Pharmaceutical flimflam: drug advertising in medical journals is a global issue

Advertising may be described as the science of arresting human intelligence long enough to get money from it.  ~  Stephen Leacock, Garden of Folly (1924) ‘The Perfect Salesman’

A recent systematic review in PLoS One demonstrates quite effectively something that shouldn’t surprise any intelligent high school student: pharmaceutical advertising in medical journals often provides “poor quality information.” This strikes me as the authors’ excessively polite way of saying that drug ads, even those that appear in authoritative periodicals widely read by physicians, are unregulated, manipulative, meretricious and mendacious. Selling the latest SSRI is not really different from shilling shampoo, with the difference, of course, that there is superior evidence of shampoo’s efficacy.

Othman N, Vitry A, Roughead EE. Quality of pharmaceutical advertisements in medical journals: a systematic review. PLoS One. 2009 Jul 22;4(7):e6350. PubMed PMID: 19623259; PubMed Central PMCID: PMC2709919.

The article, buffed to a high scholarly polish with any hint of libellous language or ethical disdain well suppressed, warrants close reading. Here are some highlights:

Advertising in medical journals is one of the techniques used by pharmaceutical companies to promote their products to medical doctors. During the first four years of a new medicine on the market, pharmaceutical companies may gain approximately US $2.43 for each dollar spent on medical journal advertisements for a medicine. The return on investment has been reported to increase to more than US $4 after that period.

We found that pharmaceutical advertisements in medical journals usually provided brand and generic name and indication. Other essential information required for rational prescribing including contraindications, interactions, side effects, warnings and precautions were less commonly provided. The majority of references cited to support pharmaceutical claims were journal articles. However, less than two-third [sic] of the claims were supported [emphasis mine] by a systematic review or a meta-analysis (110/1375, 8%) and randomised control trial (455/1500, 30%).

This review noted that references used to support pharmaceutical claims were often of low quality. The inappropriate use of references in journal advertising suggests that the availability of references does not always guarantee the quality of claims.

Information on medicines is essential to help doctors ensure the optimal use of medicines. However, studies show that doctors who use journal advertisements as a source of information may prescribe less appropriately. In addition, reliance on journal advertising for information is associated with increased costs of prescribing. Even doctors who think that they obtain their knowledge from the scientific literature can be influenced by promotional sources without being aware of it. As information provided in journal advertising has the potential to change doctors’ prescribing behaviour, our review indicates that ongoing efforts including complaints and recommendations by researchers, health professionals and policy makers to improve the quality of advertisements in medical journals are crucial.

Governments may need to take more proactive action such as engaging independent experts to help in designing regulation for journal advertising where self regulatory codes are limited. In addition to that, effective regulatory system may complement pharmaceutical litigation to ensure accuracy and reliability of information in journal advertising.

Our review found that the low quality of journal advertising was a global issue. Poor quality advertising has been observed in developing countries and post-Soviet Russia where controls might be weak and limited as well as in developed countries which have stricter regulations.

Globally, pharmaceutical advertising in medical journals often provides poor quality information. The impact of this problem on doctors’ prescribing behaviour might be even greater in developing countries and post-Soviet Russia where access to industry-free medicine information is limited. 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.

It is the most extraordinary thing, but I never read a patent medicine advertisement without being impelled to the conclusion that I am suffering from the particular disease therein dealt with in its most virulent form.  ~  Jerome K. Jerome, Three Men in a Boat (1889)
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1 Response to “Pharmaceutical flimflam: drug advertising in medical journals is a global issue”


  1. 1 shebamuturi November 17, 2009 at 1:18 am

    Thank you Mark for highlighting this important issue. In my humble opinion, the advertising of drugs is always problematic in whatever context, whether in medical journals aimed at physicians or the more controversial “direct to consumer” advertising via print and broadcast media. The biggest problem is that unlike other health services (such as hospital beds), drugs are promoted as commercial commodities by pharmaceutical companies through aggressive campaigns that highlight benefits while concealing risks in small print. The rapid rise in drug costs is mainly attributed to the substitution of newer, more expensive drugs in place of existing, less expensive products (“me-too” drugs).

    This makes it critical that physicians have access to accurate, unbiased and up-to-date evidence about a drug’s safety and effectiveness. Academic detailing (physician education by neutral, academic experts) seems a viable way of countering pharmaceutical promotion through the use of advertising, company representatives, medical workshop sponsorship etc. Academic detailing has been proven to positively influence prescribing behaviour.

    It’s worth noting however that evidence based only on short-term, trials in carefully selected patient groups is not a sound basis for accurately predicting a drug’s safety and effectiveness in the ‘real world’. As highlighted by Vioxx® and Bextra®, the performance of a drug can only be fully measured based on real world experience where it is used in different population groups at varying doses and for long periods of time – and compared with other drugs.

    Pharmaceutical advertising needs to be strictly regulated and as the article points out, developing countries tend to have weaker regulatory mechanisms. It will be interesting to see what FDA guidelines may arise out of the recent public hearings on the use of social media by the pharmaceutical industry.
    http://shebamuturi.wordpress.com/


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