

Following the introduction of new regulations for drug advertisement in Switzerland, 53% of all assessed pharmaceutical claims published in major medical journals are not supported by the cited referenced studies or based on potentially biased study information. In light of the discrepancy between the new legislation and the endorsement of these regulations, physicians should not trust drug advertisement claims even when they seem to refer to scientific studies.

How is research evidence used to support claims made in advertisements for wound care products?

AIMS AND OBJECTIVE

To investigate the amount, type and accuracy of citations use in support of product related claims from advertisements of wound care products.

BACKGROUND

Although articles submitted to most medical journals are subjected to peer review, such scrutiny is often not required for the content of advertisements.

DESIGN

A contents survey of advertisements from two wound care journals (Journal of Wound Care and Ostomy Wound Management) from 2002-2003 and the British Medical Journal, 2002-2003.

METHODS

Data collected from advertisements included identification of product related claims made and any corresponding citations. Where journal articles were cited to support claims, the articles were obtained. Where data on file were cited, this material was requested. In each case the accuracy of claims in relation to the content of the supporting citation was assessed.

RESULTS

The use of citations to support product related claims was infrequent in advertisements from wound care journals, where 35% of advertisements containing a product related claim also contained at least one citation, compared with 63% of advertisements from the British Medical Journal. Of citations that were supplied, journal articles were less common in the wound journals (40% vs. 73% in the British Medical Journal) and data on file more common (38% vs. 6% in the British Medical Journal). Where journal articles were obtained, 56% of claims in the wound care journals advertisements were not supported by the cited article, compared with 12% of claims in the British Medical Journal.

CONCLUSION

The wound journals advertised predominantly medical devices. The use and accuracy of referencing in advertisements from wound care journals was poor.

RELEVANCE TO CLINICAL PRACTICE

Nurses have increasing responsibilities for the prescribing of both drugs and devices, which must be accompanied by the ability to interpret marketing materials and research evidence critically. Nurse educators must ensure that nurse education generally and nurse prescriber training particularly, builds skills of information retrieval and critical appraisal.

A content analysis of advertisements for psychotherapy workshops: implications for disseminating empirically supported treatments

This study involved a content analysis of 261 unique advertisements for psychotherapy workshops that appeared in two bimonthly clinical magazines, Psychotherapy Networker and Counselor, during a 2-year period. Two independent judges coded each advertisement and documented the type and prevalence of advertising appeals used. From the seminal diffusion of innovations model, Rogers' (2003) five perceived characteristics of innovations found to influence adoption in diverse fields were not well represented in these workshops appeals, appearing less than 10% each. Few advertisements cited specific empirically supported treatments or presented any evidence of treatment effectiveness beyond expert testimonials. The most frequently noted appeals were to benefit the clinician (e.g., earning education credit or developing skills), characteristics that enhance credibility of the workshop (e.g., reference to storied history or mention of faculty), and features of the advertisements itself (e.g., use of superlatives and exclamation points). Promotional strategies to advertise psychotherapy workshops can be used to inform the dissemination of empirically supported treatments.

["When the ad is good, the product is sold." The MonitorACAO Project and drug advertising in Brazil]

This paper presents an analysis on drug advertising in Brazil, based on the final report of the MonitorACAO Project, by the group from the Universidade Federal Fluminense, Niterói, Rio de Janeiro. Due to a partnership between the university and the National Agency for Health Surveillance (ANVISA), drug advertisements were monitored and analyzed for one year, according to the methodology defined by the Agency. The samples were collected in medical practices and hospitals, drugstores, pharmacies and in scientific magazines. TV and radio programs were monitored, in the case of OTC drugs. 159 advertisements referring to pharmaceuticals were sent to ANVISA,from a total of 263 irregular ads analyzed between October 2004 and August 2005. The main problems found were the poor quality of drug information to health professionals, as well as misleading drug use to lay population. Based on the results of this project and on other studies, the banning of drug advertising in Brazil is proposed.

Claims in advertisements for antihypertensive drugs in a Dutch medical journal

BACKGROUND

Advertising claims must not conflict with the official summary of product characteristics. After a drug has been approved, new clinical evidence may become available.

