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LETTERS: Daniel G Hackam and John S Ashcroft Drug treatment of hypertension BMJ 2003; 326: 764a [Full text]

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Journals should be more rigorous in selecting which pharmaceutical industry adverts to publish

James J Oliver, Dr Simon R Maxwell   (15 April 2003)

Journals should be more rigorous in selecting which pharmaceutical industry adverts to publish 15 April 2003
James J Oliver, Specialist Registrar in Clinical Pharmacology Clinical Pharmacology Unit, Western General Hospital, Edinburgh, EH4 2XU , Dr Simon R Maxwell Send response to journal: Re: Journals should be more rigorous in selecting which pharmaceutical industry adverts to publish	Until the publication of the ALLHAT study [1] there was little, if any, evidence of the clinical benefit of amlodipine in the treatment of hypertension. Nevertheless, as testimony to the marketing success of Pfizer, amlodipine, sold in the UK as Istin and in the USA as Norvasc, has become the world's biggest selling antihypertensive. Pfizer are naturally keen to publicise the results from ALLHAT, which demonstrate for the first time both the efficacy and safety of their drug. A number of medical journals, including the BMJ, have recently printed an advertisement for amlodipine in which it is claimed "with the results of the ALLHAT study, lowering blood pressure with Istin in high risk hypertensive patients is now proven to be equivalent to a diuretic in stroke outcome". While the advertisement is factually correct, unsurprisingly, it fails to mention the relative cost of amlodipine. According to the latest British National Formulary prices it costs about 16 times more to treat hypertension with amlodipine than it does with bendrofluazide, the most commonly prescribed thiazide diuretic in the UK. If equivalent efficacy is accepted, this makes amlodipine about 1/16th as cost effective. Given that hypertension is the commonest treatable chronic medical condition in the UK, a treatment strategy based on amlodipine would be wasteful. Most would agree that those who prescribe have a duty to consider cost effectiveness, especially where there is a choice of effective treatments [2]. In light of this, it is disappointing that major medical journals, particularly those that have championed transparency in health service- industry partnership, are prepared to accept adverts that contain information that may be considered misleading. We suggest that reputable journals should take account of any potentially misleading content in deciding which adverts to publish. 1. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981-97. 2. Gillon R. Medical ethics: four principles plus attention to scope. Br Med J 1994;309:184-8. Competing interests:   Dr Oliver holds an educational research grant from Pfizer Ltd