Healthy Skepticism Library item: 20475

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

Mansfield PR
Phenylbutazone
Medical Journal of Australia 1986 Jan 6; 144:55

Abstract:

To the editor: The Medical Lobby for Appropriate Marketing (MLAM) would gain nothing and lose much if our reports of misleading drug advertising were inaccurate. Unfortunately, Dr Smith, the medical director of CIBA-GEIGY Australia Ltd (MJA, September 2, 1985), has drawn attention away from the major issues involved in the marketing of phenylbutazone by questioning the reliability of our information that, in Malaysia, his company had promoted phenylbutazone for such indications as viral infections. Dr Smith quoted the package inserts that CIBA-GEIGY had printed in Switzerland in 1984. Our report referred to data sheets that were actually in phenylbutazone packages in chemist shops in 1985; they may have been printed earlier. We have obtained some of these data sheets from Malaysia and will be happy to provide copies of them.

Other examples of CIBA-GEIGY’s out-of-date marketing policies include the promotion of fixed-dose combinations of phenylbutazone with prednisolone and with the controversial analgesic agent, propyphenazone, in the Philippines until March 1985. 1

In Thailand, oxyphenbutazone was recommended for “traumatology and surgery, inflammation and swelling due to sprains, bruises, dislocations, fractures, soft tissue injuries, surgical interventions; as preoperative and post-operative medication to prevent and treat inflammation and swelling; as an adjunct to chemotherapy in inflammatory conditions due to infection” until Feburary 1985. 2

The key point is that inappropriate indications such as these can be replaced with adequate prescribing information after negotiation between the medical profession and the industry, when stimulated by organisations such as MLAM. CIBA-GEIGY have ceased the production of oxyphenbutazone and have rationalized their indications for the use of phenylbutazone which no longer vary among countries.

CIBA-GEIGY is to be congratulated for this major improvement which, together with the decision to cease the production of oral clioquinol, places them among the best of all drug companies in the Third World. However, the implications of this international standardization for Australia are the phenylbutazone is now described as a second line drug and acute osteoarthritis has been added to the previously recommended indications for its use. By contrast, MLAM accepts the advice of Professor Peter Brooks (MJA, August 18, 1984) that the limited place of phenylbutazone is as a drug of last resort for the treatment of seronegative spondyloarthropathies, acute gout and rheumatoid arthritis.

MLAM is pleased to report that Sandoz have agreed to mention in MIMS appetite stimulation and weight gain, the most common adverse effects of pizotifen and to avoid the expression “safe for all ages”. Bayer have acknowledged that their advertising for ampicillin in Indonesia was misleading. We are currently in correspondence with Wyeth about non-compliance with the WHO Code for Marketing of Breast Milk Substitutes; Pfizer about tetracycline syrups for children; and Roche about potentially toxic doses of vitamin A, and vitamin A and E combinations for “arteriosclerosis, deafness, threatened abortion, acne vulgaris, geriatric debility, infertility”. 3

MLAM is happy to provide additional information about any of the above topics. Membership enquiries are welcome.

Peter Mansfield, MB BS
MLAM Secretary
22 Renaissance Arcade
Adelaide, SA 5000

1. Ng CT, ed. Philippines IMS 1984; 13; 101
2. Ng CT, ed. Philippines IMS 1984; 13; 90
3. Ng CT, ed. Philippines IMS 1985; 14; 221