AIMS

To determine how the pharmaceutical industry deals with evolving clinical evidence in advertising claims for antihypertensive drugs, and whether such pharmaceutical promotion is up to standard.

METHODS

We examined all advertisements from the Dutch Journal of Medicine published between 1996 and 2004. We judged whether claims were in agreement with the information available from the summary of product characteristics or evidence from cited clinical trials. Subsequently, we reviewed whether these claims had been assessed by the Code of Practice authority.

RESULTS

We identified 50 unique advertisements with, in total, 492 appearances for 16 antihypertensive drugs. Claims of blood pressure lowering and convenient use were all judged to be sufficiently substantiated. For calcium-channel blockers, insufficiently supported safety claims had been made in three cases (41 appearances). Claims suggesting effects on long-term outcomes started in 1999 for angiotensin II receptor blockers, and were made during the whole period for several other antihypertensive drugs. In 16 cases (135 appearances), such claims were not supported by the available information. Some claims were premature, others transferred results from a specific patient group to the general population of hypertensive patients. Only two cases were reviewed by the Code of Practice authority.

CONCLUSIONS

Overall, 35% of the advertisements for antihypertensive drugs contained suggestive claims not supported by the offered evidence. The current system of self-regulation cannot ensure that pharmaceutical promotion is always accurate, balanced and evidence-based.

Food and Drug Administration surveillance of dermatology-related and nondermatology-related prescription drug advertising in the USA, 2000-2003

BACKGROUND

Spending on advertising of prescription medicines in the U.S.A. is increasing by nearly a billion dollars yearly. The Food and Drug Administration (FDA) is legally mandated to regulate pharmaceutical advertising in the U.S.A. Prior studies have documented inaccuracies in pharmaceutical advertisements, in the U.S.A. and the rest of the world.

OBJECTIVES

To assess trends in FDA surveillance of dermatology-related prescription drug advertising, and to investigate pharmaceutical companies' responses to FDA regulatory actions.

METHODS

We analysed all FDA citations of prescription drug advertisements issued during 2000-2003, and responses from cited companies to our mailed requests for follow-up information.

RESULTS

Twenty-four dermatology-related drugs from 21 companies accounted for 30 (15.2%) of the 198 letters sent by the FDA; of these, 18 letters cited advertisements or promotions of these medications for dermatology-related uses. The most common violation cited overall was insufficient communication of risk (32.4% overall, 33.9% dermatology-related). Most FDA letters cited physician-targeted advertising (71.6% overall, 62.1% dermatology-related). The number of dermatology-related letters sent declined by 69.2% from 2000 (n=13) to 2003 (n=4), paralleling the 69.6% decline in the total number of letters sent (n=79 in 2000, n=24 in 2003). Compared with 2000, the FDA took longer to issue citation letters in 2003 for advertisements overall [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.27-0.72, P=0.001], although this trend was not present for dermatology-related advertisements (HR 1.12, 95% CI 0.39-3.29, P=0.83). Eight of the 16 companies (50%) that received requests from the authors for information replied. Seven of the eight (87.5%) reported complying with FDA requests to discontinue the cited advertisements, while one (12.5%) reported disagreeing with the citation and successfully clarifying the issue with the FDA.

CONCLUSIONS

Dermatology-related advertisements accounted for 15.2% of FDA citations of pharmaceutical advertisements between 2000 and 2003. Recent controversy over pharmaceutical advertising may lead to changes in pharmaceutical advertising practices and surveillance of pharmaceutical advertising in the U.S.A.

Advertising in dermatology journals: journals' and journal editors' policies, practices, and attitudes

BACKGROUND

Problems in some advertisements in medical journals, including dermatology journals, have been identified in various studies. Examples have included poorly supported claims, failure to balance claims of efficacy with potential adverse effects of a drug, and slogans that recommend prescribing a drug for groups of patients different from those assessed in a referenced study.

OBJECTIVE

We sought to assess dermatology journals' and dermatology journal editors' policies, practices, and attitudes toward prescription-medicine advertising in dermatology journals.

METHODS

We searched dermatology journals' paper copies and World Wide Web sites for statements of advertising policy and sent surveys to dermatology journal editors.

