Drug Promotions Between Ethics, Regulations, and Financial Interests.

BACKGROUND: The promotion of the latest medicines produced by the pharmaceutical industry is an important issue both from an ethical point of view (the level of accessibility, the way research is carried out) and from the point of view of marketing and especially from the lobbying issues raised. AREAS OF UNCERTAINTY: The ethical dilemmas raised by the promotion of new drugs revolve between the need to discover new molecules important for treating a wide range of diseases and the need to establish a battery of ethical rules, absolutely necessary for regulations in the field to be compliant with all ethical principles. DATA SOURCES: A literature search was conducted through PubMed, MEDLINE, Plus, Scopus, and Web of Science (2015-2023) using combinations of keywords, including drugs, medical publicity, and pharma marketing plus ethical dilemma. ETHICS AND THERAPEUTIC ADVANCES: The promotion of medicines is governed by advertising laws and regulations in many countries, including at EU level, based on the need for countries to ensure that the promotion and advertising of medicines is truthful, based on information understood by consumers. The ethical analysis of the issues raised is more necessary and complex as the channels used for promotion are more accessible to the population, and the information, easier to obtain, can be the cause of increased self-medication and overeating. Large amounts of money invested in the development of new molecules, but also the risk of scientific fraud through manipulation of data during clinical trials, selective or biased publication of information can have repercussions on the health of the population. CONCLUSIONS: The development of new pharmaceutical molecules is necessary to intervene and treat as many conditions as possible, but marketing must not neglect the observance of ethical principles. The promotion of medicines should be the attribute especially of the medical staff, which should also be a mandatory part of the mechanism for approving the marketing methods and means used by the pharmaceutical companies.

The paradoxical extinction of the most charismatic animals.

A widespread opinion is that conservation efforts disproportionately benefit charismatic species. However, this doesn't mean that they are not threatened, and which species are "charismatic" remains unclear. Here, we identify the 10 most charismatic animals and show that they are at high risk of imminent extinction in the wild. We also find that the public ignores these animals' predicament and we suggest it could be due to the observed biased perception of their abundance, based more on their profusion in our culture than on their natural populations. We hypothesize that this biased perception impairs conservation efforts because people are unaware that the animals they cherish face imminent extinction and do not perceive their urgent need for conservation. By freely using the image of rare and threatened species in their product marketing, many companies may participate in creating this biased perception, with unintended detrimental effects on conservation efforts, which should be compensated by channeling part of the associated profits to conservation. According to our hypothesis, this biased perception would be likely to last as long as the massive cultural and commercial presence of charismatic species is not accompanied by adequate information campaigns about the imminent threats they face.

The physical activity and nutrition-related corporate social responsibility initiatives of food and beverage companies in Canada and implications for public health.

BACKGROUND: As diet-related diseases have increased over the past decades, large food companies have come under scrutiny for contributing to this public health crisis. In response, the food industry has implemented Corporate Social Responsibility (CSR) initiatives related to nutrition and physical activity to emphasize their concern for consumers. This study sought to describe the nature and targeted demographic of physical activity and nutrition-related CSR initiatives of large food companies in Canada and to compare companies who participate in the Canadian Children's Food and Beverage Advertising Initiative (CAI), a self-regulatory initiative aimed at reducing unhealthy food advertising to children, with non-participating companies. METHODS: A cross-sectional study was conducted in 2016. Thirty-nine large food companies, including 18 participating in the CAI, were included in the study. The webpages, Facebook pages and corporate reports of these companies were surveyed to identify CSR initiatives related to nutrition and physical activity. Initiatives were then classified by type (as either philanthropic, education-oriented, research-oriented or other) and by targeted demographic (i.e. targeted at children under 18 years or the general population). Differences between CAI and non-CAI companies were tested using chi-square and Mann-Whitney U tests. RESULTS: Overall, 63 CSR initiatives were identified; 39 were nutrition-related while 24 were physical activity-related. Most (70%) initiatives were considered philanthropic activities, followed by education-oriented (20%), research-oriented (8%) and other (2%). Almost half (47%; n = 29) of initiatives targeted children. Examples of child-targeted initiatives included support of school milk programs (n = 2), the sponsorship of children's sports programs (n = 2) and the development of educational resources for teachers (n = 1). There were no statistically significant differences in the number of CSR initiatives per company (CAI: Mdn = 1, IQR = 3; non-CAI: Mdn = 0, IQR = 2; p = .183) or the proportion of child-targeted initiatives (CAI: 42%; non-CAI: 54%; p = .343) between CAI and non-CAI companies. CONCLUSION: Food companies, including many that largely sell and market unhealthy products, are heavily involved in physical activity and nutrition-related initiatives in Canada, many of which are targeted to children. Government policies aimed at protecting children from unhealthy food marketing should consider including CSR initiatives that expose children to food company branding.

Tu Youyou winning the Nobel Prize: Ethical research on the value and safety of traditional Chinese medicine.

