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      Critical Evaluation of Drug Advertisements in a Medical College in Lalitpur, Nepal

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          Abstract

          Purpose

          The information provided in drug advertisements (DAs) often do not follow the recommended criteria and may promote irrational prescribing behaviors. Recently Health Action International (HAI) formulated detailed criteria to evaluate DAs which further develop and expand on the World Health Organization (WHO) criteria. This study was done to evaluate DAs using both criteria.

          Methods

          The study was carried out from October 2019 to January 2020 in the Department of Pharmacology of KIST Medical College, Lalitpur, Nepal. A structured proforma was used to collect data.

          Results

          Altogether 100 DAs were analyzed. Maximum (85%) were having pictorial presentations. Majority (89%) were found to have authentic information and 3% were found to have exaggerated information. All DAs mentioned generic name, brand name, active drug per dosage form and approved therapeutic uses. Only 4% of DAs mentioned about the adverse effects that can be caused by the use of these medicines. The DAs evaluated as per the HAI criteria for pictures and images showed that people portrayed did not seem to be Nepalese. Females and males were portrayed differently with females being laypersons and males being healthcare professionals. Nineteen DAs contained 33 references to scientific literature. Thirty references contained adequate citation information to be identified and were retrievable. Retrieved references were of high methodological quality and from peer-reviewed journals. There was only one graph in the DAs and it contained the number needed to treat (NNT) information. The graph was not having statistical calculations and was not obscured by other visual material.

          Conclusion

          Using both HAI and WHO criteria for assessing the DAs was the strength of this study. None of the DAs fulfilled all the criteria. Additionally, lack of any information on harm in the large majority of DAs, and very limited backing of claims with references was also seen.

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          Most cited references23

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          Antibiotics/antibacterial drug use, their marketing and promotion during the post-antibiotic golden age and their role in emergence of bacterial resistance

          John Odda, David Kyegombe, Norah Mwebaza … (2014)
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            Quality of Pharmaceutical Advertisements in Medical Journals: A Systematic Review

            Noordin Othman, Agnes Vitry, Elizabeth E. Roughead (2009)
            Background Journal advertising is one of the main sources of medicines information to doctors. Despite the availability of regulations and controls of drug promotion worldwide, information on medicines provided in journal advertising has been criticized in several studies for being of poor quality. However, no attempt has been made to systematically summarise this body of research. We designed this systematic review to assess all studies that have examined the quality of pharmaceutical advertisements for prescription products in medical and pharmacy journals. Methods and Findings Studies were identified via searching electronic databases, web library, search engine and reviewing citations (1950 – February 2006). Only articles published in English and examined the quality of information included in pharmaceutical advertisements for prescription products in medical or pharmacy journals were included. For each eligible article, a researcher independently extracted the data on the study methodology and outcomes. The data were then reviewed by a second researcher. Any disagreements were resolved by consensus. The data were analysed descriptively. The final analysis included 24 articles. The studies reviewed advertisements from 26 countries. The number of journals surveyed in each study ranged from four to 24 journals. Several outcome measures were examined including references and claims provided in advertisements, availability of product information, adherence to codes or guidelines and presentation of risk results. The majority of studies employed a convenience-sampling method. Brand name, generic name and indications were usually provided. Journal articles were commonly cited to support pharmaceutical claims. Less than 67% of the claims were supported by a systematic review, a meta-analysis or a randomised control trial. Studies that assessed misleading claims had at least one advertisement with a misleading claim. Two studies found that less than 28% of claims were unambiguous clinical claims. Most advertisements with quantitative information provided risk results as relative risk reduction. Studies were conducted in 26 countries only and then the generalizability of the results is limited. Conclusions Evidence from this review indicates that low quality of journal advertising is a global issue. As information provided in journal advertising has the potential to change doctors' prescribing behaviour, ongoing efforts to increase education about drug promotion are crucial. The results from our review suggest the need for a global pro-active and effective regulatory system to ensure that information provided in medical journal advertising is supporting the quality use of medicines.
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              Promotion of Prescription Drugs to Consumers and Providers, 2001–2010

              Rachel Kornfield, Julie M. Donohue, Ernst Berndt … (2013)
              Background Pharmaceutical firms heavily promote their products and may have changed marketing strategies in response to reductions in new product approvals, restrictions on some forms of promotion, and the expanding role of biologic therapies. Methods We used descriptive analyses of annual cross-sectional data from 2001 through 2010 to examine direct-to-consumer advertising (DTCA) (Kantar Media) and provider-targeted promotion (IMS Health and SDI), including: (1) inflation-adjusted total promotion spending ($ and percent of sales); (2) distribution by channel (consumer v. provider); and (3) provider specialty both for the industry as a whole and for top-selling biologic and small molecule therapies. Results Total promotion peaked in 2004 at US$36.1 billion (13.4% of sales). By 2010 it had declined to $27.7B (9.0% of sales). Between 2006 and 2010, similar declines were seen for promotion to providers and DTCA (both by 25%). DTCA’s share of total promotion increased from 12% in 2002 to 18% in 2006, but then declined to 16% and remains highly concentrated. Number of products promoted to providers peaked in 2004 at over 3000, and then declined 20% by 2010. In contrast to top-selling small molecule therapies having an average of $370 million (8.8% of sales) spent on promotion, top biologics were promoted less, with only $33 million (1.4% of sales) spent per product. Little change occurred in the composition of promotion between primary care physicians and specialists from 2001–2010. Conclusions These findings suggest that pharmaceutical companies have reduced promotion following changes in the pharmaceutical pipeline and patent expiry for several blockbuster drugs. Promotional strategies for biologic drugs differ substantially from small molecule therapies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Multidiscip Healthc
                Journal ID (iso-abbrev): J Multidiscip Healthc
                Journal ID (publisher-id): jmdh
                Journal ID (pmc): jmulthealth
                Title: Journal of Multidisciplinary Healthcare
                Publisher: Dove
                ISSN (Electronic): 1178-2390
                Publication date (Electronic): 29 July 2020
                Publication date Collection: 2020
                Volume: 13
                Pages: 717-725
                Affiliations
                [1 ]Department of Pharmacology, KIST Medical College , Gwarko, Lalitpur, Nepal
                [2 ]Department of Pharmacy, Central Institute of Science and Technology , Baneshwor, Nepal
                [3 ]Department of Basic Sciences, Oceania University of Medicine , Apia, Samoa
                Author notes
                Correspondence: Nisha Jha Email nishajha32@gmail.com
                Author information
                http://orcid.org/0000-0003-1089-6042
                http://orcid.org/0000-0001-6105-5636
                Article
                Publisher ID: 259708
                DOI: 10.2147/JMDH.S259708
                PMC ID: 7406374
                PubMed ID: 32801734
                SO-VID: 00c8f544-b3e1-4ee4-8006-2c1b74806fa1
                Copyright © © 2020 Jha et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 29 April 2020
                Date accepted : 15 July 2020
                Page count
                Figures: 3, Tables: 10, References: 31, Pages: 9
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Medicine
                Keywords: drug advertisements,ethical criteria,evaluation,health action international,nepal
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: drug advertisements, ethical criteria, evaluation, health action international, nepal

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