RESULTS

Of 22 journals, 8 (36.4%) had an advertising policy published in a paper copy or a World Wide Web site. Of 17 editors (70.8%) from 17 journals (77.3%) who responded to the survey, 3 reported having an advertising policy; these policies were also identified in searches of paper copies or World Wide Web sites. Two editors whose journals each had a published policy reported not having one. In all, 7 editors (41.2%) reported that they or other physician members of the editorial board reviewed advertisements before publication in the previous year. A total of 8 editors (47.1%) agreed somewhat or strongly that advertisements in medical journals, including dermatology journals, generally present information that is accurate, and 12 (70.6%) agreed somewhat or strongly with the same statement regarding advertisements appearing in their own journal. In all, 12 editors (70.6%) agreed somewhat or strongly that advertisements should be reviewed for accuracy by the editorial staff before publication, and 3 (17.6%) agreed somewhat or strongly that advertisements should be reviewed for accuracy before publication in a peer-review process similar to that used for submitted manuscripts.

LIMITATIONS

This study did not assess processes by which editors or other members of editorial or publishing staffs review advertisements before publication.

CONCLUSIONS

Policies, practices, and attitudes toward advertising vary among dermatology journals and dermatology journal editors. Journals, especially those without a policy, should consider establishing policies to separate and, therefore, minimize conflicts of interest between editorial and business aspects of publication.

Communicating safety information to physicians: an examination of dear doctor letters

PURPOSE

Recent research suggests that letters to healthcare providers may not effectively communicate safety-related information. This study examined whether content, organization, and formatting of dear doctor letters (DDLs) influences physicians' responses to the letters.

METHODS

Drugs with warning label changes during 2000 and 2001 were identified, and corresponding DDLs were obtained. Letters were coded for content, organization, and formatting. Ten physicians rated letters on presentation, criticalness of the information, and likelihood of changing practice as a result of the letter. Areas of deficiency were identified. The relationships between key characteristics of the letters and physicians' ratings were examined using correlations; reliability of physicians' ratings was estimated using generalizability theory.

RESULTS

For 2000 and 2001, 124 drugs were identified as having had changes to the warning section of the label; DDLs were sent in 32 (25.8%) instances. Letters varied in terms of the placement of key information, use of formatting, and length. Physicians' ratings suggested 25% of the letters were deficient in clarity, 28% in readability, 36% in the ratio of relevant information to supporting information, 36% in key information easily discernable, and 28% in overall effectiveness of communication. Letters with formatting highlighting key information were preferred. Letter length and placement of key information were not correlated with physicians' ratings.

CONCLUSIONS

Many DDLs do not communicate labeling changes clearly and effectively. If DDLs are used to communicate safety information to physicians, special formatting and explicit wording should be used to emphasize new information.

Antibiotic drug advertising in medical journals

Advertising is a leading strategy for drug promotion. We analysed 779 advertisements in 24 medical journals, 25% of which featured antibiotics. Antibiotic advertisements showed differences compared to those of other drugs. None addressed the issue of antibiotic resistance. Efforts to prevent antibiotic resistance should take antibiotic advertising into consideration.

The role of drug and therapeutics committees

PURPOSE

Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers.

DESIGN/METHODOLOGY/APPROACH

Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. "Patient awareness" was studied by content analysis.

FINDINGS

In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development.

ORIGINALITY/VALUE

The importance of "patient awareness" within DTCs must be further explored.

Psychoactive drug advertising: a comparison of technical information from three countries: Brazil, United States and United Kingdom

CONTEXT AND OBJECTIVE

Studies carried out in the 1970s and 1980s showed that there were country-dependent disparities in the information given for the same drug in medical advertisements. National and international regulations have been published to do away with such disparities and to foster the rational use of drugs. The purpose of this study was to compare the information contained in psychoactive drug advertisements published in psychiatric journals in Brazil, the United States and the United Kingdom, before and subsequent to the publication of the United States Export Act, in 1986, the WHO criteria, in 1988, and the Brazilian Sanitary Surveillance Agency Resolution no. 102, in 2000. TYPE OF STUDY AND SETTING: Content analysis, at Centro Brasileiro de Informações sobre Drogas Psicotrópicas (Cebrid).

METHODS

We gathered advertisements from Brazilian, American and British psychiatry periodicals published before and after each ruling. We analyzed a total of twenty-four Brazilian advertisements that were for the same psychoactive drugs as advertised in American and/or British publications from the same period.

