Healthy Skepticism Library item: 20494

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: news

Smith D
When misleading ads can kill
The National Times 1985 May 23

Abstract:

Deborah Smith reports on a group of Australian doctors and researchers who have established the world’s first medical lobby in pursuit of better pharmaceutical advertising in developing countries.

Full text:

IN EARLY 1982 Peter Mansfield, then a medical student from Adelaide, spent part of his training in Bangladesh. One day, a malnourished boy came to the clinic clutching a small bottle. It contained a solution of sugar and water – Glactose D, sold by Glaxo.

The concerned parents of the underfed child had put their trust in Western medicine, Mansfield told The National Times last week.

The tragedy was that the money they spent on the sugared water could have bought at least two weeks meals for the boy.

In Bangladesh Mansfield became aware at first hand of what he believes is an abundance of misleading drug advertisements in the Third World. One of the more serious at the time was the promotion of anabolic steroids – body building hormones – as “ensuring normal growth, stimulating appetite … safe even for children and infants”.

Once back in Australia, Mansfield worked towards the eventual launching in late 1983 of the Medical Lobby for Appropriate Marketing. In the past 18 months this watchdog has established an international reputation with about 200 current members, lay and medical, from over 22 countries.

Inaccurate or inappropriate advertising is its prime target. Contacts in the Third World send suspect ads to the lobby secretariat. A search of the worldwide literature on the drug reveals any discrepancies between ad and scientific data, which are then noted in a letter to the drug manufacturer.

As an important safeguard, the proposed letter is then reviewed by the lobby’s editorial panel – a group of 13 eminent medical specialists from Australia and overseas and including Professor Felix Bochner, a pharmacologist at Adelaide University; Dr Ian Gust, a virologist at the Fairfield Hospital for infectious Diseases in Melbourne; and Dr Basil Hetzel, Head of the CSIRO Division of Human Nutrition.

Professor Garry Kneebone, head of paediatrics at Flinders University, was one of the founding editors, with Professor Peter McDonald, head of Clinical Microbiology at the same medical school. Kneebone, one of Mansfield’s teachers, had also experienced inappropriate marketing of drugs first hand when he worked in Hong Kong and Malaysia.

In particular, he was once offered a lifetime gratuity of $60,000 a year by a company if he would formulate a breast milk substitute – a baby milk powder – that they could promote as recommended for Asian babies of the region by the Professor of Paediatrics in Hong Kong.

Kneebone declined. But this kind of situation is one he believes has not altered radically since then. Although all companies make superior claims about their products, the difference is that it is dangerous when drugs are promoted with extravagant or untrue claims, he says. “And sadly, a double standard does exist. Products are promoted differently in countries where there is little official surveillance of the claims in ads,” he added.

Kneebone, the president, describes the approach of the medical lobby as gentle. Alienation of the industry is not its intention.

While its letters are clearly pertinent they are always constructive. Every letter has been a winner, said Kneebone, in the sense that companies have not been able to refute the lobby’s claims and have responded with changes in their policy.

The Third World is the fastest growing market for the pharmaceutical industry. In 1980, the people of the Third World spent $US15 billion of their limited resources on drugs. A fifth of this went on drug promotion.

Penicillin drugs are very valuable agents against bacteria. But their usefulness is being undermined by overuse.

The medical lobby counts as a recent success the fact that Bayer has undertaken to modify its ads for a penicillin they call Binotal (ampicillin). It had been inaccurately described in ads to Indonesian doctors as effective against a wide variety of bacteria. Yet gonorrhoea, for example, one of the recommended uses, has reportedly a 30 to 50 per cent resistance rate to this drug.

The medical lobby was also one of the groups to express concern recently about differences in the promotion of two drugs, phenylbutazone and oxyphenbutazone, between Europe and Asia. Both are effective, widely used treatments for rheumatoid arthritis. But their side effects are also serious. In Britain between 1964 and 1976, 250 people died from a blood condition, aplastic anaemic, associated with these drugs.

With other safer, equally effective drugs available, Britain decided to ban oxyphenbutazone and strictly limit the uses for phenylbutazone. Last year the manufacturer, Ciba-Geigy, informed countries like Holland and Australia of precautions that should be taken with these drugs – using them only in a few situations and for short times.

Yet in Indonesia, Malaysia and Thailand the drugs were promoted with no mention of precautions and were even recommended for long term treatment and quite inappropriate uses like tension headache and viral infections.

Last month, however, Ciba-Geigy announced a worldwide withdrawal of oxyphenbutazone, and strict limitations on when to use phenylbutazone.

Approximately three million infants will die each year during the 1980s who would have lived if they were breastfed, according to the lobby. Nestle, the largest manufacturer of breast milk substitutes, now obeys the World Health Organisation’s Code of Marketing for these food preparations. However most other manufacturers still violate this code, Mansfield considers.

He believes the medical literature accompanying these products should include information on the high death rates among infants fed substitutes for breast milk – three times higher, according to a Chilean study.

The most common cause of death in children under three in the world is dehydration from diarrhoeal disease. The Medical Association for Appropriate Marketing is also keeping a close watch on the promotion of Lomotil, an antidiarrhoeal drug.

According to the lobby, this drug obscures the symptoms of the disease and there is no evidence it stops dehydration. In fact it slows down excretion of the infecting organism and so actually prolongs the illness. While Lomotil is not recommended for children under 12 in Australia it is recommended for children over two in Asia and other parts of the world.

The medical lobby’s latest interest is a drug sold in Australia as a preventative treatment for migraine and recommended as unsuitable for children. However in the latest listing of drugs for Indonesian doctors a two page colour ad recommends it as an appetite stimulant (a side effect rarely dwelt on in western advertising) and safe for all ages.

The Australian Pharmaceutical Manufacturers Association has a strict marketing code for Australia and regularly monitors ads and marketing practices here. While admitting that some deplorable marketing practices have occurred in the Third World, the Association is concerned that this does not reflect adversely on all pharmaceutical companies, John Weissel, executive director, told The National Times.

Some of the companies may not be members of reputable organisations like his association. And drug promotion in the Third World is often carried out by local representatives whose practices may not have been endorsed by the home company.

Some lobby members could be accused of biting the hand that feeds them. In fact, Kneebone’s research at Flinders University is supported financially by the manufacturer of a breast milk substitute. On one occasion an executive of the company did ring Kneebone to question their continued funding, given his association with the lobby.

But Kneebone makes light of the incident: “I pointed out it was a bonus for them, that I had more than an ordinary concern that things are done properly. That can’t be bad. And we’ve been friendly ever since”.