Intended for healthcare professionals

Rapid response to:

Rapid Response:

Is it time for the BMJ to abolish medical advertisements?

Dear Editor

In June 2020, the Danish Medical Association abolished medical advertisements from Ugeskrift for Læger[1], the first national association to make such a decision.

Proponents of marketing for healthcare professionals claim that advertisements inform clinicians; clinicians can discern marketing from science; and income sustains medical journals[2 - 4].

The first two arguments have been refuted in systematic reviews[5-7]. Industry marketing shapes clinicians’ prescription patterns; this influence is not beneficial[5-7]. In the US, the industry spends more on healthcare professionals’ marketing ($20.3 billion) than on ‘direct-to-consumer’ marketing ($9.6 billion)[8]. Marketing in medical journals is effective and profitable.

Income-related arguments should be dissected for each journal/publisher. The ‘BMJ Publishing Group’ reports £81.7 million total revenue (2019)[9], including £3.2 million (4%) from ‘product advertising’ plus £2.3 million industry income as ‘commercial sponsorship’ and ‘reprints’. BMJ’s ‘product advertising’ income was £2.6 million (13% of total revenue)[9].

The British Medical Association (BMA) reports (2019) £1.95 million net surplus for the BMJ Publishing Group and £3.14 million surplus for the BMA itself[10]. (Note: not all advertising revenue comes from prescription drugs).

BMJ prohibits tobacco advertisements[11]. In 2019 it banned breast milk formula advertisements[12], because they are often misleading, they negatively impact breastfeeding rates, legislation is weak and violated by the industry, and best evidence is not found in advertisements[12]. Similar arguments apply for prescription drug advertisements[13, 14].

A decision to ban medical advertisements costs more than banning milk formula advertisements (£300.000 annually[12]), but there are options to level losses. Medical advertisements may be substituted with other advertisements; production and distribution costs may be reduced by phasing out the print version; and increase of membership costs. BMA’s £2.6 million advertising income divided by 159,690 members[10] is £16 per member, 3.5% of a standard membership fee (£460)[15].

We encourage BMJ and the BMA to abolish medical advertisements.

KB wrote the first draft and both authors worked on producing the final paper.

1. Nu forsvinder lægemiddelannoncer fra Ugeskrift for Læger [Medical advertisements now disappear from Ugeskrift for Læger]. 19 June 2020. (accessed March 2022).
2. Smith R. Should medical journals carry drug advertising? Yes. BMJ 2007;335:74.
3. Pharmaceutical Research and Manufacturers of America (PhRMA). Pharmaceutical marketing in perspective. Its value and role as one of many factors informing prescribing. July 2008. (accessed March 2022).
4. Gaddis GM, Olsen JE, Wright DW. Academic emergency medicine can print pharmaceutical advertising while not compromising its mission or its integrity. Acad Emerg Med 2009;16:978-81.
5. Spurling GK, Mansfield PR, Montgomery BD, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: a systematic review. PLOS Med 2010;7:e1000352.
6. Brax H, Fadlallah R, Al-Khaled L, et al. Association between physicians’ interaction with pharmaceutical companies and their clinical practices: A systematic review and meta-analysis. PLOS One 2017;12:e0175493.
7. Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ Open 2017;7:e016408.
8. Schwartz LM, Woloshin S. Medical marketing in the United States, 1997-2016. JAMA 2019;321:80-96.
9. The BMJ. Sources of revenue. (accessed March 2022).
10. British Medical Association. Annual Report and Financial Statements for the year ended 31 December 2019. (accessed March 2022).
11. The BMJ. Resources for advertisers and sponsors. Last updated Feb 2019. (accessed March 2022).
12. Godlee F, Cook S, Coombes R, El-Omar E, Brown N. Calling time on formula milk adverts. BMJ 2019;364:I1200.
13. Fugh-Berman A, Alladin K, Chow J. Advertising in medical journals: Should current practices change? PLOS Med 2006;3:e130.
14. Williams G. Should medical journals carry drug advertising? No. BMJ 2007;335:75.
15. British Medical Association. Join the BMA. Not dated. (accessed April 2021).

Competing interests: No competing interests

08 April 2022
Kim Boesen
Post-doctoral fellow
John PA Ioannidis (Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA)
Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health at Charité, QUEST Center for Responsible Research
Berlin, Germany