RESULTS

We observed that Brazilian advertisements omitted information on usage restrictions, such as contraindications, adverse reactions, interactions, warnings and precautions, and that such information was present in American and British advertisements.

CONCLUSIONS

The data suggest that disparities in the information given for the same drug still persist. The information depends on the country in which each drug is marketed. The legislation is insufficient for eradicating such disparities.

Are direct to consumer advertisments of prescription drugs educational?: comparing 1992 to 2002

We investigate the educational value of direct-to-consumer (DTC) prescription drug advertisements from 58 popular magazines published in 1992 and 2002. We find that the number of DTC prescription drug ads increased nine-fold from 1992 to 2002, while the advertisements for other health care products increased only slightly. We examine changes in 1992-2002 DTC prescription drug ads both quantitatively and qualitatively. We find that the educational value as it relates to serious medical conditions decreases over time based on the media logic that the primary purpose of advertisements is to promote consumption, rather than education. We enumerate and describe the media logic tactics employed, and find a statistically significant increase in the number of such tactics per ad in 2002.

Industry guidelines, laws and regulations ignored: quality of drug advertising in medical journals

PURPOSE

To document the quality of evidence base for marketing claims in prescription drug advertisements, to facilitate identification of potential targets for quality improvement.

METHODS

A sample of 1036 advertisements from four major Finnish medical journals published in 2002. Marketing claims were classified in four groups: unambiguous clinical outcome, vague clinical outcome, emotive or immeasurable outcome and non-clinical outcome. Medline references were traced and classified according to the level of evidence available. The statistical variables used in the advertisements were also documented.

RESULTS

The sample included 245 distinct advertisements with 883 marketing claims, 1-10 claims per advertisement. Three hundred thirty seven (38%) of the claims were referenced. Each claim could be supported by one reference or more, so the number of references analysed totalled 381, 1-9 references per advertisement. Nine percent of the claims implied unambiguous clinical outcomes, 68% included vague or emotive statements. Twenty one percent of the references were irrelevant to the claim. There was a fair amount of non-scientific and scientific support for the 73 unambiguous claims, but not a single claim was supported by strong scientific evidence. Vague, emotive and non-clinical claims were significantly more often supported by non-Medline or irrelevant references than unambiguous claims. Statistical parameters were stated only 34 times.

CONCLUSION

Referenced marketing claims may appear more scientific, but the use of references does not guarantee the quality of the claims. For the benefit of all stakeholders, both the regulatory control and industry's self-control of drug marketing should adopt more active monitoring roles, and apply sanctions when appropriate. Concerted efforts by several stakeholders might be more effective.

Men's emotional inexpressivity: advertising for psychotropic drugs in Scandinavian medical journals

Aim

Men's use of psychotropics and the portrayal of men in psychotropic drug advertising have been underresearched and undertheorized in past research on psychotropics. The focus on women's health as the primary target of medicalization and commodification has scanted the same processes for men. This study aims to illuminate the construction of patienthood in the patient portrayals of men's mental health.

Method

A quantitative and qualitative analysis was done of all the advertisements (N=366) for psychotropics that appeared in the national medical journal in Denmark, Finland, Norway, and Sweden in 2000.

Results

In the gender portryal of men in the psychotropic ads two images of men's patienthood were constructed: men's relational problems with family and men as victims of ontological insecurity.

Conflicts between commercial and scientific interests in pharmaceutical advertising for medical journals

In 1992, researchers from the University of California, Los Angeles, published a study on the scientific merit and validity of pharmaceutical advertisements in medical journals. Their results led them to conclude, provocatively, that many pharmaceutical advertisements contained deficiencies in areas in which the U.S. Food and Drug Administration had established explicit standards of quality. This article provides a detailed account of third-party reactions to the study following its publication in the Annals of Internal Medicine, as well as the implications for those involved, including the authors, editors, and publisher. The increasingly diverging interests between medical journal editors and publishers are also discussed and highlighted by two recent cases of editors' departures from prominent general-interest medical journals.

Anúncios de medicamentos em revistas médicas: ajudando a promover a boa prescrição?

