Intended for healthcare professionals


Ethical drug marketing criteria for the 21st century

BMJ 2018; 361 doi: (Published 30 April 2018) Cite this as: BMJ 2018;361:k1809
  1. Lisa Parker, researcher,
  2. Jane Williams, researcher,
  3. Lisa Bero, professor
  1. Charles Perkins Centre, Faculty of Pharmacy, University of Sydney, NSW, Australia
  1. Correspondence to: L Bero lisa.bero{at}

Lisa Parker and colleagues call for WHO to expand and update its criteria for ethical drug promotion to take account of changing marketing practices

The World Health Organization has a long history of promoting the rational use of drugs with the aim of improving health. One element of its multipronged approach is to use its authority1 to establish normative guidance on promotion. An early guidance document, drafted in 1968, focused on advertising of drugs. In 1988, it was updated in a new document, “Ethical criteria for medicinal drug promotion,” which was endorsed through a resolution adopted by the World Health Assembly.2 Recommendations endorsed by the WHA are among the strongest guidances produced by WHO.

The 1988 ethical criteria (box 1) were intended as guidance for countries to use when developing their regulations and practices around medicinal drug promotion.34 The document is still used by regulators, governments, and academics as a yardstick for measuring the acceptability of promotional activities.5678 The criteria have also been incorporated into curriculums for educating health professionals about drug marketing tactics.9 WHO guidance documents are particularly important in countries where local regulation is absent or insufficient. These countries are likely to receive increasing promotional attention from drug companies as the potential for market growth in high income countries shrinks.10

Box 1

Summary of WHO ethical criteria for medicinal drug promotion, 19882


  • Improving health through the rational use of drugs, using the ethical foundation of truthfulness and righteousness.


  • Promotion—All activities by manufacturers and distributers that induce prescription, supply, purchase and/or use of drugs

  • Drugs—All products that are promoted as a medicine, including prescription drugs, non-prescription (over-the-counter) drugs, and traditional medicines

Intended audience

  • Industry, prescribers, dispensers, governments, teachers, professional and consumer associations, media


  • Advertising—Guidance on content, types of drug for which advertising to the public is acceptable

  • Medical representatives—Guidance …

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