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Some examples of inaccurate, exaggerated and ambiguous extrapolation of references in drug advertisements
Source publication
The objective of the study was to critically assess references cited in support of claims in drug advertisements.
Drug advertising brochures were collected from privately practicing General Practitioners from different parts of Karachi. Three blinded reviewers then categorized each reference in the brochure according to the sources viz: journals (b...
Context in source publication
Citations
... Leading drug companies mostly invest more on commercialization rather than research and development (Angell, 2004). Pharmaceutical marketing impact in Pakistan illustrates that medicines being promoted to the prescribers are prescribed quickly, and physicians rely most on the information provided by pharmaceutical companies regarding their products (Aamir and Zaman, 2011;Rohra et al., 2008). ...
Pharmaceutical advertising (PA) affects both healthcare professionals and consumers. Ethical and legal challenges of PA are often odious and unmet to the standards. This study was designed to assess perceptions, knowledge, and practices of healthcare professionals towards pharmaceutical advertisement in Pakistan. A survey-based descriptive cross-section study, of 764 sample records and analyzed by SPSS, version 21. A Chi-square test was performed (p ≤ 0.05) to find out differences among variables. We found 34.8% (n=266) physicians, 8.4% (n=64) dentists, 13.6% (n=104) hospital pharmacists, 15.7% (n=120) community pharmacists, 8.4% (n=64) regulatory pharmacists, 8.3% (n=63) marketing pharmacists and 10.9% (n=83) physicians and pharmacists from distributions and other relevant fields participated in this study. The result showed that 81.4 % (n=622) believed that medical advertisements should seek government approval, 71.3% (n=545) assumed that only registered drugs could be advertised. 34.0% (n=260) answered only prescription drug could be advertised. 7.2% (n=284) showed a negative response towards advertised drugs. 33.0% (n=252) answered that advertising encourages the patients to decide on their choice of a drug without the help of a healthcare professional, while 31.4%(n=240) of the respondents were agreed that advertising provided reliable information regarding a medicine. 36.4% (n=278) of respondents were agree that advertisements increased drugs cost. 32.7% (n=250 and 37.4% (n=286) answered that patients buy an advertised drug without referring a doctor. This study concluded that the awareness regarding PA was low among the healthcare professionals in Pakistan. Healthcare personals were in the favor of advertisement, regardless of little knowledge about the current advertisement rules in the country. Comparatively, Pharmacists have better knowledge of PA than physicians do.
... In a previous study in Pakistan, it was shown that pharmaceutical advertisement agents and their brochures are the main conveyor of recently developed drugs to physicians [14]. Therefore, ideally, the information provided on the advertisements and its supporting evidence should be irrefutable in order to support physicians in practicing evidence-based medicine. ...
... Therefore, ideally, the information provided on the advertisements and its supporting evidence should be irrefutable in order to support physicians in practicing evidence-based medicine. It was also reported that the claims made by pharmaceutical companies in their promotional material [13] and the references substantiating these claims are inaccurate in Pakistan [14][15][16]. Thus, considering the serious influence these advertisements have on the prescribing behavior of physicians [16,17], this study was designed to assess the consistency between the evidence (references) and claims presented in advertising brochures in the Kingdom of Saudi Arabia. ...
Drug advertisement brochures (DABs) contain claims that are often supplemented by references in medical literature. Several studies have evaluated the DABs as they are commonly distributed by drug companies to practicing physicians. The objective of this study is to assess the consistency between the claims and references referred to in the DABs in Saudi Arabia. DABs were collected from medical practitioners in Riyadh, Saudi Arabia. Authors developed a protocol to be followed for quality assessment of the DABs. The vast majority of cited scientific papers were indexed in PubMed. Consequently, each reference was categorized as: justifiable, false, exaggerated or ambiguous. A total of 89 DABs were collected; 48 (53.9%) brochures were excluded from further analysis and the remaining 41 brochures (46.1%) contained 240 references with an approximate average of 5.9 references per DAB. A total of 201 cited papers were traced (83.8%). The majority of references (93.0%) supported the claims for which they were cited. However, 1.5%, 4.0% and 1.5% of claims were deemed inaccurate/false, exaggerated, and ambiguous, respectively. This study supports that the majority of the claims made in the DABs of pharmaceutical companies in Saudi Arabia were unreferenced. However, most of the evidence presented to substantiate claims made was considered true.
