Healthy Skepticism Library item: 20518

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

Follea L
Drug companies under fire for their Third World advertising practices
Le Monde 1993 Sep 1513

Abstract:

Laurence Follea reports on pharmaceutical laboratories’ use of misleading advertising.

Full text:

A report just published shows that misleading advertising is still being used by pharmaceutical laboratories when marketing their products in Third World countries. The alarm call was first sounded in 1983, when an international network of doctors and pharmacists formed the Medical Lobby for Appropriate Marketing (MALAM) to try and stem laboratories use of two-tier advertising policies for their products.

The new report, published by MALAM’s French Branch, PIMED, shows that such practices persist not only in Africa but in South America and Asia. Some 100,000 pharmaceutical products are currently on the world market. An international survey published this year looked at 6,170 adverts in 23 large-circulation medical magazines between July 1987 and June 1988. Contra-indications and precautions were omitted in half of them, and undesirable side-effects in 40 per cent.

Another study, commissioned by the Congress from the Office of Technology Assessment, revealed that about two thirds of 241 medicinal products sold by American laboratories to four developing countries (Brazil, Kenya, Panama and Thailand) did not carry enough information to enable doctors to prescribe them effectively and safely.

Almost all the pharmaceutical multinationals have come in for flak from MALAM. As a result of its active lobbying, nine specialities have been withdrawn from sale or had their fortune changed since 1987. The advertising of 16 other products has been totally or partly stopped.

The drugs withdrawn include Expetra (Burroughs Wellcome), recommended for bronchitis in Pakistan, and Coramine (Ciba Geigy), prescribed for respiratory ailments in Thailand (it is still marketed in France for other complaints).

Those reformulated include Smith Kline and French’s Furoxone, Upjohn’s Kaomycin and Parke-Davis’s Humagel’ (all recommended for diarrhoea), Sterling Withrop’s Franol (for asthma, bronchitis and emphysema), and Merck’s Ilvio (for the prevention and treatment of colds and flu).

The main product whose advertising had to be changed was Rhone-Poulenc’s vaccine Tetracocq, which was described in The Philippines as being effective vaccine against diphtheria, whooping cough, tetanus and poliomyelitis. The French firm admitted that no vaccine could be 100-percent effective, nor could it be guaranteed as having no side effects.

One reason for these abuses has been a certain woolliness in registration procedures. The “ethical criteria” applicable to the advertising of medicines as defined by the World Health Organisation (WHO) in 1988 do not always tally with those in the code of the International Federation of Pharmaceutical Manufacturers’ Associations, which was adopted in 1981 and has been updated three times since then.

What is WHO’s attitude? It says, first, that active promotion of medicines in any country must be restricted solely to those legally obtainable there, and that advertising must conform to national regulations and health policies.

Such requirements are very hard to meet in the less developed countries, where health legislation is sometimes rather sketchy and assessment structure are often conspicuous by their absence.

WHO also distinguishes between advertising aimed at health professionals (which must contain comprehensive information about the product) and advertising to the general public (permitted only when medicines are available without prescription) and which must contain essential information about the product, such as its non-proprietary or generic name, main indications, directions for use, contra-indications, and warnings.

As regards direct marketing, WHO has been taking a particularly close interest in medical sales reps who visit prescribing doctors at their practices. It urges that they should be suitably trained and give their clients the scientifically approved information sheet for each project. This is a sector where widespread abuse has been recorded (for example, the number of application of a given product may be extended, or its undesirable side effects left unmentioned).

WHO specifically states that the advertising criteria followed should be the same as those in force in the country where the product is manufactured.

Many of these regulations have been flouted, with alarming consequences for the health of those who have been misled. Studies of the impact of advertising campaigns have proved they have a powerful effect on prescribing doctors, especially in those countries where promotional material is often the main source of medical information.

The treatment of children in developing countries with anti-diarrhoeal medicines that do not carry vital information about rehydration is still having disastrous effects. Similarly, the use by general practitioners of certain medicines – generally expensive ones – which are restricted to hospital use in the developed countries can encourage the emergence of new forms of resistant organisms.

One task of the future European agency for medicines will be to regulate such marketing practices. The March 1992 European directive on advertising of drugs for human use will provide a basis for its action. It largely reiterates WHO’s definitions. But in cases of abuse, offending companies will be required only to withdraw misleading advertising and publish a correction – scarcely a sufficient deterrent to the laboratories’ ardour in the pursuit of gain.