Healthy Skepticism Library item: 19929

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: Magazine

Parnell K
What degree of separation in advertising and editorial?
Australian Doctor 2004 May 1426

Full text:

I’d like your opinion about an issue close to my heart, but let me give you some background first.
Many people, doctors included, maintain advertising does not affect them.
As BMJ editor Richard Smith 1 wrote recently, you never meet a doctor who says: “I prescribe X because of that pretty ad in the BMJ”. But, as he also says, you never meet anybody who who admits to buying a Saab because of their advertising either.
However, the billions of dollars spent on advertising suggests it does work, whether people view ads in a deliberately conscious way or not. There’s also evidence of advertising’s effectiveness.
This doesn’t mean drug advertising influences all doctors all of the time, but according to some commentators, it’s effective enough to justify spending on average 30-35% of sales on promotions. 2
Let’s be clear that there’s nothing inherently evil about advertising – it’s a legal, legitimate aspect of business.
And there are rules. Ads are meant to be clearly identifiable as such, and not disguised as comment.
Ideally, they also have to tell the truth, the whole truth and nothing but the truth, although with many consumer products this isn’t always the case. For example, just about every washing powder manufacturer claims their brand will produce the whitest wash.
But we accept a certain degree of advertising hyperbole on the basis that as consumers we can exercise our own judgement, detect distortions and adjust for spin.
Appropriately, a higher bar is set for pharmaceutical advertising.
The Medicines Australia Code of Conduct stipulates that: “All information, claims and graphical representations provided to healthcare professionals and members of the general public must be current, accurate, balanced and must not mislead either directly, by implication, or by omission.
Claims must be referenced where there is a possibility that a reader may be mislead if the source of the reference is not disclosed”. 3
There’s another important distinction between pharmaceutical and consumer advertising – there’s a third party involved in the former.
In contrast to a consumer who decides, after gathering information, to purchase brand X washing powder, doctors make decisions on behalf of someone else – their patient. This phenomenon is dubbed ‘information asymmetry’, when the patient is almost always dependent upon the doctor for information and guidance about medications. 4
In ceding doctors this right, patients rightfully expect decisions to be based on evidence and experience, rather than which company has the cleverest advertising campaign.
Furthermore, it’s the taxpayer or patient who pays for the drugs that doctors prescribe, not doctors themselves, resulting in a lack of price-sensitivity a situation distinct from day-to-day purchasing choices.
Some believe that because of these factors, ethical issues are more complex in pharmaceutical advertising than in consumer advertising.
Note that in the consumer would, in a bid to get maximum bang for their buck, advertisers target their audience carefully. You won’t find girly products promoted during the footy, or car tyres during ‘Sex and The City’.
Nor will you find their equivalents in print – cars are advertised in car magazines, dresses in fashion magazines and financial products in publications favoured by suits.
Go deeper still and you’ll sometimes find even closer links between advertising and editorial – for example, a car ad next to an article singing its praises is probably not a coincidence.
Which brings me to my question: should pharma companies be allowed to place their ads according to topic in a medical publication?
I’m not talking here about companies trying to influence what we write – that can never be countenanced – but the placement of their ads near a story relevant to their drug; for example, an ad for a diabetes drug next to an article on diabetes. Similarly, is an antihypertensive ad opposite an article on the hazards of untreated hypertension okay?
We’ve never allowed advertising to topic in the pages of Australian Doctor, often to the disgruntlement of our advertisers, and this remains our policy today.
Yet other medical publications regularly allow it.
So tell us honestly, have you noticed?
More importantly, do you care?

1. BMJ 2004; 328; Editors choice
2. Australasian Psychiatry 2001; 9:95-99
3. Medicines Australia Code of Conduct Edition 14, page 12
4. MJA 2004; 180:409-10