Only 6% of drug advertising material is supported by evidence
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7438.485-a (Published 27 February 2004) Cite this as: BMJ 2004;328:485
All rapid responses
I fail to see how drawing attention to the fact that bmj.com tops the
list of results when Google is searched for "medical journal" is
misleading.
It's what happened when the advertisement was planned and it was
still true a minute ago. The list went bmj.com, the free medical journals
website, the Medical Journal of Australia, the Southern Medical
Journal,the Irish Medical Journal, the Canadian Medical Association
Journal, and so on.
The ad appeared in the paper version of the BMJ, which goes mainly to
members of the British Medical Association as a benefit of membership.
According to our research, only 8% of BMA members access the website in
any week, which we think is a shame because the website has lots of
interesting features, not least of which is rapid responses.
(see: http://bmj.com/aboutsite/quest2003/ for research)
As most members were probably aware of the pre-eminence of Google, we
thought a gentle reminder that this powerful search engine was listing
"their" website as the number one search result for "medical journal"
might prompt a visit from them out of curiosity.
It's Mago and Tripathi who have decided that "the obvious
implication" of the ad was that we were claiming bmj.com as "the best
medical journal website." But we never made that claim. As is widely
known, Google uses a complicated algorithm to determine its listing order.
The last time I heard they took 17 variables into account, with the most
important being the number of links to a site weighted by the reputation
of the linking sites.
(For a brief description of Google's PageRank tool, see:
http://www.google.com/technology/index.html)
If this is true, then a tentative claim could be made for bmj.com
being the most useful website with "medical journal" in its name. But we
didn't even go that far in our advertisement.
Competing interests:
As editor of bmj.com, I'm probably over sensitive to criticisms of it.
Competing interests: No competing interests
Sir:
In response to Heidelberg¡¯s (2004) article1 on misleading
advertising by drug companies, and intermittent publication of articles on
this topic, we want to draw attention to the misleading advertisement for
bmj.com that appeared several times in BMJ2. The advertisement had a
picture of the home page for GoogleTM (the popular internet search engine)
and stated, in part, ¡°Search GoogleTM for ¡®medical journal¡¯ and see who
tops the list¡±. The obvious implication was that bmj.com is the best
medical journal website. However, the actual reason bmj.com shows up at
the top of the list is because the title for the website bmj.com is
¡°bmj.com ¨C electronic BMJ (British Medical Journal)¡±. Also, the
¡°keywords¡± for the bmj.com website contain the words ¡°medical
journal¡±, ¡°medical¡±, ¡°journal¡±, etc. (The keywords for any website
can be seen by going to ¡°View¡± ¡ú ¡°Source¡± on the web browser.) The
search engine looks for the specific words ¡°medical¡± and ¡°journal¡± in
the titles and keywords of websites (and highlights these words in
displaying the results). That is why the other websites at the top of the
list are ¡°freemedicaljournals.com¡±, ¡°Medical Journal of Australia¡±,
¡°Southern Medical Journal¡±, and ¡°Irish Medical Journal¡±.
The Editor of BMJ has noted3 that advertisements placed in medical
journals by pharmaceutical companies are often misleading and encouraged
readers to criticize advertisements just as they criticize editorial
pages. We believe that advertisements in medicine, just like
advertisements for any product, have both a stated content and a message
by implication or association. We believe that strict policing of the
stated content of advertisements is needed because the reader usually does
not doubt the factual information stated in the advertisement. However,
we believe firstly, that the readers have as much common sense as any
proposed advertisement policeman and can evaluate non-factual messages in
advertisements just as well as the latter. Secondly, it would be
difficult or impossible to purge advertisements of all implied messages.
To use reductio ad absurdum, that would require that the ¡°patients¡± in
pharmaceutical advertisements be obese, unattractive, and unsmiling, and
state only begrudgingly that the medication has made their condition
somewhat better!
Pharmaceutical companies, like the manufacturers of any other
product, would like to present their products in the most favorable light,
and this motivation has the beneficial effect of highlighting any possible
advantages of a particular medication. They must not be allowed to make
factually inaccurate claims but it is the reader who must take the
responsibility of being appropriately skeptical of implicit messages in
advertisements -- for example, that being first in the list of GoogleTM
search results makes bmj.com the best online medical journal.
Rajnish Mago, MD
Thomas Jefferson University
Philadelphia, PA 19107
rajnish.mago@jefferson.edu
Neeta Tripathi, MD
Cooper University Hospital
Camden, NJ 08103
tripathi-neeta@cooperhealth.edu
REFERENCES
1. Heidelberg AT. Only 6% of drug advertising material is supported by
evidence. BMJ 2004;328:485.
