Abstract
BackgroundHealthcare professionals are exposed to advertisements for prescription drugs in medical journals. Such advertisements may increase prescriptions of new drugs at the expense of older treatments even when they have no added benefits, are more harmful, and are more expensive. The publication of medical advertisements therefore raises ethical questions related to editorial integrity.MethodsWe conducted a descriptive cross-sectional study of all medical advertisements published in the Journal of the Danish Medical Association in 2015. Drugs advertised 6 times or more were compared with older comparators: (1) comparative evidence of added benefit; (2) Defined Daily Dose cost; (3) regulatory safety announcements; and (4) completed and ongoing post-marketing studies 3 years after advertising.ResultsWe found 158 medical advertisements for 35 prescription drugs published in 24 issues during 2015, with a median of 7 advertisements per issue (range 0 to 11). Four drug groups and 5 single drugs were advertised 6 times or more, for a total of 10 indications, and we made 14 comparisons with older treatments. We found: (1) ‘no added benefit’ in 4 (29%) of 14 comparisons, ‘uncertain benefits’ in 7 (50%), and ‘no evidence’ in 3 (21%) comparisons. In no comparison did we find evidence of ‘substantial added benefit’ for the new drug; (2) advertised drugs were 2 to 196 times (median 6) more expensive per Defined Daily Dose; (3) 11 safety announcements for five advertised drugs were issued compared to one announcement for one comparator drug; (4) 20 post-marketing studies (7 completed, 13 ongoing) were requested for the advertised drugs versus 10 studies (4 completed, 6 ongoing) for the comparator drugs, and 7 studies (2 completed, 5 ongoing) assessed both an advertised and a comparator drug at 3 year follow-up.Conclusions and relevanceIn this cross-sectional study of medical advertisements published in the Journal of the Danish Medical Association during 2015, the most advertised drugs did not have documented substantial added benefits over older treatments, whereas they were substantially more expensive. From January 2021, the Journal of the Danish Medical Association no longer publishes medical advertisements.
Highlights
The pharmaceutical industry promotes prescription drugs in many ways, e.g. through sales visits to medical personnel, by arranging conferences with key opinion leaders, distributing reprints of studies published in prestigious medical journals, and through print advertisements [1]
Medical advertisements for health care professionals, i.e. marketing content about new prescription drugs sponsored by pharmaceutical companies, are allowed in most countries and published in most medical journals
Researchers have recommended medical journals to abandon such advertisements arguing that they make medical doctors prescribe new drugs at the expense of older, cheaper, and often equivalent or better alternatives [4]
Summary
The pharmaceutical industry promotes prescription drugs in many ways, e.g. through sales visits to medical personnel, by arranging conferences with key opinion leaders, distributing reprints of studies published in prestigious medical journals, and through print advertisements [1]. Medical advertisements directed towards patients, often called” direct to consumer” advertisements, are allowed only in a few countries, including the United States and New Zealand. Opponents argue that these advertisements medicalise normal experiences and lead to unnecessary drug use [2]. Medical advertisements for health care professionals, i.e. marketing content about new prescription drugs sponsored by pharmaceutical companies, are allowed in most countries and published in most medical journals. A case-control study of four international and three Russian medical journals (total of 214 issues) found 90 instances of advertisements published in an issue with closely related scientific content [8]. The publication of medical advertisements raises ethical questions related to editorial integrity
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