Are drug advertisements in Indian edition of BMJ unethical?
BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7106.459 (Published 23 August 1997) Cite this as: BMJ 1997;315:459
- B Gitanjali, assistant professor of pharmacologya,
- C H Shashindran, professor of pharmacologya,
- K D Tripathi, head of pharmacologya,
- K R Sethuraman, professor of internal medicinea
- Accepted 11 December 1996
Introduction
The BMJ publishes local editions in 16 countries, including India. These make reliable information available in countries where doctors either do not speak English or cannot afford the weekly journal. The local editions contain articles from the weekly edition of the BMJ, some local material, and advertisements.
The Indian edition of the BMJ has been published monthly since 1986. All the articles in it are from the BMJ's international edition except for one or two pages dealing with local news. The edition is reasonably priced and is therefore available to many readers. Unfortunately, the advertisements in the Indian edition do not have the same international standard as those in the weekly BMJ, are misleading, and make unsubstantiated claims.
Method and results
We studied advertisements from pharmaceutical companies appearing in five issues of the Indian edition (August to December 1992; 116 advertisements) and in four issues of the British edition (March 1993; 87 advertisements). Advertisements for parenteral fluids, milk foods, and laboratory equipment were excluded. We noted whether the advertisements included indications for treatment, dosage, precautions, contraindications, adverse effects, price of the drug, the postal address of the drug company, and whether the claims made in the advertisements were referenced.
The generic name was absent in 19 (16%) of the Indian advertisements and none of the British advertisements. Scientific information was inadequate in 23 (20%) of Indian and 3 (3%) of British advertisements. In total, 76 (66%) Indian and 80 (92%) British advertisements provided an address for further information, and 76 (66%) and 84 (97%) mentioned the price. Eight advertisements in the Indian edition (7%) were for indigenous herbal and ayurvedic products.
In addition, we sent 10 randomly selected advertisements from the Indian edition of the BMJ to a clinical pharmacologist from Britain, a member of the medical therapeutic committee for Victoria, Australia, and a pharmaceutical advisor to the International Organisation of Consumers Unions (now Consumer International), in Malaysia. They found that all the advertisements were misleading or made unsubstantiated claims. Excerpts from their opinions give an idea of the standard of advertising in the Indian edition of the BMJ (box).
Opinions of international panel on drugs advertised in Indian edition of BMJ
Trental 400 (pentoxifylline): “The advertisement makes unsubstantiated claims of improvement in mental function.” (This drug is marketed only for peripheral vascular disease in America and Britain; in India it is indicated for cerebrovascular disease as well.)
Relaxyl (diclofenac): “The claim 'gentle on the gastrointestinal tract' is not in accord with the reported high incidence of gastrointestinal side effects (up to 30% in Australian approved product information).”
Alarsin products (Indian preparation): “There is no information on active constituents, side effects, or contraindications, and the claims made are unsubstantiated.”
Keflor (kefaclor): “Makes unsubstantiated claims such as 'respiratory specific.'”
Fludac (fluoxetine): “This advertisement distorts the side effect profile by mentioning only the advantages it has over tricyclic antidepressants. There is no information on contraindications or dosage.”
Globac (haemoglobin ferric ammonium citrate, copper sulphate, manganese sulphate, zinc sulphate): “No evidence for therapeutic effect is given, and there are no clear indications for use.”
Mentat (Indian preparation): “There is no information on constituents, indications, precautions, or dosage. There is no evidence given for clinical efficacy, and the reference is to a study in an obscure (in house) journal.”
Ciprodac (ciprofloxacin): “The claim 'super power in your hands' is meaningless. There is no mention of the generic name, constituents, contraindications, or side effects.”
Ciprowin (ciprofloxacin): “Makes unsubstantiated superlative claims such as 'surgical infections: most effective and cost effective therapy' and 'LRTI: better than third generation cephalosporins.'”
Ciprobid (ciprofloxacin): “The claim 'superior to chloramphenicol, aminoglycosides, cephalosporins in … bronchopneumonia, osteomyelitis' is misleading.”
Comment
The words “Selections from the BMJ,” which appear at the bottom of every page of the Indian edition, may give some readers the impression that the advertisements have the approval of the BMJ. The advertisement for Trental (pentoxifylline) is a clear example of misleading, unethical advertising and exposes the double standards of the company marketing the drug; it is prepared to promote a treatment in India in a way that would not be permitted in Britain. The advertisements for indigenous drugs are unscientific. Broad claims of cures for sleepiness, infertility, liver diseases, and infections are made, and the only proof is papers in journals published by the manufacturer. When such advertisements appear in the BMJ they acquire an aura of respectability.
It is unfortunate that the BMJ is involved in such promotion, as the journal's reputation lends respectability to these dubious advertisements. In Britain the BMJ has to conform to a stringent code for advertising.1 For its local editions, the BMJ should follow the ethical criteria for medicinal drug promotion laid down by the World Health Organisation2; we hope that this will set an example for drug advertising in India and other developing countries.
Acknowledgments
We thank the late Professor Paul Turner, former Head, Department of Clinical Pharmacology, St Bartholomew's Hospital, London; Dr Ken Harvey, member of the Victorian medical therapeutic committee, La Trobe University, Australia; Dr K Balasubramaniam, pharmaceutical advisor, Consumer International, Regional Office for Asia-Pacific, Penang, Malaysia, for their comments.