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The Pharmaceutical Journal
Vol 270 No 7234 p154
1 February 2003

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  OFT report
  The Profession
  Skill mix
  Community pharmacy
  Food and drugs

Letters to the Editor

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Prescribers need appraisal training programmes

From Mr A. R. Cox, MRPharmS

With regard to Trevor Jones's defence of pharmaceutical advertising (PJ, 25 January, p116), he doth protest too much, methinks.

Current advertising and promotion of prescription medicines is not always accurate and reliable. In 2001?02, the Medicines Control Agency identified 81 breaches from complaints,1 and 138 complaints were made to the Prescriptions Medicine Code of Practice Authority in 2001. A breach of the code was found in 111 cases. Tellingly, the industry submitted the highest number of complaints to the authority.2

If the industry itself does not always accept that "advertisements for prescription medicines they see are reliable and accurate", should health professionals be any less vigilant?

One recent example of a poor advertisement was for a drug to aid weight loss. Rows of obese torsos were shown, each labelled with a symptom or disease related to obesity. This misleadingly gave the impression that the drug was suitable in obese people with these co-morbidities. In fact, some of these symptoms and conditions were contraindications to use of the drug. Ironically, one of the co-morbidities, hypertension, was a potential adverse reaction to the drug.3

Advertisements continue to refer to "data on file", which are not open to scrutiny, and to extract selective and over-simplified messages about drug benefits from published papers. They may not be false, but they do not provide the whole truth.

Perhaps more important than the overt messages in advertisements are the more subtle claims they convey through the image promoted, rather than the utilitarian properties of the drug. By using this "strategy of desire" pharmaceutical advertising attempts to exploit the unconscious motives and desires of prescribers.4

One GP commenting on a recent NSAID advertisement explained that the "knight in armour suggests strength and the armour is protecting the stomach". An advertisement for one coxib shows two "humorous, happy ladies with mobility improvement". Another coxib advertisement shows a large waterfall, drawing on the power and symbolism of nature.5

Other advertisements exploit feelings of guilt or fear of failing patients. A picture of a life-belt and a suggestion that prescribers should "throw their high-risk patients a lifeline" promotes an angiotensin II antagonist.

Current and future prescribers are unlikely to see a reduction in the sea of advertising, gifts, representatives and sponsored meetings they will encounter. It is vitally important that training programmes at undergraduate and postgraduate level teach the skills necessary to appraise industry marketing critically.6

Anthony Cox
West Midlands Centre for Adverse Drug Reaction Reporting
City Hospital NHS Trust


1. National Audit Office. Safety, quality, efficacy: regulating medicines in the UK. London: The Stationery Office; 2003

2. The Prescriptions Medicine Code of Practice Authority. Annual Report for 2001. London; 2002.

3. The Prescriptions Medicine Code of Practice Authority. Primary care group prescribing advisor v Knoll. Reductil journal advertisement. Code of Practice Review 2001;34:55-57.

4. Scott DK, Ferner RE. "The strategy of desire" and rational prescribing. Br J Clin Pharm 1994:37:217?9.

5. Rose J, Christy J. A moment's notice: old favourites still lead in the NSAID market but newer campaigns are getting noticed. Pharmaceutical Marketing 2002:14:55.

6. Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: attitudes and practices of medicine housestaff towards pharmaceutical industry promotions. Am J Med 2001:110:551?7.

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