Information Contained In Drug Advertisements.

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BRITISH MEDICAL JOURNAL 29 NOVEMBER 1975
Contemporary Themes
Information contained in drug advertisements
GERRY V STIMSON
British Medical3Journal, 1975, 4, 508-509
In drug advertisements pharmaceutical manufacturers have an
opportunity to proclaim the existence of a drug, promote its
advantages, and also provide useful information to help a doctor
decide whether and when to use the drug. Three main types of
printed drug advertisements are sent to general practitionershandouts such as booklets that are given by representatives,
advertisements in periodicals, and individual direct mail
advertisements. This study was designed to look at the information content of the advertisements that appear most oftenthose in periodicals.
Regulation of advertising
The Medicines Act 19681 provides that any commercially interested
party who issues a false or misleading advertisement relating to
medicinal products is guilty of an offence under the Act and that
advertisements must not include recommendations for the use of the
product other than those specified in the product licence under which
the preparation is produced. The Act also requires that no advertisement may be sent to a practitioner unless a data sheet is also sent or
has been sent within the previous 15 months. The data sheet "is to
provide the practitioner with an objective statement, in a convenient
form for reference, giving essential particulars about the medicinal
product."2 The details on this sheet must be consistent with the
product licence, and all advertisements for the product must be consistent with both data sheet and licence.
The data sheet must be of a particular size, colour, and weight of
paper. The brand name must be in type no more than 2-25 times the
size of type for other information. The name and address of the
holder of the product licence must be given together with the following
information: a description of the appearance and pharmaceutical
form; the active ingredients described by their approved or monograph names; the quantity of each ingredient contained in each unit
dose, or when there is no unit dose the percentage of each active
ingredient in the product; the pharmacological action and the indications for which it is recommended; recommended doses for adults and
children; methods and routes of administration; contraindications;
warnings; precautions; action to be taken in the event of an overdose;
main side effects and adverse reactions likely to be associated with the
product; pharmaceutical precautions; legal category; package quantities; and product licence number.
CODE OF PRACTICE
These requirements apply only to data sheets and not to advertisements. Apart from the legal requirement that they must be consistent
with the product licence and not be misleading regulation of advertisements is voluntary. Most pharmaceutical manufacturers in the UK are
members of the Association of the British Pharmaceutical Industry
(ABPI), which has a code of practice: "to secure the universal acceptance of high standards of conduct in the marketing of medical products designed for use under medical supervision." The code emphasises that information should be presented to doctors in a form that
conforms to legal requirements and also to "professional standards
of ethics and canons of good taste." Acceptance of the code and observance of its provisions are a condition of membership of the ABPI.
The code demands less of an advertisement than the Medicines Act
demands of a data sheet. An advertisement aimed at providing a
doctor with enough information on which to reach a decision for
prescribing must give the active ingredients using approved or other
non-proprietary names contained in each unit dose; the recommended
dose, method of use, and route of administration; side effects, precautions, and contraindications; a statement that further information
is available; and the company's name and address. When the advertisement is only to remind doctors of the availability and the main indication of a product or when "it is ... obviously impracticable to display
legibly the full information" the ABPI code requires as a minimum the
approved or non-proprietary names of the active ingredients, a statement that "full prescribing information is available," and the company's name and address. The code further requires that the basic
NHS cost of the product must be given in all promotional literature
except when such information would clearly be inappropriate.
Sample of advertisements
The advertisements examined in this study appeared in periodicals
sent to general practitioners. Controlled circulation (free) periodicals
were monitored from October to December 1974, along with other
journals with large circulations (see Appendix). In the 122 issues
examined there were 3895 advertisements for drugs, an average of just
under 1300 advertisements a month. An analysis of the extent of
advertising appears elsewhere.' Every unique advertisement was
analysed. When a drug was promoted in several advertisements that
differed in content each different copy was analysed. In the three
months 591 different advertisements for 316 drugs were examined
and the information content coded.
TABLE i-Distribuition of advertisements and prescriptions according to type
of drug
Of advertisements Of prescriptions
Type of drug and area of action in each group in each group, 19735
Alimentary system 7 4 7 74
Cardiovascular system and
diuretics 15 6 10 30
Lower respiratory system 8 5 9 70
Nervous system ..22 8 26 90
Genitourinary system 2 4 0 71
Infections (systemic action) 11 3 13 80
Metabolism 4 7 3 20
Nutrition and blood 3-0 5 36
Rheumatic diseases . 4 7 3 32
Allergies . .10 2 65
Ear, nose, and oropharynx 3 4 2 71
Eye .03 1I38
Skin and mucocutaneous junctions 12 2 6-94
Others, including immunological
preparations 2 5 2-68
Dressings and appliances Not coded 2 62
Total 100 100 01
n = 591) (n 263 873 000)
Medical Sociology Research Centre, University College of Swansea,
Swansea
GERRY V STIMSON, PHD, research fellow (present address Addiction
Research Unit, Institute of Psychiatry, London SE5 8AF)
508
BRITISH MEDICAL JOURNAL 29 NOVEMBER 1975 509
TABLE iI-Year of introduction of drugs advertised
Introduced: Before 1960 1960-4 1965-9 1970-4 Total
No(' )ofdrugs .. .. 112(190",,) 82(139"o,) 133(225%',) 264(4477%) 591 (100)
TABLE III-Prescribing information given in advertisements
Information: Active ingredients Recommended dose NHS cost Contraindications Side effects Special precautions
No (%X,) with each item .255 (43 1) 84 (14-2) 37 (6 3) 25 (4-2) 23 (3 9) 18 (3-0)
Type of drugs-The advertisements examined were broadly representative of those drugs that are in common use (table 1).
