Transcript Powerpoint template for scientific posters (Swarthmore College)

Drug Advertisements in Medical Journals: Education or Deception
Joel Lexchin MSc, MD*
School of Health Policy and Management, York University & Emergency Department, University Health Network
*Conflicts of interest: Retained by Canadian federal government to provide expert advice in relation to a lawsuit regarding the legality of direct-to-consumer advertising in Canada
Why Study This Topic
Results
Journal advertising is only a small percent of overall promotion:
Journal advertising 2004 (US): $500 million
Total promotion 2004 (US): $57.4 billion
Level of evidence*
Doctors use journal ads
However, there are lots of ads
0
Journal advertising in Canada - 2000
Product
Study
10
20
30
40
50
Medical journals
Number of pages of ads
1090
Celebrex
613
Pharmaceutical reps
52.9
Mailings
43.6
Reference publications
42.9
Lipitor
559
Baycol*
361
27.6
Conference symposia
974
Systematic review or metaanalysis
Randomized controlled trial
Other evidence
Smart - 1997
2/139 (1)
41/139 (30)
96/139 (69)
Loke - 2002
99/855 (12)
297/855 (35)
75/855 (9)
Villanueva - 2003
--
84/125 (67)
18/125 (14)
Lankinen - 2004
9/381 (2)
33/381 (9)
135/381 (36)
48.1
CME courses
Effexor
70
66.5
Colleagues
Vioxx*
60
26.3
Prescription pads
26
Audio cassettes
24.1
Dinner meetings
21.6
How are benefits presented*
Percent of doctors
exposed to
advertising about
medications in
past week
Study
Lexchin - 1999
*Removed from market for safety reasons
Gutknecht - 2001
Loke - 2002
Journals make lots of money from ads
Lankinen - 2004
Organization
ACC
ACP
AMA
ATS
IDSA
MMS
Journal
JACC
Annals
JAMA
AJRCCM
CID
NEJM
Revenue from
ads per year
(000,000)
$4.67
$6.00
$18.63 $0.717
$0.715 $14.31
Ad revenue as 13.8
% total
revenue
12.9
10.4
2.1
31.3
21.3
Ad revenue as 93.0
%
membership
dues and
assessments
133.9
26.2
17.1
125.4
792.7
Results
Country
Unambiguous clinical outcome
n (%)
Vague clinical outcome
n (%)
Emotive or immeasurable
outcome
n (%)
Non-clinical outcome
n (%)
418/1504 (28)
437/1504 (29)
301 (20)
346 (23)
81/883 (9)
326/883 (37)
270/883 (31)
206/883 (23)
Finland (Lankinen –
2004)
Doctors don’t think that they are influenced by promotion
Doctors perceptions of whether
they are influenced by
promotion
Study
Becker - 1972
1%
61%
A little
None
Data sources
1.Othman et al. PLoS One 2009;4:e650
Walton – 1980
Healthcare
Communications - 1989
Jones - 1999
Prosser - 2003
Charbit - 2003
Hemminki - 2004
Study
Watkins - 2003
Measurement
Frequency of use of journal ads as a source of prescribing information
and appropriateness of prescribing
Measurement
Frequency of use of journal ads as information source and number of
chloramphenicol prescriptions
Journal ad recognition and number of prescriptions for medication
Journal ad recognition and market share of advertised medication
Change in prescribing quality
Infrequent use of ads was not associated with better prescribing
Use of journal ads and frequency of general practitioner prescribing
Influence of journal ads and number of prescriptions written
Use of journal ads and prescriptions for various antihypertensives
No association between use of ads and volume of prescribing
High volume prescribers more likely to cite ads as influential than low volume prescribers
Increase (decrease) in number of advertisements associated with increase (decrease) in number of
prescriptions
More use of ads associated with more prescriptions
Change in prescribing costs
No association between frequency of reading of ads and cost of prescriptions
Use of journal ads and prescriptions for HRT
Measurement
Frequency of reading of journal ads and cost of prescriptions
Change in prescribing frequency
Infrequent use of ads associated with lower number of chloramphenicol prescriptions
Conclusions
3.Author’s personal files
•Level of evidence cited in ads is generally poor
•Benefits are presented predominantly as relative risk reductions
.
•Most claims in ads are vague in nature
•Using ads as a source of information is associated with negative effects on prescribing
5.Healthy Skepticism database on drug promotion
www.healthyskepticism.org
Number needed to treat
Original data permitting
calculation by readers
29/130 (22)
0 (0)
0 (0)
9/130 (7)
Not reported
Not reported
0 (0)
Not reported
13/174 (7)
0 (0)
0 (0)
2/174 (1)
Not reported
1/245 (0.4)
0/245 (0)
Not reported
“Myth is often deployed in drug advertising to depict exaggerated therapeutic efficacy:
armed with such drugs, the clinician can liberate patients from the oppression of
disease and restore them to normality. With medicine as their alibi advertisers exploit
the nude… Mythology transports the clinician into a wider sociocultural context than
that of medicine alone. Viewing exotic or erotic scenes derived from “old masters,” the
reader is relocated from office to gallery, obtaining visual relief from the clinical
grind… Associations between diseases and drugs are made to seem natural
unmotivated by commercial interest.”
Scott et al BMJ 2004;329:1484-8
Images of women
An analysis of advertisements for antidepressants
in Scandinavian and American journals in 1995
showed that the Scandinavian advertisements tended
to construct antidepressants as female gendered and
Depression as detached from any social context. Both
American and Swedish advertisements used images of
couples and showed the drug as being key to maintaining
the relationship, and the woman as the person needing
the drug. (Lovdahl et al. Scan J Pub Hlth 1999;27:306-10)
Although depression is diagnosed about twice as often in
women than in men the ratio of females to males in advertisements in the American Journal of Psychiatry was
5:1 and in the American Family Physician it was 10:0.
(Hansen et al. Women & Therapy 1995;16:129-141)
Higher ad recognition associated with larger volume of prescriptions
Higher ad recognition associated with higher market share
2.Ongoing systematic review of the effects of promotion on prescribing
4.Health Action International/World Health Organization database on drug
promotion www.drugpromo.info
Absolute risk reduction
Effects on prescribing
Study
Becker - 1972
A lot
Relative risk reduction
Appeals to myths
Nature of claims made
Drug companies make money from ads:
For every $1.00 spent there is a return of $2.43
Advertisements with n (%)
From: Othman et al. PLoS One 2009;4:e650
Australia (Loke – 2002)
38%
Level of evidence n (%)
For further information
Joel Lexchin
[email protected]