... Such an influence is termed as "Red-Herring" effects which is defined as statements being used that have no link or association with clinical effectiveness of drug or statements with unique property of drug that may have no relevance to the therapeutic effect [15]. Out of 33 ambiguous claims, 20 were found proclaiming larger than life phrases like "best proven choice, " "most prescribed molecule worldwide, " and "remarkably safe, " hence exhibiting the Red-Herring effect, hence ascertaining the belief that the pharmaceutical companies are blatantly exploiting the biomedical literature to substantiate the ambiguous claims in support of their products [16]. It was observed that the claims in 70% of the cases laid emphasis on the efficacy and superiority while clinically relevant safety outcomes were negligibly (1%) highlighted. ...
Introduction. Drug promotional advertisements (DPAs) form a major marketing technique of pharmaceutical companies for promoting their products and disseminating ambiguous drug information which can affect prescribing pattern of physicians. Drug information includes product characteristics, various marketing claims with references in support to increase its credibility and authenticity. Material and Methods. An observational study was carried out on fifty printed drug advertisement brochures which were collected from different OPDs of Guru Nanak Dev Hospital attached to GovernmentMedical College, Amritsar, India.These advertisements were analyzed and claims were categorized into true, false, exaggerated, vague, and controversial on criteria as reported by Rohraa et al. (2006). References of DPAs in support of the claims were critically analyzed for their retrievability from web and validity pertaining to claims. Results. Out of 209 claims from 50 advertisements, only 46% were found to be true, 21% false, 16% vague, 7% exaggerated, and 10% controversial in nature. Out of 160 references given in support of claims, 49 (30%) of references were irretrievable. Out of 111 (70%) retrievable references, 92 (83%) references were found valid. Conclusion. Drug information provided in the DPAs was biased, incomplete, unauthentic, and unreliable with references exhibiting questionable credibility.
... Such promotional strategies may add an impression of authenticity rather than communicate the evidence behind product claims. 11 Under these circumstances, a critical attitude toward journal advertising appears justified. ...
Objective:
To examine the supporting evidence of advertisements published in six leading orthodontic journals.
Materials and methods:
The 2012-2013 printed issues of American Journal of Orthodontics and Dentofacial Orthopedics, Australian Orthodontic Journal, Journal of Orthodontics, European Journal of Orthodontics, Journal of Clinical Orthodontics, and Journal of Orofacial Orthopedics were screened for advertisements implying superior performance compared with competitor products. Advertisements were classified according to type of product, availability, and currency of supporting references.
Results:
A total of 99 unique advertisements claiming clinical benefit or superiority were identified. The overwhelming majority of the identified advertisements promoted appliance products (62.6%), orthodontic materials (14.1%), and dental operatory equipment, including imaging systems (12.1%). Advertisements were found to provide references or not regardless of the product type. Half of the advertisements referred to at least one peer-reviewed publication, whereas unpublished studies were cited by 25% of the advertisements. Most of the referenced articles were published within the past 5 years.
Conclusions:
The scientific background of advertisements in the orthodontic literature appears limited. While surveillance of journal advertising needs to be regulated, clinicians are urged to critically appraise the claims being made in orthodontic print advertisements by consulting the associated existing evidence.
... In the eastern context, possessions could affect the socioeconomic position of the individual in the society. Finally, the Pakistan pharmaceutical industry has been criticized for dubious promotional campaigns pursued to convince physicians prescribe their brands, especially general practitioners who consider pharmaceutical industry as primary source of information regarding medicines (Rohra et al., 2008); the possibility of biased findings due to the complex physician-industry relationship cannot be ruled out. Therefore, generalization of these results should be done with caution and should take into account these limitations. ...
The global healthcare delivery system is largely inequitable and patients suffer inequalities in relation to their socioeconomic status (SES). In this study, we applied univariate measures to predict the SES in a sample of patients. We investigated the relationship between patient's SES, adherence to drug, dietary intake and health behaviour. We also investigated if inequalities exist in physician's choice on multisource oral solid hypoglycaemic and antihypertensive drugs in a sample of male type II diabetes mellitus patients with concurrent hypertension. Questionnaires were administered on patients (N=500) with diabetes mellitus and concurrent hypertension to determine their SES, prescribed drugs, dietary regime and health behaviour in Lahore, Pakistan. Correlation was determined using chi-square test for category characteristics, Kruskall-Wallis or ANOVA for continuous data variables non-normal or normally distributed data, respectively. The patient's SES was indicated by univariate like income, occupation, and education. Patients with high SES were more adherent to drug, dietary intake and health behaviour (χ2 =13.16, p<0.001; 34.71, p<0.0001; 79.24, p<0.0001, respectively). Patients with lower SES were prescribed cheaper hypoglycaemic and antihypertensive alternatives than their richer counterparts (p<0.0001). Socioeconomic differentials exist within urban communities; these differentials have direct effects on healthcare delivery and patient health.