Ante a inexistência de estudos no Brasil, este trabalho se propôs a fazer uma avaliação dos anúncios com base nos critérios sugeridos pela OMS e que deveriam incluir-se em qualquer material de divulgação. Foram avaliados todos os anúncios contidos nas edições de agosto/2000 a fevereiro/2001 do Jornal de Pediatria, Revista Brasileira de Medicina e Jornal Brasileiro de Medicina, averiguando a presença nos mesmos de: nome genérico, mecanismos de ação, efeito farmacológico, indicação, contra-indicação, posologia, reações adversas, interações, superdosagem, apresentação e fabricante/importador. Em um total de 1.774 páginas, 539 (30,4%) se destinavam a anúncios, compreendendo 649 ao todo. Nenhum dos critérios propostos pela OMS esteve presente em todas as propagandas, e apenas em cerca de 20% delas há referência a reações adversas, contra-indicações e interações. Os produtos mais anunciados foram antibióticos, hipotensores e os à base da associação de vários fármacos. Omitindo dados importantes, em especial contra-indicações, reações adversas e interações, os anúncios são tendenciosos, atendendo a propósitos mercadológicos, não sendo um meio que subsidie a prescrição e a utilização correta e segura dos produtos anunciados.

Direct-to-consumer advertisements for prescription drugs: what are Americans being sold?

BACKGROUND

Pharmaceutical companies spent US$1.8 billion on direct-to-consumer advertisements for prescription drugs in 1999. Our aim was to establish what messages are being communicated to the public by these advertisements.

METHODS

We investigated the content of advertisements, which appeared in ten magazines in the USA. We examined seven issues of each of these published between July, 1998, and July, 1999.

FINDINGS

67 advertisements appeared a total of 211 times during our study. Of these, 133 (63%) were for drugs to ameliorate symptoms, 54 (26%) to treat disease, and 23 (11%) to prevent illness. In the 67 unique advertisements, promotional techniques used included emotional appeals (45, 67%) and encouragement of consumers to consider medical causes for their experiences (26, 39%). More advertisements described the benefit of medication with vague, qualitative terms (58, 87%), than with data (9, 13%). However, half the advertisements used data to describe side-effects, typically with lists of side-effects that generally occurred infrequently. None mentioned cost.

INTERPRETATION

Provision of complete information about the benefit of prescription drugs in advertisements would serve the interests of physicians and the public.

The construction of gender and mental health in Nordic psychotropic-drug advertising

The authors examine the advertisements for psychotropic drugs in the major medical journals of Denmark, Finland, Norway, and Sweden in 1975, 1985, and 1995, with the object of illuminating the gender construction of the portrayed user. Using both a longitudinal and a cross-sectional approach, the study looked for a common Nordic gender display and whether it varied over time. The Nordic journals clearly conveyed a message that psychotropics are a gendered product, but without any uniform pattern. In 1975, men dominated the gender portrayals in Finland and Denmark, and women in Norway and Sweden. In 1985, the pattern was reversed: women dominated in Finland and Denmark, and men in Sweden and Norway. By 1995, the advertisements were mainly for antidepressants, and women were portrayed as the predominant users in Denmark, Finland, and Norway; the Swedish journal displayed couples only. In advertisements with dual-gender positions, however, the focus was on the female; they showed that the drug would assist her in fulfilling the expected supportive female gender behavior.

[(Mis)information on drugs: the double standard practiced by pharmaceutical companies]

Different factors have been identified as influencing drug prescribers. Some studies emphasize the role played by sources of information available to physicians. Reports have been published on the influence of marketing strategies on these health professionals. Such strategies include advertisements in medical journals, sales representatives, free samples, leaflets, distribution of gifts and prizes, etc. The research reported here aimed to identify information provided by a commonly used Brazilian prescription handbook, the Dicionário de Especialidades Farmacêuticas (DEF), in relation to the 44 most frequently sold pharmaceutical products in Brazil, using as parameters the WHO guidelines for information to be included in informative materials offered to physicians. The information was then compared to that included in the PDR (Physicians' Desk Reference) and USP-DI (Drug Information for the Health Care Professional) used by prescribers in the United States. The results showed lack of data in the Brazilian publication (contraindications, side effects, drug interaction), suggesting lack of reliability in prescription quality and thus in the ultimate utilization of drugs.