2. Advertisement. BMJ 2003;327:424
3. Smith R. Medical journals and pharmaceutical companies: uneasy
bedfellows.
BMJ. 2003;326(7400):1202
Competing interests:
None declared
Competing interests: No competing interests
i have always suspected misadvertising with malafide intention which
is to make a quick buck...by any means fair or foul.
at individual level doctors cannot devote so much time and effort to
study every claim and go thru their literature and "apply the mind".
similar problems beset the readers of journals, even reputed ones. one can
never be sure if it is a breakthru or a breakdown to the 'mantra' of a
quick buck. so what can diligent and honest physicians do? how can we get
the information and yet not be taken for a ride. credibilty everywhere is
lacking.
in view of all the circumstances, "wmd" (read weapons against modern
diseases can be found only in certain well-tested text-books. it is my
view that if it is not given there i do not try it. when a newer edition
come i usually buy it and bring myself up to date. in this way i am less
likely to subject my patients to dangerous therapies, or worse make them
into guinea pigs. the happy development is that certain biblical texts are
coming out sooner (every three years as opposed to five) and also with
updates which is a god-send answer to our dilemma.
Competing interests:
None declared
Competing interests: No competing interests
This study hammers the nail on its head! It clearly establishes a
fact suspected by most members of the medical profession. It indicates
that we need to be more alert when we come across any pharmaceutical
claim. The medical profession should be armed with complete information on
all drugs that are newly introduced.
We also have the additional responsibility of publicising false claims
made by drug manufacturers so that the other practitioners are alerted to
such claims. This study should spur more clinicians to carry out elaborate
observations on all future drug launches.
Competing interests:
None declared
Competing interests: No competing interests
I have had the opportunity to be a part of a few focus groups on
various drug advertisments. In every case the groups we were in felt that
the advertisents were fantasy in the extreme. Imagine going from unable to
walk to playing baseball and the like. We gave our opinions and in the end
were ignored.
Oh and it is easy to figure out what drug it is despite the names and
companies being with-held from us.
Competing interests:
None declared
Competing interests: No competing interests
As Annette Tuffs article was published in the BRITISH Medical Journal
would it not have been more informative to have entitled her piece "Only
6% of GERMAN drug advertising material is supported by evidence" ?
Furthermore, it may have been helpful and interesting for your readers for
the author to have compared the UK and German regulatory situations
regarding the substantiation of claims in promotional material. Here in
the UK, the ABPI Code of Practice for the Pharmaceutical Industry contains
an entire clause (clause7) which deals exclusively with "Information,
Claims and Comparisons". In particular, Clause 7.4 states explicitly that
"Any information, claim or comparison must be capable of substantiation".
Companies who do not adhere to this requirement can, and are, disciplined
by the Prescription Medicines Code of Practice Authority (PMCPA). Indeed,
if the article in question had been reporting on activities taking place
in the UK, the PMCPA would almost certainly have spotted it and taken
action themselves.
As a practising Pharmaceutical Physician in the UK it is an important
part of my job to ensure that all promotional claims used by my employers
are capable of appropriate substatiation. Indeed, I have a statutory
responsibility to do so, and I take this responsibility very seriously. I
am therefore extremely disappointed to see that, yet again, this journal
has, either deliberately, or as a result of ignorance, created a negative
impression of the UK Pharmaceutical Industry.
There are many hundreds of hardworking, diligent and professional
Pharmaceutical Physicians in the UK (most of whom are probably members of
the BMA) who will share my disappointment and frustration with the BMJ.
Your articles, and indeed your titles, need to be more balanced,
informative and accurate when dealing with Pharmaceutical Industry (and
Pharmaceutical Medicine) issues.
Competing interests:
I am a UK based Pharmaceutical Physician employed by a UK based Pharmaceutical Company.
Competing interests: No competing interests
A deliberately misleading title?
Alan S. Black huffs and puffs that the title of the piece is
misleading because it is from a survey in Germany. He goes on to
substantiate his case by emphasising the rigour applied to pharmaceutical
advertising literature in the UK.
In other words, what he is saying is that pharmaceutical companies
will be as 'misleading' (or insert your own choice of synonym) as they can
where they think they will get away with it. How reassuring. I wonder if
the standards applied to advertising and promotion in many third world
countries are as rigorous, if they can get away with only 6%
substantiation in Germany?
In some respects, I think the 85% of citations that either don't
exist or are cited deceptively is the most telling.
Competing interests:
None declared
Competing interests: No competing interests