... This requires further research, specifically, that previous research indicates the frequent use of poor quality evidence to support claims of products efficacy. [22][23][24][25] The majority of graphs used in analaysed advertisement are simple univariate displays which are easy to understand; however, Cooper et al. warn that such simple graphical displays may fail to convey the complexity of data and may distort the findings. 26 The current study did not evaluate the accuracy of information reported in text or graphs used in the analysed advertisements. ...
... The accuracy of information presented in advertisements have been criticised in many studies. 8,9,10,22 Further investigation into this very important aspect of advertisement is a research priority. ...
... This requires further research, specifically, that previous research indicates the frequent use of poor quality evidence to support claims of products efficacy. [22][23][24][25] The majority of graphs used in analaysed advertisement are simple univariate displays which are easy to understand; however, Cooper et al. warn that such simple graphical displays may fail to convey the complexity of data and may distort the findings. 26 The current study did not evaluate the accuracy of information reported in text or graphs used in the analysed advertisements. ...
... The accuracy of information presented in advertisements have been criticised in many studies. 8,9,10,22 Further investigation into this very important aspect of advertisement is a research priority. ...
Advertising is a crucial component of pharmaceutical industry promotion. Research indicates that information on advertisement materials might be inadequate, inaccurate, biased, and misleading.
To analyse and critically assess the information presented in print pharmaceutical advertisements in Saudi Arabia.
Pharmaceutical advertisements were collected from 280 community pharmacies in Riyadh city, Saudi Arabia. The advertisements were evaluated using criteria derived from the Saudi Food and Drug Authority (SFDA) regulation, the World Health Organization (WHO) ethical medicinal drug promotion criteria, and other principles reported in similar studies. The data were extracted independently by two of the researchers using a standardized assessment form.
One hundred eighty five printed advertisements were included in the final sample. Approximately half of the advertisements (n = 94, 51%) were for over-the-counter (OTC) medications, and 71 (38%) were for prescription-only medication. Information such as the name of active ingredients was available in 168 (90.8%) advertisements, therapeutic uses were mentioned in 156 (98.7%) of analysed advertisements. Safety information related to side effects, precautions, and major interactions were stated in 53 (28.5%), 58 (31%), and 33 (16.5%) advertisements, respectively. Only 119 advertisements (64%) provided references for information presented.
Our findings suggest that print advertisements do not convey all the information necessary for safe prescribing. These results have implications for the regulation of drug advertising and the continuing education of pharmacists.
... 11,12 In fact, direct contact between the pharmaceutical companies and doctors has been considered the most effective way of successful drug promotion in developing countries. 13 Organizing educational events or financially supporting doctors to participate in national or international conferences and other events has been established as a promotional tool 5 and a way to directly access doctors for pharmaceutical marketing in Pakistan. 14 In their code of ethics, international organizations such as the World Health Organization (WHO) and International Federation of Pharmaceutical Manufacturers Association (IFPMA) clearly demand that such pharmaceutical sponsorships should be without the direct intention of drug promotion. ...
... Many prior studies have demonstrated the clear and significant influence of this type of educational activity on the prescribing behavior and decisions of physicians. 2,5,13,[22][23][24][25] Prior research has also shown that physicians rate the pharmaceutical companies as the most important source of information about the drugs. 11 Furthermore, a majority of physicians in past studies have been of the opinion that pharmaceutical marketing has a significant influence on their prescribing practices. ...
The objectives of this study were to identify and document various medical educational events attended by physicians in Pakistan. A cross-sectional study using a structured questionnaire was undertaken with a representative sample of physicians in four major cities: Bahawalpur and Lahore in Punjab province and Loralai and Quetta in Balochistan province. All the data were analyzed using SPSS version 15. Frequencies and percentages were used to summarize the data, and Chi-squared tests, Fisher Exact tests, and Spearman rho were used whenever appropriate. The main study finding indicated that most of the physicians (i.e. general practitioners (GP), GP/specialists and specialists) had attended industry-sponsored educational events. It was found that 173 (69.2%) of 250 respondents attended 727 educational events during the last 1 year. Of these 727 events, 222 (30.54%) were lectures, 207 (29.47%) were scientific conferences, 112 (15.41%) were drug launching ceremonies, 58 (7.98%) were seminars, 38 (5.23%) were training courses and 29 (3.99%) were discussion forums. Out of 173, most of the doctors attended educational events organized by professional organizations of the medical community and sponsored/co-organized by the pharmaceutical industry (n ¼ 115, 67.3%; p ¼ 0.001). Some of them (n ¼ 27, 15.8%) attended the events which were organized by pharmaceutical companies inde-pendently, without involvement of professional organizations. The pharmaceutical industry was the largest sponsor source for physicians (n ¼ 123, 71.9%) to attend educational events. The type of expenses paid for attending the educational events included meals (n ¼ 162, 94.7%), accommodations (n ¼ 118, 96%; p < 0.001), airfare (n ¼ 96, 56%; p < 0.001), registration fees (n ¼ 96, 56%; p < 0.001), taxi fare (n ¼ 75, 43.9%; p ¼ 0.012), and participation fees (n ¼ 14, 8.2%). Educational events are extensively being used as a promotional tool for phar-maceutical products. The findings of the current study reflect the significant role of the pharmaceutical industry in the organization of doctor-led educational events.