Information contents of drug advertisements: an Indian experience

OBJECTIVE

To critically analyze the drug information contained in Indian pharmaceutical advertisements.

DESIGN

Analysis of pharmaceutical advertisements supplied by drug representatives (DRs) to prescribers from July 1, 1995, to June 30, 1996.

SETTING

A university-affiliated urban teaching hospital in India.

PARTICIPANTS

585 pharmaceutical ad pamphlets.

MAIN OUTCOME MEASURES

The ads supplied by DRs to physicians in different clinical departments of the hospital were collected. These were distributed to different systems/categories and a special reference to fixed-dose drug combinations was given. The drug information contained in these ads was evaluated by using a checklist, framed by incorporating the World Health Organization ethical guidelines for medicinal drug promotion and some relevant items from other studies.

RESULTS

The most frequently occurring ads were for antimicrobial agents. The ads on fixed-dose drug combinations constituted 37.9% of the total. More than 85% of the ads mentioned the generic name, brand name, contents, and pharmaceutical dosage forms, as well as the name and address of the company. The information concerning adverse effects, precautions, contraindications, warnings, major interactions, ingredients known to cause problems, pharmacology, drug overdose, references, drug storage, and cost was present in less than 40% of these ads.

CONCLUSIONS

There has been inadequate information in pharmaceutical ads supplied by DRs to the physicians in India. The current scenario could be improved by formulating some definite legislative guidelines for the minimum level of information to be included in pharmaceutical ads and adhering to that legislation.

Tranquillizers and Hypnotics-Sedatives as a Social Problem in Finland and Sweden

This paper documents debates over benzodiazepine-based tranquillizers and hypnotics-sedatives in Finland and Sweden during the period of 1981–1994. It looks at the emergence of benzodiazepine dependence as a social problem in medical journals, newspapers, magazines, and administrative documents. The paper analyses the role of the media, experts, authorities, the drug industry, and patient organizations in the claims-making process. It compares Finnish and Swedish cases and locates the position of patients as self-conscious actors in the debates.

In Sweden there was genuine debate where physicians, medical authorities, and patient organizations took part. The public media had an important role in defining the status of the problem. The Finnish discussion was composed of single articles or debate articles, but did not form an interactive debate. Finnish authorities did not debate publicly with physicians or other actors. In the Swedish debate patients took part as self-conscious actors, while patients were missing from the Finnish debate.

Finally, the author considers the change in actor relations in medicine, drug, and health politics, and concludes that it may be more and more difficult for the traditional actors to marginalize the patient.

[Advertising of drugs: risk or benefits?]

It is obvious how important is the role of the physicians on drugs consumption. On account of their intermediary in the procurement and consumption of medicines, the prescriber is the main focus of manufacturers' promotional activities aiming at increasing sales and profits although these activities often are disguised as a means of education or information. Many reports have been issued emphasizing the influence of commercial sources upon the prescription. This text reviews two of them -advertisements in medical journals and the representatives- arriving to the conclusion that first ones display informations that are biased and incomplete while the representative in fact acts as a sales agent. The professional sources of information for prescribers are also described being evaluated how far-reaching the sources referred can be.

Health-related messages in consumer magazine advertising

OBJECTIVE

To characterize the patterns of health-related messages in consumer advertising from U.S. magazines.

DESIGN

Observational survey of advertisements occupying a third of a page or more from the January 1994 issues of the 11 most popular consumer magazines.

MEASUREMENTS AND MAIN RESULTS

Health messages were present in 22.8% (85/372) of all the advertisements reviewed. Of the advertisement categories (prescription medication, over-the-counter medication, exercise-related product, health service, health device, diet/health-related food, and other), over-the-counter medications were the most common among the advertisements that had health messages (32.9%, 28/85) (7.5% of the total advertisements, 28/372). The five advertisements for prescription medications were duplications of two different advertisements, one for a hair promotion product and one for hormone replacement therapy. Products related to diet and exercise together represented 29.4% (25/85) of all advertisements with health messages. Three advertisements (3.5%) were for health devices, and five (5.9%) were for health services.

CONCLUSIONS

Health-related messages are frequent in consumer advertising. The effects of health marketing on consumer protection, health care costs, and the physician-patient relationship are discussed.