Editor's Choice

Advertising: boon or bother?

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7445.0-f (Published 15 April 2004) Cite this as: BMJ 2004;328:0-f
  1. Richard Smith, editor (rsmith{at}bmj.com)

    “One ad is worth more to a paper than 40 editorials,” wrote Will Rogers in 1924. Looking through issues of the BMJ from a 100 years ago, Stephen Lock, my predecessor, observed that only the advertisements were interesting. The rest was dated pap. Henry Ward Beecher, writing in 1887, agreed: “The advertisements in a newspaper are more full of knowledge in respect to what is going on in a state or community than the editorial columns are.”

    It was, I think, Gore Vidal in Myra Breckinridge in 1968 who predicted that television advertisements would soon be better than the programmes they interrupted. He's been right for at least five years, but the advertisements in medical journals are not nearly as compelling—presumably because competition is much less intense than for beer or cars and because the audience is undemanding.

    But does advertising work? The billions that are spent suggest it must, but you never meet a doctor who says: “I prescribe X because of that pretty ad in the BMJ.” But then did you ever meet anybody who admits to buying a Saab because of the fun advertisements? The evidence base for advertising seems depressingly weak, and the trade is full of strange saws—like you should always be in the front of the book (advertising speak for a journal) even though the back might be better read.

    Now a group from the Netherlands provides evidence on the impact of an “information campaign” that advised people with onychomycosis to visit their doctors (p 931). The campaign was conducted by Novartis, the manufacturers of terbinafine (a treatment for onychomycosis), and included television advertising. The Dutch Society of General Practitioners objected to the campaign, arguing that it was emphasising an unimportant health problem, but a Dutch court ruled that the campaign didn't break laws prohibiting advertising of prescription drugs because neither Novartis nor terbinafine was mentioned.

    The campaign increased consultations for onychomycosis and, even more so, prescriptions for terbinafine. Dutch guidelines recommend terbinafine rather than the alternative of itraconazole—and one reason is because of a trial comparing the two that was published in the BMJ (1995;311: 919). We were criticised at the time for promoting a treatment for a trivial condition, and one of our editorial registrars later discovered that a high proportion of the editorial staff had onychomycosis—making us, he implied, a soft touch (1999;319: 1196a).

    But perhaps the problem of advertising lies less with those doing the advertising and more with those following it. “The deeper problems of advertising come less from the unscrupulousness of our ‘deceivers,'” wrote Daniel J Boorstein in 1962, “than from our pleasure in being deceived, less from the desire to seduce than from the desire to be seduced.” Or is this just the BMJ copping out?

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