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

Critical Appraisal of Drug Promotional Literature in Accordance With WHO Guidelines

Background

Drug promotional literature (DPL) is used as a marketing tactic to publicize the introduction of new medications. As drug companies are promoting the literature for their brand products, bias is possible. Various studies have demonstrated that printed DPLs disseminated by pharmaceutical companies are typically skewed.

Material and method

A prospective, observational study was carried out in the outpatient departments of a tertiary care hospital to analyze the DPL of different pharmaceutical companies using WHO criteria for "Ethical criteria for medicinal drug promotion, 1988".

Results

Out of 192 DPLs analyzed, information regarding the generic name, brand name, amount of active ingredient, and manufacturer name was found in all the DPLs (100%). Though therapeutic uses were mentioned in 91% of DPLs, dosage schedule (regimen) was mentioned only in 60%. Drug safety information such as the side effects and significant adverse drug reactions, precautions and warnings, contraindications, and major drug interactions were present in 24%, 36%, and 20%, respectively. Address of the manufacturer and reference to scientific literature were present only in 63% and 53% of DPLs, respectively. References mainly were from journals, present in 71% of DPLs. Most of the claims made in DPLs were regarding efficacy (73%), followed by safety (34%). 

Conclusion

In our study, not a single DPL fulfilled all the nine WHO criteria. A doctor should rigorously evaluate study findings before prescribing because misleading and incorrect information is now frequently found in this literature.

Drug Promotion in India Since 2000: Problems Remain

Pharmaceutical companies engage heavily in promoting their products worldwide, and India is no exception. This article begins with an analysis of the therapeutic value of medications on the Indian market because, by definition, if a drug has no therapeutic value or has a negative benefit-to-harm ratio, then any promotion of that drug is inappropriate. It then examines 2 Indian case studies: drug promotion in Mumbai and the misuse of the World Health Organization logo in promotion. Next it describes specific types of promotion: advertisements in medical journals, brochures, and pamphlets; the actions of sales representatives; and the content of continuing medical education courses and medical conferences. The next sections examine medical students' and trainees' exposure to promotion and their attitudes about promotion; the attitudes of doctors about their interactions with the pharmaceutical industry; and whether promotion has an influence on prescribing. The article concludes with a critique of the existing industry, professional, and government regulatory regimes in India.

Evaluating patient education material regarding unicompartmental knee arthroplasty

BACKGROUND

Variability in quality and accuracy of information has been well documented in other orthopedic procedures. Given the growing role of the Internet in patient education, it is important to assess the quality of material provided. The purpose of this study was to evaluate online patient education materials regarding unicompartmental knee arthroplasty (UKA).

METHOD

The first 50 websites generated from a search of the term, partial knee replacement, using three search engines, Google, Yahoo!, and Bing, were analyzed for quality, content, and authorship. Categorical data between the three search engines were compared using the Freeman-Halton extension for the Fisher's exact test. Fisher's exact test was used to compare categorical data between the search terms partial knee replacement and unicompartmental knee arthroplasty.

RESULTS

Most websites mentioned benefits of UKA (69%) but only a minority (39%) mentioned risks. A more technical search term, unicompartmental knee arthroplasty, yielded fewer websites authored by manufacturers/industry and miscellaneous sources (p=0.018 and p=0.039, respectively), more mentions of risks (p=0.0014), and more references to peer-reviewed literature (p=0.0026).

CONCLUSIONS

Overall, online information related to UKA is of questionable quality and may be geared more towards attracting patients than providing high-quality information.

