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Healthy Skepticism Library item: 20472

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: Magazine

MLAM rallies health care activists against 'inappropriate' marketing
International Barometer 1985 Nov1 & 3

Full text:

Like venture capital-driven entrepreneurs, Medical Lobby for Appropriate Marketing (MLAM) borrowed from the established banks of activists, and now pursues a crucial niche in the issues surrounding pharmaceutical marketing.

Headquartered in Australia, with members in 30 countries, MLAM is developing into a pointman for activist health care professionals, physicians, pharmacists and others involved in the international movement to restrict pharmaceutical marketing. While only 260 members large and relatively new, MLAM percolates with potential because it is organizing the pharmaceutical companies’ true constituents.

Scarlet letters
Common, but effective, MLAM’s tactic is raising pointed criticisms through letters. Each month one corporation is singled out and the marketing of a product is critiqued. The primary goal is to solve issues over specific products. But, representatives of companies targeted by MLAM said that another problem is the negative press attention MLAM members and affiliated groups can stir with the letters.

The group’s definition of inappropriate marketing is similar to the one used by Health Action International (HAI) for its forthcoming kit on “dangerous drugs”. [See page S-2 HAI is the activist umbrella organization that promotes the World Heath Organization’s essential drugs program.] As described by MLAM founder Dr Peter Mansfield in a recent issue of New Doctor, the criteria are: the sale of products with poor risk/benefit or cost/effectiveness ratios, promotion of inappropriate indications for prescription, and inadequate warnings about adverse effects.

International editorial board

The MLAM editorial board “ensure[s] that MLAM letters are in accord with current scientific consensus, and that [their] questions and suggestions are reasonable”, said Mansfield in written response to questions posed by International Barometer.

The board is made up of 12 physicians and medical professors, some with established activist careers, such as Dr Andrew Herxheimer, head of the International Organization of Consumer Union’s (IOCU) Heath Working Group.

Circular ads, fliers, medical magazines, various national prescriber’s guides and other product marketing information is collected by MLAM members, including representatives of IOCU, HAI and Third World consumers groups.

A typical letter critiques variations among the marketing in different countries including differences in indications, warnings and labeling information. Scientific studies are quoted in an attempt to discredit marketing practices and promote MLAM’s suggestions for changes.

“There is an aura of professional participation, but on the other hand, they just write letters, like many other groups”, said one executive of a firm contacted by MLAM who asked to not be indentified.

Promoting participatory decision-making

While MLAM asks for specific changes in marketing. “Ultimately, we would like them to set up internal advertising quality control units so that MLAM is no longer needed to watch them”, according to Mansfield.

“However we do not want the industry strangled by legislation. Litigation can lead to inappropriate decisions being made for legal rather than medical reasons. Another reason for not relying on legislation alone is that as medicine advances, legislation lags behind”, he said.

MLAM sees pharmaceutical companies as “complex non-democratic decision making systems where different motives compete to determine corporate behavior. We are interested in the interaction between commerical and medical motives…
“Companies may reduce conflict between motives by limiting the flow of information. Thus marketing executives may be able to make profitable decisions because they do not have knowledge of the medical consequences.

MLAM aims to strengthen the hand of those moved by medical motives and to cut across the companies’ internal communications barriers”, Mansfield said.

The group claims that half of its letters have resulted in a “small measurable change to marketing” while 10 percent have yielded a “large measurable change”.

Corporate critics of the group maintain that MLAM sometimes quotes from old ads, and that successes claimed by the group often reflect already existing practices.

Pfizer’s Peter Keating said that some of the information requested by MLAM in a recent letter is “readily available”.

Since starting in November 1983 MLAM has critiqued Bayer, Ciba-Geigy, Hoescht, ICI, Nestle, Organon, Pfizer, Sandoz, Searle, Winthrop and Wyeth. Mansfield says the most positive interactions were with Ciba-Geigy, Nestle, Searle, Organon, Bayer and Sandoz. The worst marks were given to Winthrop, Hoescht, ICI and Wyeth.

Pharmaceuticals have been the only products critiqued so far. Mansfield indicated that in the future. MLAM might turn its attention on herbacides, including promotion of paraquet in Figi cigarettes and weapons.

Still, with a budget limited to membership dues ($25 annually). MLAM will be most effective using pharmaceutical firms’ concern over their corporate images with doctors and pharmacists to promote its agenda with those firms.


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