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Healthy Skepticism AdWatch

AdWatch illuminates the logical, psychological and pharmacological techniques used in drug advertisements.


December 2006, Italy

Avelox (moxafloxacin) from Bayer

"Use the best first". Come l'industria farmaceutica disinforma i Medici di Famiglia: un esempio a proposito di terapia antibiotica delle alte vie respiratorie
("Use the best first". How family doctors can be misled by drug companies: an example concerning antibiotic therapy for upper respiratory tract infections.)


PDF version of this AdWatch in English

View/Hide: English Italiano

By Guido Giustetto, Family Medicine, Pino Torinese (Italy) member of No Grazie Pago Io (No thanks, I’ll pay)

In June 2005, Italian family doctors were mailed a booklet titled Use the Best First. It claimed to contain a ‘revolutionary’ message. The booklet reported the conclusions of a workshop, organised by Bayer and held at the Istituto Superiore di Sanità  in Rome. The booklet claimed that it is necessary to radically change the way upper respiratory tract infections (URTIs) are treated. The booklet did not disclose that Bayer was involved. The booklet asserts that the first line of attack in effectively treating pharyngitis, tonsillitis, otitis and rhinosinusitis is a powerful and wide-spectrum antibiotic like moxafloxacin. It claims this will treat and avoid the onset of these infections and the spread of antimicrobial resistance.

We are not aware of any evidence to support these claims that use of moxafloxacin is the appropriate first line antibiotic for all URTI and will reduce resistance. So what’s Bayer’s real objective in distributing this booklet?

In particular, the aim of the chapter ‘ENT infection to be treated without uncertainty’ is to widen the use of moxifloxacin from limited application for treatment of sinusitis to any URTI. Such use would be ‘off label’ because it is not approved by AIFA (Italian Drug Agency) but would increase sales of the drug. The three communication techniques of data manipulation, recourse to a third party and the use of a trademark are used to achieve this promotional goal.

The booklet distorts the facts by presenting a mixture of accurate and misleading information:

• alarming statements (1):
the fact that URTIs affect adults two to three times each year (90 to 140 million cases annually in Italy) is used to infer a high risk of meningeal infection and intracranial abscess, but that risk is actually very low

• misleading references to tables in the text (2):
viruses are identified as the more frequent cause of infection in the text, but are not mentioned in the table, and their importance could be missed

• deliberately truncated quotations (3):
the quoted guidelines concern sinusitis but not other URTIs

• evocative and allusive words (4):
such as ‘immune system desert’

• citing unknown or long-deceased specialists (5):
to improve credibility and reliability, 40 specialists - often either unheard of or long dead - have been cited, including Paul Erlich (deceased 1915)

• implying official support (6):
it is inferred by the use of ambiguous statements that the claims are supported by institutions such as the Istituto Superiore di Sanità  (third party technique)

• coining of slogans (7):
the use of the slogan ‘Use the Best First’ ensures the message is remembered.

This booklet is not a scientific instrument but a misleading promotion which attempts to interfere with doctors’ independent and appropriate therapeutic choice. The patients’ best interests have been sacrificed to the demands of marketing.





AdWatch (Italy)


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