Healthy Skepticism Library item: 14905
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: Journal Article
Shankar PR, Subish P.
Authors' reply. Medical journals and pharmaceutical marketing.
Singapore Med J 2008 Dec; 49:(12):1058
http://smj.sma.org.sg/4912/4912le2.pdf
Full text:
Dear Sir,
We agree with Drs Rehman and Jawaid that medical journal advertisements can play an important role in disease mongering.(1) The World Health Organisation (WHO) Ethical Criteria for Medicinal Drug Promotion describes the type of information which advertisements to physicians and health-related professionals and to the general public should contain.(2) The criteria states that all promotions making claims regarding medicinal drugs should be reliable, accurate, truthful, informative, balanced, up-to-date, capable of substantiation and in good taste.(2)
At our institution, Manipal College of Medical Sciences, Pokhara, Nepal, we teach students to critically appraise drug advertisements and promotional materials against the WHO Ethical Criteria.(3) We have begun teaching students to check the claims made by advertisements against more reliable sources. We agree with the authors that drug advertisements published in medical journals may have many flaws. It has been our observation that advertisements published in medical journals from developing countries have more lacunae and provide less information compared to those published in journals from developed countries.
The cycle of dependence between pharmaceutical companies and medical journals has been widely discussed. The editors of PLoS Medicine, an open access journal, had declared that they will not become “part of the cycle of dependency … between journals and the pharmaceutical industry”.(4) An author had stated that a much bigger problem may lie with the original studies, particularly the clinical trials published by journals.(5) Randomised controlled trials are widely regarded as one of the highest levels of evidence. The author states that peer review does not solve the problem. He states that there should be more public funding of clinical trials and perhaps journals should stop publishing trials.(5) The protocol and the results can be made available on regulated websites. Medical students and doctors should also be taught to critically appraise published clinical trials. A recent article had claimed that most published research findings are false and had developed the corollary that the greater the financial and other interests and prejudices in a scientific field, the more likely the findings are to be false.(6) There was, however, an extensive debate after the publication of this article.
Thus, there are wide variations in the quality of advertisements and clinical trials published in various medical journals. We personally think journal editors should get together and frame guidelines for advertisements and clinical trials submitted for publication to a journal. All journal editorial staff should be educated with these guidelines. Journals can also form a panel to vet all advertisements and clinical trials as suggested by Drs Rehman and Jawaid. (1) The information contained in the advertisements can be compared with accepted sources. If the advertisement refers to a published article, then the original article should be obtained and the information provided in the advertisement should be factually verified against the findings reported in the article. It is well known that quoting small portions from a published study can lead to bias. Also for clinical trials, the study design, sponsorship and other factors should be considered.
However, many journals are dependent on the revenue contributed by advertisements. We would like to add that the industry in developed countries have formulated guidelines for drug advertisements and drug promotion (www.phrma.org; www.abpi.org.uk). The application of these guidelines to developing countries is required. Thus, a concerted effort on the part of journal editors, advertisers, other doctors and regulators is recommended. International cooperation and an exchange of ideas are also urgently required!
Yours sincerely,
P Ravi Shankar
Subish Palaian
