Personal Views Personal views

A complaint about drug company advertising

BMJ 2001; 323 doi: (Published 24 November 2001) Cite this as: BMJ 2001;323:1259
  1. David Carvel, general practitioner
  1. Biggar

    Several months ago, I and 17 999 other general practitioners received, with the morning mail, a package marked “URGENT.” Naturally my eye was drawn to this word, 5 cm long and 1.5 cm high, in red upper case letters. As a GP I receive numerous letters, messages, faxes, and emails every day. A few of them are trivial, most purely informative, and some crucially important. Without the luxury of a personal assistant, I have to determine the priority and importance of these messages myself. I took the apparent importance of this piece of correspondence at its word and opened the package, only to discover it was an unsolicited pharmaceutical advertisement for an expensive bisphosphonate. I was being urged to prescribe this new medicine for post-menopausal women to prevent bone loss and fractures. (By no means do I wish to undermine this particular patient group, and their need for bone protection, but I do not believe prescribing for them in this context is an “urgent” matter at 8 30 on a Monday morning.) The enclosure also offered me the chance to win an electronic calendar.

    Since when has a drug company's correspondence been urgent?

    I was incensed by this shameless advertising gag and incensed that I had been duped by it. Since when has a drug company's correspondence been “urgent,” except, perhaps, when it notifies the immediate withdrawal of a product? An advertisement is never “urgent.” My indignation was further heightened when I noticed this “urgent” product had been posted second class. After surgery I sat down and wrote a letter to the pharmaceutical company responsible. Two weeks later I had not even received an acknowledgement, so I wrote to the Prescription Medicines Code of Practice Authority (PMCPA) in London.

    The Association of the British Pharmaceutical Industry (ABPI), the drug industry's regulatory body, set up the PMCPA in 1993 to administer its code of practice and to deal with complaints from all parties. The PMCPA's latest review, in May 2001, details recent cases that seem to be mainly concerned with one drug company complaining about another's claims to superiority. These strike me as “dog eat dog” or a form of commercial warfare and not as points of principle as my complaint was.

    Unfortunately the PMCPA said that as the “box was glossy and colourful … the panel did not consider that the use of the word ‘urgent’ was unacceptable.” The authority did, however, note during its deliberations that “the size and form of the package was such that it would be too large for a standard letterbox” and “conveyed” this to the drug company.

    Pharmaceutical companies, we read in the business pages, are huge. They amalgamate and get even bigger. Resources are vast. There are many reasons for this wealth but fundamentally it comes down to doctors prescribing their products. To do this we have to be convinced that drug A is better and more cost effective than rival B. Perhaps in reality we just describe the one that is more familiar to us. We are therefore constantly subject to drug promotion either in the form of smiling reps laden with sandwiches or numerous personally addressed letters and packages. I wish I could say that what I prescribe is based on my reading of independent double blind placebo controlled crossover trials in peer reviewed journals, but I don't have time to read them in the evenings and, anyway, I love my wife. Therefore, like many other doctors, I suspect, I am subject to short cuts and, I dare say, glossy brochures have their appeal. My main objection here, however, is that not only are drug companies getting more powerful, they are now taking over the language. I challenged them by formally complaining to their regulatory body in this country and got nowhere.

    In medical practice the appropriate use of language is important. The inappropriate use of a word in a consultation could damage my relationship with a patient and his or her family forever. As I pointed out in my letter to the PMCPA, the last time a message to me was marked “urgent” was in a fax from our local public health department notifying local GPs of a confirmed case of meningococcal meningitis in the community. This was undoubtedly urgent. What is now to stop drug companies stating their products are “urgent,” “essential,” “imperative,” or any other adjective they choose?

    Perhaps this was no landmark ruling, but I do feel that as doctors we should be prepared to argue points of principle, particularly when they have an effect on the way we practise and ultimately upon patient care. I am not a self appointed guardian of the English language but I do object to the deliberate misuse of words in an advertising context.

    I would strongly encourage others to do as I did and complain to the PMCPA when they find inconsistencies in pharmaceutical company claims or merely in the presentation of adverts. Otherwise standards will only get lower and the wood will be even harder to see for the forests of mail we receive.

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