Year of introduction of preparations-Understandably, many of the
advertisements were for new drugs: 23", were for drugs introduced
in the past two years, and 45)), for drugs introduced during the past
five years. Some drugs introduced over 15 years earlier, however,
were still being advertised (table II).
Brand and approved names-The brand name appeared three to
four times more often than the approved name; it was mentioned a
mean of 4 6SD3 3 times in each advertisement; in one advertisement it appeared 24 times. In contrast, the approved name
appeared a mean of 1 3SD 11 times. The average type for brand names
was 9 mm wide and for approved names it was 1-4 mm (typewriter
letters (elite style) are 2 mm wide). On average brand names were
seven times the size of approved names. The legal requirement for
data sheets prevents the brand name being any more than 2-25 times
the size of the approved name type. In some advertisements the
approved or non-proprietary name was hard to find, being hidden in
the text, in the title of a reference article, or in small print, and in 8",,
it was absent altogether. Over half of the advertisements with no
approved name were from members of the ABPI, and these advertisements appeared in many different types of journal.
Prescribing information-The most common item of information
(in 43",, of advertisements) was the quantitative list of active ingredients of the preparation, and the next most common item was the
recommended dose, although this appeared in only 14",, of advertisements. Contraindications, side effects, and special precautions were
rarely mentioned (table III). In most of the advertisements the manufacturers must have considered it inappropriate to give the NHS cost
of the drug as only 6 3",, of all advertisements contained this information. Extensive prescribing information (all items in table III except
NHS cost) was given in 1-7"/, of advertisements, and 0 5),, gave all six
items of prescribing information. Taking a minimum of prescribing
information to be the presence of one item 49))) of advertisements
contained no prescribing information. There were no appreciable
differences in the amount of information given for different types of
drugs.
Pictorial content of advertisements-Although the advertisements
tended not to have much useful prescribing information many
devoted space to diagrams (63",)), product pictures (26-7))), disease
pictures (933",)), or pictures of doctors (2 7),) or patients (34 3",,).
Conclusions
Clearly advertisements for drugs that appear in periodicals in
the UK give very little information and generally do not provide
enough for the practitioner to make a decision on prescribing.
This low level of information cannot be due to problems of
space or cost. The average entry in MIMS, measuring perhaps
26 cm2, manages to include more information than the average
periodical advertisement. (Periodical advertisements range in
size from 50 cm2 to 1000 cm2, with most about 250 cm2). A
MIMS entry includes brand name, approved name and active
ingredients, legal category, appearance, indications, NHS cost,
recommended dose, and manufacturer's name, and it may
mention special precautions and contraindications.
It is surprising also that the recommendations of the ABPI
are not always followed by members. For example, the approved
name of the drug was not given in 80) of advertisements, and
those from companies which are members of the ABPI were
among these. The basic NHS cost was given in only 6 3",, of
advertisements. Not all companies belong to the ABPI, but if
members sometimes contravene the code some effective
monitoring system for advertisements seems to be needed. Even
when the approved name was given it was often hard to find,
being somewhere in the text of the advertisement or only in the
title of a reference article. The approved name would be easier
to find if it was printed clearly on its own and in large type.
Possibly the low level of information in advertisements has
arisen because companies now rely on the data sheet, but without a comparison with earlier practice this cannot be known.
What is certainly the case, however, is that data sheets need be
sent to practitioners only every 15 months, whereas the average
general practitioner is potentially exposed to 1300 advertisements each month.4
I thank the editors who supplied copies of the controlled circulation
periodicals, and Mrs S McGlynn for coding the data.
APPENDIX
The periodicals monitored were: Pulse, Doctor, Medical News,
Medical Week (ceased November 1974), General Practitioner,
World Medicine, Update, Modern Medicine, Medical Digest,
MIMS (Monthly Index of Medical Specialties), MIMS Magazine, Modern Geriatrics, Practice Team, Medicine, Interface,
Pulse Magazine, Patient Care, Update Review (started January
1975), British Journal of Sexual Medicine, BMA News, MIMS
Colour Index, Rostrum (Pfizer), Documentia Geigy, British
Medical J7ournal, Journal of the Royal College of General Practitioners, Practitioner, Prescriber's_Journal (Department of Health
and Social Security), Medical World (Medical Practitioners
Union).
References
I Medicines Act 1968, London, HMSO, 1968.
2 Department of Health and Social Security, Medicines Act 1968, Notes on
Data Sheets, MAL 25. London, DHSS, 1973.
3Cod3 of Practice for the Pharmaceutical Industry. London, Association of
the British Pharmaceutical Industry, 1974.
4 Stimson, G V, Extent of Advertising for Pharmaceutical Products, 1975.
Mimeograph.
5 Department of Health and Social Security, Health and Personal Social
Statistics for England and Wales. London, HMSO, 1974.
Is the innoculation of bacille Calmette Guerin (BCG) with a Dermojet
safe?
BCG can be administered effectively by one of the standard jet
injectors. In a detailed study of this method' jet injection was compared with a syringe and needle technique, and produced a higher
proportion of local abscesses and nodules at four months. By 12
months, however, the two groups were comparable. Tuberculin conversion rates were similar. Jet injectors do not always function efficiently, and care must be taken to test them before use and replace them
when defective. The jet injector would probably have considerable
advantages for mass vaccination in developing countries.
British Thoracic and Tuberculosis Association, Tutbercle, 1971, 52, 155.

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