Critical Evaluation of Drug Advertisements in a Medical College in Lalitpur, Nepal

Figures & data

Table 1 WHO and HAI Criteria Used to Assess the Drug Advertisements

S.N.	WHO Ethical Criteria for Medicinal Drug Promotion	HAI Criteria
1.	Generic name	With regard to graphs and data the criteria which were examined were presence of numeric or visual distortion, and whether the graphs were self-explanatory. Whether the graphs were obscured by other visual material and if reproduced from another source has it been reproduced exactly. The data parameters examined were relative risk reduction, absolute risk reduction and number needed to treat. Information about whether the study was randomized and blinded was also noted.
2.	Brand name	With regard to references the authors examined the original citation and looked at it critically. References to data on file and to poster presentations were not considered. Studies in special journal supplements sponsored by the pharmaceutical company were also not considered. The authors examined whether the cited study supported the claims made in the advertisement. Conflict of interest of the authors involved were also examined.
3.	Active drug per dosage form	With regard to pictures the following were noted: whether the people portrayed correspond to the population of Nepal, have both men and women been portrayed in the advertisements in equal number as both patients and care providers, have men and women been shown in a similar fashion and what symbols and metaphors have been used in the advertisements.
4.	Approved therapeutic use/s
5.	Other ingredients known to cause problems
6.	Dosage form
7.	Side effects and major adverse drug reactions
8.	Precautions, contraindications and warnings
9.	Major interactions
10.	Manufacturer/Distributor’s name and address
11.	References to the scientific literature as appropriate

Abbreviations: HAI, Health Action International; S.N., serial number; WHO, World Health Organization.

Table 2 Examples of Catchy Slogans/Terms Used

S.N.	Catchy Term	Medicine
1.	Bounce back to life	Lorazepam
2.	Healthy heart Happy Life	Amlodipine+Losartan
3.	Put smile back	Amitriptyline
4.	Addition to Diabetes Care	Teneligliptin
5.	New wave of Iron salt	Iron and combination
6.	An advanced neuroprotector	Methylcobalamin
7.	The golden bond	Ciprofloxacin
8.	Goes deeper, cures better	Cefpodoxime
9.	Power of acid control: power of protection	Esomeprazole
10.	Periods are normal. Periods pain is not.	Mefenamic acid
11.	For the healthier rhythm of heart	Atorvastatin
12.	Suitable contraceptive for lactating mothers	Desogestrel
13.	For healthy heart of diabetics	Empagliflozin
14.	Rebreathe the joy of life	Montelukast
15.	Takes care throughout pregnancy	Calcium
16.	Real pain relief	Diclofenac
17.	Complete relief from allergy	Levocetirizine
18.	Let your patients have a break-free treatment	Ornidazole
19.	Make a positive impact with the positive expert	Cephalexin
20.	Statin with highest intensity and potency	Rosuvastatin

Abbreviation: S.N., serial number.

Figure 1 Deals with common therapeutic classes of drugs depicted. Antimicrobials, cardiovascular and anti-diabetic drugs were most commonly advertised.

Table 3 Evaluation of Pictures and Images in Drug Advertisements as per HAI Criteria (n=85)

S.N.	Criteria	Comments
1.	Do the people portrayed in the advertisements reflect the racial and ethnic composition of people of Nepal?	No
2.	Are both men and women portrayed in advertisements as both patients and health- care providers in equal numbers?	Females were portrayed as patients in 18 DAs whereas males were portrayed as healthcare providers as surgeons and physicians in 8 DAs.
3.	Are the ways that men and women are portrayed (as workers, facial expressions, body language, etc.) similar?	As in number 2, only men were portrayed as Health Care Providers and only females as patients.
4.	How are the elderly portrayed in advertisements?	Not portrayed
5.	Are symbols or metaphors used in advertisements?	No
6.	What kinds of associations do these symbols and metaphors convey?	Not Applicable
7.	Are illnesses portrayed as individual events or are they put into a social context?	They were portrayed as individual events

Abbreviations: Das, drug advertisements; HAI, Health Action International; S.N., serial number.

Table 4 Evaluation of References in Drug Advertisements as per HAI Criteria (n=33)

S.N.		Yes	No
1.	Do citations contain all of the information necessary to identify references?	30	3
2.	Are all references cited retrievable including those to “data on file”?	30	3
3.	Are references of high methodological quality?	30
4.	Do journal references come from peer-reviewed medical or pharmacy journals?	30
5.	Did the company finance the research reported in the reference?	0	30 3 not sure

Abbreviations: HAI, Health Action International; S.N., serial number.

Figure 2 Provides information about the types of visual depictions used in the drug advertisements. Pictures were most commonly used while graphs and tables were used rarely.

Figure 3 Shows types of pictures used in the advertisements. Pictures of body organs, women and healthy people were used. Among other images used were of nature, sunlight and medical instruments.

Table 5 WHO Ethical Criteria for Medicinal Drug Promotion Met by Drug Advertisements (n =100)

S.N.	WHO Ethical Criteria for Medicinal Drug Promotion	Number of DAs Meeting the Criteria
1.	Generic name	100
2.	Brand name	100
3.	Active drug per dosage form	100
4.	Approved therapeutic use/s	100
5.	Other ingredients known to cause problems	0
6.	Dosage form	98
7.	Side effects and major adverse drug reactions	4
8.	Precautions, contraindications and warnings	2
9.	Major interactions	4
10.	Manufacturer/Distributor’s name and address	94
11.	References to the scientific literature as appropriate	19

Abbreviations: Das, drug advertisements; S.N., serial number; WHO, World Health Organization.