... Finally, physicians in Pakistan are subject to widely criticized dubious industry-led promotional campaigns; each firm persuades physicians to prescribe its own branded medicines. There is a possibility of biased conclusions due to the complex physician-industry relationship since general practitioners consider the pharmaceutical industry as a primary source of information [22,23]. ...
Patients suffer differential prescribing behavior as a function of their socioeconomic status. The current study was conducted in a qualitative and two observational phases in Lahore metropolitan area to investigate physician's perspectives of patients' socioeconomic status and the important indicators influencing prescribing behavior. Semi-structured interviews were conducted with physicians (N=20) from 2 hospitals, 2 diabetes care centers and 2 private clinics and scripts were analyzed for socioeconomic indicators. In the second phase, the opinions of a panel of prescribers (N=43) on the influence socioeconomic indicators on prescribing behavior were elicited. In the third phase a bipolar 5-point Likert rating scale was used to elicit the importance of indicators for physicians (N=100) originated from urban and rural areas. In the interviews physicians gave 15 potential socioeconomic indicators. Following the two Delphi rounds, consensus was reached on 11 (73.3%) of the indicators, the remaining 4 (26.7%) were highly disputable. Bivariate analysis showed that literacy, educational background, compliance, dress and appearance were important indicators at the time of clinical decision making for physicians originating from urban areas than for physicians originating from rural areas. Physicians originating from urban and rural areas perceived the socioeconomic status differently. © Versita Sp. z o.o.
... Printed brochures are another common form of marketing aid provided to prescribers. Such brochures may highlight the results 16 Of those that were traceable, 63.5% made "justifiable" claims. Only 1.4% were cited as "data on file". ...
Background: Pharmaceutical advertising, in a variety of forms, has been shown to influence prescribing behaviour. Regulatory systems have therefore been concerned with the quality of advertising and compliance with either imposed or self-regulatory codes of practice. Although the South African Medicines Act provides for an enforceable code of practice, the draft version published in 2004 has yet to be put into effect. This study aimed to assess the quality of pharmaceutical advertisements for reproductive health products, published in South African medical publications over the period 2001 to 2005. Compliance with the draft code of practice was considered, as well as the usefulness of the code itself.
Methods: Half-page and larger print advertisements for reproductive health medicines were sought from two South African peer-reviewed and four non-peer-reviewed medical publications. Advertisements published in three consecutive months in 2001 to 2005 were selected. This period represented the period prior to legislation being developed and the period during which the code of practice was developed and published for comment. Details from each advertisement were captured independently by two reviewers using a pre-determined, pre-tested 60-question questionnaire. Differences were resolved by consensus. The questionnaire was pre-tested and adapted before being applied. Questions sought to identify characteristics of the advertisement that were indicative of quality relating to claims and evidence used in support of the claims, as well as adherence to the draft code of practice. The number of claims made in each advertisement was identified, and for each claim the evidence provided in the form of references was assessed.
Results: A total of 136 reproductive health product advertisements were retrieved from 105 medical publications. Only 63 advertisements were unique. On average each medical publication selected contained 1.3 reproductive health product advertisements. All but three advertisements were for registered orthodox medicines. A total of 191 ‘claims’ could be discerned in advertisements placed in medical publications (average 3.0 ‘claims’ per advertisement). Only 7/103 (6.8%) references cited in unique advertisements in medical publications could be retrieved in abstract form from Medline, and only 1/7 (14.3%) of these references could be retrieved in free full-text format. In total, 14/103 (13.6%) of the references cited in advertisements placed in medical publications were listed as “data on file”. Compliance with the relevant general regulation was easier to judge, and seen more often, than was the case in respect of the more subjective elements included in the draft code of practice.
Conclusions: The quality of advertisements for reproductive health products placed in medical publications appears to fall short of at least some of the requirements of both existing and draft regulatory instruments. This may potentially have deleterious consequences for both prescriber and consumer behaviour. The draft code of practice is, however, often difficult to apply in an objective and consistent manner, and may be open to interpretation and therefore variable standards of quality.
