Published November 20, 2014
Less than half the claims in ads from top ear, nose and throat journals are backed by data referenced by the advertiser, a new study finds.
That's a problem, some experts say, because such ads are known to sway how doctors treat their patients.
"As a result, people could be getting information that is misleading," said Dr. Jeffrey Spiegel, a head and neck surgeon at Boston University, who led the work. "It doesn't have to lead to actual harm, but it can still be wasted time and effort."
The study jibes with findings in other areas of medicine and stokes an already heated debate among editors of medical journals, the main lines of communication between doctors.
The global drug market is expected to hit $1.1 trillion in 2014, and it's estimated that drugmakers generate $2 to $5 for each dollar spent on advertising in medical journals -- which might explain why they spend nearly twice as much on promotion to doctors than to consumers.
While most journals carry ads, a few have decided to ban them. Last February, for instance, editors from Emergency Medicine Australasia pulled the plug on ads, arguing they "conflict with the ethical duty of doctors to provide sound, unbiased advice for their patients."
But others say ads may help busy doctors stay abreast of the latest development in their field.
"I think the ads do serve a role," said Dr. Richard M. Rosenfeld, editor in chief of Otolaryngology - Head and Neck Surgery, one of the journals whose ads were reviewed in the new study.
"Many times readers are alerted to a product they might not have discovered otherwise," Rosenfeld added.
Trade Group Calls for Accuracy
That sentiment resonates with Pharmaceutical Research and Manufacturers of America (PhRMA), a trade association.
"We believe that advertisements about prescription medicines can service the public health in a variety of ways, including increasing awareness about diseases and available treatment options," the group said in an emailed statement.
"That's why the PhRMA Guiding Principles clearly state that information in advertisements 'should be accurate and not misleading, should make claims only when supported by substantial evidence, should reflect balance between risks and benefits, and should be consistent with FDA approved labeling.'"
But the new study, in Archives of Otolaryngology - Head & Neck Surgery, questions whether some companies are living up to those standards.
Spiegel and his colleagues chose a sample of 50 claims from ads in four top ENT journals and sent them to five ENT doctors for review. The reviewers then compared the claims to the references listed in the ads.
The researchers found a third of the claims were supported by the referenced data. But 12 percent of the time, the data actually contradicted the claims.
When asked if the claims had enough backing to support treatment decisions, the answer was no 58 percent of the time.
Spiegel said that is problematic, because for a busy doctor one-line glossy ads are much easier to use than long scientific articles.
"The fact is that the scientific literature is copious and much of it is somewhat obscure," he told Reuters Health.
What's an Ad?
Still, Rosenfeld said the new results were not clear-cut, because the five expert reviewers often couldn't reach consensus on which claims held up.
"The fact that they can't agree reflects the nature of what an ad is," Rosenfeld said. "The problem is that we're attempting to provide a level of precision to something that was never intended to be precise. Ads are intended to attract interest."
The U.S. Drug and Food Administration told Reuters Health it regularly reviews the claims in promotional materials from drug and device makers and objects to claims it finds unsubstantiated.
But with tens of thousands of claims submitted to the FDA each year, Spiegel and his colleagues suggest the system might be overwhelmed -- especially since there is no requirement for claims to be vetted before they're published.
The FDA did not comment on whether or not this is the case.
Given that backdrop, Spiegel proposed that journal editors take responsibility by reviewing ads before they print them.
"Perhaps it would be appropriate for the medical journals to go the extra distance and help its readers by rating the ads," he said.
How Much Money Do They Bring In?
Dr. Paul Levine, editor in chief of the Archives of Otolaryngology - Head & Neck Surgery, said he has no role in reviewing ads, the revenue from which isn't "overwhelming."
His journal contributed ads to the new study and also published the findings.
While Levine said he thinks promotion to physicians is an important topic, he added that he still isn't sure how to best deal with it.
"We need to figure out a methodology to better evaluate the veracity of these ads," he told Reuters Health. "What is implied in the study is that it's everybody's responsibility to ensure that claims of any type are in fact true."
Dr. Jonas Johnson, editor of Laryngoscope, had little to say about the findings. "Ads in med journals are legal. FDA," he said in an email to Reuters Health.
Some editors, such as Rosenfeld, whose journal is the official publication of the American Academy of Otolaryngology - Head and Neck Surgery Foundation, scrutinize the ads they print, however. The journal runs between seven and ten ads per issue.
"As the editor in chief I am sent all advertisements to review," he said. "When I sign off what I'm saying is I feel that the advertisers are providing a reasonable and fair representation of their product."
By the same token, he readily rejects ads he finds are unfounded -- which is made easier by the fact that the journal's publisher SAGE, not the journal itself, makes money from printing the ads
Still, that's no excuse for blind trust in promotional claims.
"They are obviously looking to spin their product in the best light possible," Rosenfeld said. "I think the bottom line from this study is caveat lector, let the reader beware."