A Critical Analysis of Claims and Their Authenticity in Indian Drug Promotional Advertisements

Introduction. Drug promotional advertisements (DPAs) form a major marketing technique of pharmaceutical companies for promoting their products and disseminating ambiguous drug information which can affect prescribing pattern of physicians. Drug information includes product characteristics, various marketing claims with references in support to increase its credibility and authenticity. Material and Methods. An observational study was carried out on fifty printed drug advertisement brochures which were collected from different OPDs of Guru Nanak Dev Hospital attached to Government Medical College, Amritsar, India. These advertisements were analyzed and claims were categorized into true, false, exaggerated, vague, and controversial on criteria as reported by Rohraa et al. (2006). References of DPAs in support of the claims were critically analyzed for their retrievability from web and validity pertaining to claims. Results. Out of 209 claims from 50 advertisements, only 46% were found to be true, 21% false, 16% vague, 7% exaggerated, and 10% controversial in nature. Out of 160 references given in support of claims, 49 (30%) of references were irretrievable. Out of 111 (70%) retrievable references, 92 (83%) references were found valid. Conclusion. Drug information provided in the DPAs was biased, incomplete, unauthentic, and unreliable with references exhibiting questionable credibility.

Misleading advertising for antidepressants in Sweden: a failure of pharmaceutical industry self-regulation

BACKGROUND

The alleged efficacy of pharmaceutical industry self-regulation has been used to repudiate increased government oversight over promotional activity. European politicians and industry have cited Sweden as an excellent example of self-regulation based on an ethical code. This paper considers antidepressant advertising in Sweden to uncover the strengths and weaknesses of self-regulation.

METHODOLOGY

We analyzed all antidepressant advertisements in the Swedish Medical Journal, 1994-2003. The regulation of these advertisements was analyzed using case reports from self-regulatory bodies. The authors independently reviewed this material to investigate: (1) extent of violative advertising; (2) pattern of code breaches; (3) rate at which the system reacted to violative advertising; (4) prevalence of and oversight over claims regarding antidepressant efficacy and disease causality, and (5) costs for manufactures associated with violative advertising.

PRINCIPAL FINDINGS

Self-regulatory bodies identified numerous code breaches. Nonetheless, they failed to protect doctors from unreliable information on antidepressants, since as many as 247 of 722 (34%) advertisements breached the industry code. Self-regulatory bodies repeatedly failed to challenge inflated claims of antidepressant efficacy, lending evidence of lax oversight. On average, 15 weeks elapsed between printing and censure of a wrongful claim, and in 25% of cases 47 weeks or more elapsed. Industry paid roughly €108000 in fines for violative advertising, adding an estimated additional average cost of 11% to each purchased violative advertisement, or amounting to as little as 0.009% of total antidepressant sales of around €1.2 billion.

CONCLUSIONS

Lax oversight, combined with lags in the system and low fines for violations, may explain the Swedish system's failure to pressure companies into providing reliable antidepressants information. If these shortcomings prove to be consistent across self-regulatory settings, and if appropriate measures are not taken to amend shortcomings, many countries may want to reconsider the current balance between self-regulation, and legislative control with government oversight.

New Delhi Metallo-beta lactamase-1 containing enterobacteriaceae: origin, diagnosis, treatment and public health concern

One of the biggest problems associated with the antibiotic therapy is resistance. Recently published studies have revealed that enterobacteriaceae, like E. coli and Klebsiella, isolated from several Indian centers are resistant to many antibiotics including some highly potent antibiotics like carbapenems. It has been proposed that this resistance is because of a carbapenemase enzyme called NDM-1 (New Delhi Metallo-betalactamase-1). This carbapenemase is class B carbapenemase also called metallolactamases as they require zinc at their active site. This enzyme is coded by a gene called bla-NDM-1 or gene NDM-1. NDM-1 containing enterobacteriaceae can be screened in laboratory by few techniques. Metallolactamase production can be detected by disk approximation test or Modified Hodge test and NDM-1 gene can be detected by polymerase chain reaction by the use of specific primer targeting the gene. Infections caused by such bacteria are associated with high morbidity and mortality. Two classes of antibiotics i.e., polymyxins (colistin) and glycylcyclines (tigecyclines), have shown in vitro activity against NDM-1 harboring enterobacteriaceae. The safety profile of both of these antibiotics is questionable. There is a need for active screening of microorganisms for NDM-1 and research should be directed towards the development of safe antibiotics for the treatment of these kinds of infections.