Advertisements for donepezil (Aricept) in the BMJ

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7093.1555 (Published 24 May 1997) Cite this as: BMJ 1997;314:1555
  1. Selena Gray, Senior lecturer in public health medicinea
  1. a University of Bristol, Bristol BS8 1TH
  2. b Stonebow Unit, County Hospital, Hereford HR1 2ER

    Advertisement suggests an unrealistic improvement in mental status

    Editor—I wish to express my anger and concern that advertising space on the wrapper around the clinical research edition of the BMJ (issues of 3 and 10 May) was sold to promote donepezil hydrochloride (Aricept). This is the first time that I have been aware of a promotion of this nature, and I find this form of advertising disturbing. While I appreciate that the BMJ generates necessary income from pharmaceutical companies and I can deal with advertisements within the journal, I find that to be faced by a paper strip on top of the BMJ that has to be forcefully removed before one can even read the contents page is irritating and intrusive. No doubt because of this, it is a successful marketing ploy and generates enormous amounts of income. As a general policy, however, I hope that the journal will reconsider accepting this type of advertisement, as I am sure I am not alone in finding it offensive.

    The BMJ has taken great strides in supporting a critical and rational use of the evidence base in medicine. What policy is adopted in scrutinising the content of advertisements placed in the BMJ? The promotion for donepezil–“Mum has Alzheimer's but she knew I was calling today” and the related photographs–implies that in patients with Alzheimer's disease treatment with the drug will improve function enough to have a measurable impact on the carer's mood. As far I am aware there has been one published randomised controlled trial of the use of donepezil in Alzheimer's disease, and this showed no improvement in the quality of life of carers.1 The advertisement suggests an unrealistic improvement in the mental status of patients.


    1. 1.

    Local committee has declined to approve NHS hospital prescription of donepezil

    1. Nicholas Wagner, Consultant in mental health for the elderlyb
    1. a University of Bristol, Bristol BS8 1TH
    2. b Stonebow Unit, County Hospital, Hereford HR1 2ER

      Editor—The fact that the BMJ of 10 May carried an external binder, a full page advertisement, and an insert summary for the product characteristics of donepezil hydrochloride (Aricept), the recently launched drug for Alzheimer's disease, spoilt my weekend.

      I am a singlehanded psychogeriatrician serving a population of 30 000 patients aged over 65 years, spread over 2124 km2. I am not alone among my colleagues in having just about kept my head above water (with a catchment population over twice that recommended by the old age section of the Royal College of Psychiatrists) until now, when the rising tide has finally broken the defences. My referral rate for the assessment of patients aged over 65 with presumed organic mental disorder has soared, my re-referral rate is soaring too, and so are queries about donepezil from patients, relatives, carers, general practitioners, community psychiatric nurses, and other consultants. My waiting time for first outpatient appointments has increased from seven to 10 weeks and will soon break the standard in my local patient's charter (12 weeks).

      My local health authority has just refused my trust the final £20 000 needed to fund a sorely needed additional consultant in adult psychiatry. Thus I cannot very well hand all elderly patients with functional problems over to my colleagues in order to concentrate on patients with organic problems. My local drugs and therapeutics committee has just followed the health authority's directive and declined to approve the NHS hospital prescription of donepezil. None of the local fundholding general practitioners to whom I have spoken, who have patients who could benefit from this drug, are prepared to pay the estimated £1000 a year for it.

      I shall be writing three private prescriptions for donepezil this week, thinking of the 80 or so patients in Herefordshire who might benefit from the drug and all those patients and carers who would be better served by at least two of me.


      • The BMJ carries advertising to provide financial support to the journal and information to readers. Advertising must be immediately recognisable as such, and we never sell advertising linked to editorial material (unlike many medical newspapers). All advertisements are approved by the editorial team, but as European and British legislation governs pharmaceutical advertising we rarely reject advertisements on the grounds of unsubstantiated or misleading claims. We sometimes reject advertising because we think that readers will find it offensive, but generally our policy is liberal. Readers are well able to tell the difference between advertising and editorial material. Donepezil hydrochloride has received a product licence, and the manufacturer naturally wants to promote it.

        We monitor all complaints from readers, and this is the first we have received about advertising wrappers despite their having been used intermittently for two years. The wrappers don't seem to offend many readers.–Editor.

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