The New Straits Times, April 30, 2000
By Prof Dzulkifli Abdul Razak
A recent Health Ministry statement acknowledges that "there appears to have been an increase in the number of product launches by drug companies which can be construed as advertisements".
That the Ministry is taking a serious view of this trend must be lauded and supported by all, including the industry itself.
After all, quoting the Ministry "there was a heated argument between these companies over the public launching of Viagra last year".
Indeed, this issue is not confined to Malaysia. Thailand for instance reported (Bangkok Post, March 28) a concern "over rising number of direct and indirect advertisements." It urged "academics and well-known figures in the profession" to stop acting as presenters of commercial products, "especially those in the health sector, to avoid misleading consumers."
Even in early nineties the US Food and Drug Administration wrote that "companies have dramatically increased the sheer level of questionable promotional practices". Reportly more money have been
spent on advertisements to consumers, from US$20 million (RM76 million) in 1987 to US$90 million in 1990.
Another eye-opener was the French Government's inquiry into the pre-approval promotion of an antimigraine product, sumatriptan sold as Imigran. In 1992, over a period of weeks, articles had been appearing in the Press talking about the high efficacy of the drug, and that it had very few side effects.
Thus the practice as such is not new. It became widespread beginning in 1982 when a new drug 'benoxaprofen' was aggressively.
Drug companies continue to ride on the media, exploiting it to further their ultimate goal of maximising profit, even at the expense of putting public health at risk.
In the case of Opren [benoxaprofen], after just three months, the product was plagued with adverse reactions, especially in the elderly, and had to be withdrawn.
Closer to home, the recent TV launch of a new anti-diabetic drug could have resulted in similar disasters. Said the immediate past president of the Malaysian Medical Association: "The public have been wrongly led to believe thatthe new drug can cure Type II diabetes." Anecdotal reports indicate that patients flocked to have their piece of the 'wonder cure'.
Such are the risks of advertising drugs, new or old, in the lay media.
If unchecked it can lead to untold consequences, let alone the waste of resources. Ultimately it is members of the public who will be faced with the predicament due to unscrupulous advertising.
As noted by Dr H Mahler, the then Director-General of WHO (1986): "Much of the polemic surrounding the use of drugs has arisen around the ethical principle of telling the truth, the whole truth and nothing but the truth, and the all-too-often unethical practice of not doing that."
The 1995 US Consumer Report for found that one-third of direct-to-consumer (DTC) advertisements contained "factual inaccuracies or assertions that were not scientifically supported", and nearly 40 per cent were "considered more harmful than helpful" by at least one reviewer of the expert panel.
Despite these, companies tend to invest lavishly in promotional campaigns.
The generosity extends to all kinds of other health-related activities well-disguised as professional and educational programmes.
In a recent editorial, the British Medical Journal observed that "huge amounts of money already put into promotion targeted at doctors" in which "pharmaceutical companies provide far less education than jargon and promotion, and many claims prove to be inaccurate or misleading."
It is therefore no wonder that "pharmaceutical companies spend approximately 35 per cent of sales revenue on marketing" and "around double the proportion spent on research and development" according to one estimate.
A more subtle form of advertisements is by involving the professionals as implied by the Minister of Health (NST, Mar. 11). More often they are asked to contribute articles which are then published alongside or near some product advertisements, related to the topic discussed. This could be seen in many health-related magazines and newspaper articles in this country.
A glaring recent example is a series of six articles for "A Joint Public Oral Health Education Programme" which appeared in local tabloid from March 5 to April 9. Not only a good one-third of the full page was for the product advertismemts (in this case brands of toothpastes and a toothbrush), in the remaining space the articles were crammed, printed in a faint font and typeset making it rather difficult to read (compared to the regular news items).
What gave it away was the word "Advertorial" clearly marked on the top of the page of each article, meaning: an advertisement that imitates editorial format! It is rather obvious as who is advertising for whom.
Apart from the usual legal cut-and-dry controls, it is time for concrete action to restrict limit the level of advertising, including spending, in all forms. Instead companies should make mandatory contribution to a common neutral fund, managed by the Ministry, for the purposes of educating the public and professionals about medicinal drugs as well as other health-related matters, managed by the Ministry. Such mechanisms have been proven to cut off much of the biased promotional influence of the drug companies.
Clearly advertisement is a double-edged sword, especially in health care sector. Left on its own, it could prey on the innocent.
As mentioned by WHO, "human beings have always been searching for the magic cure to their ills and that it is easy for an advertiser or charlatan to take advantage of human credibility".
The Malaysian public and professionals alike must not be so gullible.
Recommended site: http://www.bmj.org/cgi/content/full/318/7194/1301 (BMJ Editorial)
