Misleading promotion is common |
For example, in the best study of its type, only 4% of 109 advertisements in leading medical journals in the United States were found to be acceptable, with 34% requiring major revision and an additional 28% deserving complete rejection.7 While Australian studies of advertisements have detected fewer misleading advertisements, these studies, in comparison, were less thorough.8 An analysis of 16 "drug rep" visits to Melbourne general practitioners found that none were balanced. The product information was contradicted at least once during 11 of the visits.9 A Canadian study found that promotional claims are often based on evidence of poor quality.10 The arguments supporting increased prescribing use many logical fallacies,11 and communication errors. Use of "red herring" intermediate end-points is an important example of a logical fallacy. It is the fallacy of believing that if a drug can alter an impressive-sounding physiological parameter then it is good for patients. Ambiguity is an example of a communication error. It takes advantage of the understandable tendency for busy doctors to glance at promotion rather than to study it carefully. For example, glancing at the phrase "unsurpassed power" may give the impression of superior efficacy, but drug companies may use such a phrase to promote a drug of equal efficacy and assert that it is not misleading because "unsurpassed" means "equal". |
The powers of promotion |
For example, 10 US physicians did not believe that going to all-expenses-paid seminars at popular sunbelt vacation sites would influence their prescribing habits. Nevertheless, their prescribing of the promoted drugs did increase significantly. 12 There may be a difference between accepting expensive gifts compared with gifts which appear trivial, such as brand name reminder pens: the difference may be that cheap gifts are a more cost-effective way to influence prescribing.13 Gifts can create reciprocal obligations and conflicts of interest. Pharmaceutical sales representatives also use other methods of influence, including friendship and appeals to authority.9 Advertising often creates associations between the drug and images that appeal to our desires for power or confidence.14 These methods of influence may work without arousing much awareness and thus bypassing critical-appraisal defences. The effects of individual influences may be small. However, repetition can build small effects up to make a big difference to what comes to mind first during a quick prescribing decision.15 |
Misleading promotion is a cause of community concern |
For example, not only can it undermine the public's trust in health professionals,16 it may be one of the important causes of inappropriate prescribing. While launching National Medicines Week in July 1996, Health Minister Michael Wooldridge mentioned that inappropriate use of medicines may be costing Australia as much as $700 million per year. Many people are concerned about the role of promotion in the soaring costs of the Pharmaceutical Benefits Scheme (PBS). There are many reasons for doctors to be concerned about misleading promotion. Inadequate warnings about adverse effects increase the risks of litigation. Further, the suboptimal outcomes that result from inappropriate prescribing may contribute to the trend towards "alternative" therapies. Given that the total public and private expenditure on health care is relatively static, increasing spending on the PBS and on alternative therapies reduces the funds available for our incomes.17 Misleading promotion is also a problem for drug companies. Inappropriate prescribing rewards and fuels further misleading promotion. This completes a vicious cycle which reduces the value that the community receives for expenditure on health professionals and from the pharmaceutical industry. In the long term this loss of value must also reduce drug companies' profitability. |
©MJA 1997
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