CJEM and Pharmaceutical Advertisements: It's time for an end

Joel Lexchin
Research Summary: 

Pharmaceutical advertisements in medical journals have repeatedly been criticized for their influence on physicians and, ultimately, their effect on prescription practices. Specifically, advertisements manipulate or bias their message using various techniques:

- presenting their information in certain ways in graphs
- presenting benefits as relative rather than absolute
- risk reductions or numbers needed to treat
- omitting confidence intervals and power calculations
- making unsubstantiated claims about clinical or economic efficacy and quality-of-life benefits
- failing to provide key messages required for guideline-concordant care
- using poor-quality references

Doctors claim to have a negative viewpoint about the educational value of advertisements and report they do not use advertisements as a source of information. However, despite these statements, there is little doubt of the success of advertising on influencing physicians. Advertisements target the newest and most expensive products contributing to the increase in prescription drug spending, thereby diverting financial resources from other areas of health care. Extensive advertising of new drugs also leads to widespread use before adequate safety information is available; this may have serious safety consequences, such as those seen with rofecoxib (Vioxx).

Not only are journal advertisements successful in increasing sales, and therefore prescriptions, there is also some evidence that physicians who use journal advertisements as sources of information prescribe less appropriately.

Journals justify running advertisements because of the income generated. This revenue can be used to build the journal and reduce subscription rates. Richard Smith, former editor of the BMJ, argues that carrying advertisements helps to diversify the revenue sources for journals and thereby contributes to their financial independence. Some societies generate more money from journal advertisements than they do from membership fees, which raises the prospect of serious potential conflicts of interest and possibly undermines the public's confidence in the independence of the medical advice that these societies give.

In light of the biases in journal advertisements, the possible negative effects that they may have on doctors' prescribing habits, their contribution to rising drug costs and the potential threat that they pose to the independence of medical societies, CJEM should refuse all advertisements for pharmaceutical products.