In 2015, the Chinese pharmacologist, Tu Youyou, was awarded the Nobel Prize for Physiology or Medicine for the discovery of artemisinin. Traditional Chinese medicine (TCM) was the source of inspiration for Tu's discovery and provides an opportunity for the world to know more about TCM as a source of medical knowledge and practice. In this article, the value of TCM is evaluated from an ethical perspective. The characteristics of 'jian, bian, yan, lian' are explored in the way they promote accessibility and economic efficiency for TCM. The article also examines how the increased use and prevalence of TCM reflects the scientific, cultural, and ethical values of TCM and their increasing attraction in meeting major challenges to medicine and health systems currently and in the future. The article discusses safety issues within TCM, which is a controversial area, and also comments on some shortcomings and challenges which pose difficulties for more widespread and greater uptake of TCM-derived clinical or therapeutic interventions. The article concludes that TCM is generally safe if it is used according to TCM theory and where such applications are cognizant of the strengths and weaknesses of TCM. TCM has important bioethical values which may inform potential measures for meeting challenges facing global health care systems and the article argues that it can have an increasing role in improving human health.

Recommendations for the sale and promotion of dermocosmetic treatments at the office.

A novel chapter in current medical settings is the promotion and attention of esthetic aspects rather than health issues by health professionals. The human aspiration related to the search for personal beauty has generated new scenarios in medical practice. The Committee on Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine of Mexico has analyzed this phenomenon and has issued recommendations directed both to medical professionals and to producers and potential consumers of esthetic procedures.

Un capítulo novedoso es la atención y promoción por parte de médicos especialistas de aspectos relacionados con procedimientos estéticos, más que con la salud. La aspiración humana de la búsqueda de la belleza personal ha generado nuevos escenarios en la labor médica. El Comité de Ética y Transparencia en la Relación Médico Industria (CETREMI) de la Academia Nacional de México ha revisado esta circunstancia y emite recomendaciones tanto a los médicos como a los productores y potenciales consumidores de procedimientos estéticos.

Pharmaceutical marketing strategies' influence on physicians' prescribing pattern in Lebanon: ethics, gifts, and samples.

BACKGROUND: Drug companies rely on their marketing activities to influence physicians. Previous studies showed that pharmaceutical companies succeeded to manage physicians prescribing behavior in developed countries. However, very little studies investigated the impact of pharmaceutical marketing strategies on prescribing pattern in developing countries, middle-eastern countries. The objective of this research was to examine the influence of drug companies' strategies on physicians' prescription behavior in the Lebanese market concerning physicians' demographic variables quantitatively. Moreover, this study tested whether Lebanese physicians considered gifts and samples acceptance as an ethical practice. METHODS: Sampling was done by using a non-probability method. An online cross-sectional study was conducted through WhatsApp. A self-administered questionnaire survey was conducted during the months of February and March 2018. Cronbach's Alpha reliability coefficient was calculated. Data were statistically analyzed by using IBM SPSS statistics version 24 software. Chi-square and Cramer's v tests were used to finding sign correlation, and Spearman test was used to measure the strength and direction of a relationship between variables. RESULTS: Results found that pharmaceutical marketing strategies are correlated to physicians' prescribing behavior. We demonstrated that the majority of the promotional tools tested were mostly or sometimes motivating physicians to prescribe promoted drugs. The major tools that physicians agreed to be mostly motivated by are visits of medical representatives and drug samples while sales calls made by pharmaceutical companies are the less influential tool. Regarding gift acceptance, this study demonstrated that physicians consider gifts' acceptance as a non-ethical practice. Results showed that most physicians use free samples to treat their patients. We demonstrated that there is a relationship between physicians' prescribing pattern and their age, gender and the location of practice. CONCLUSIONS: Findings of this study provided an insightful work, serving as one of the first humble steps in the imminent direction of merging this paper with the previous literature. From a managerial perspective, pharmaceutical marketing managers of drug companies can use the research findings to design better their strategies directed to the Lebanese physicians who can also benefit from the results obtained.

Industry Payments to Physicians Endorsing Drugs and Devices on a Social Media Platform.

This study evaluates adherence to industry and professional standards among physicians endorsing drugs and devices on a social media platform.

Medicines Information and the Regulation of the Promotion of Pharmaceuticals.

Many factors contribute to the inappropriate use of medicines, including not only a lack of information but also inaccurate and misleading promotional information. This review examines how the promotion of pharmaceuticals directly affects the prescribing and use of medicines. We define promotion broadly as all actions taken directly by pharmaceutical companies with the aim of enhancing product sales. We look in greater detail at promotion techniques aimed at prescribers, such as sales representatives, pharmaceutical advertisements in medical journals and use of key opinion leaders, along with the quality of information provided and the effects thereof. We also discuss promotion to the public, through direct-to-consumer advertising, and its effects. Finally, we consider initiatives to regulate promotion that come from industry, government and nongovernmental organizations.

Marketing the Research Missions of Academic Medical Centers: Why Messages Blurring Lines Between Clinical Care and Research Are Bad for both Business and Ethics.

Academic Medical Centers (AMCs) offer patient care and perform research. Increasingly, AMCs advertise to the public in order to garner income that can support these dual missions. In what follows, we raise concerns about the ways that advertising blurs important distinctions between them. Such blurring is detrimental to AMC efforts to fulfill critically important ethical responsibilities pertaining both to science communication and clinical research, because marketing campaigns can employ hype that weakens research integrity and contributes to therapeutic misconception and misestimation, undermining the informed consent process that is essential to the ethical conduct of research. We offer ethical analysis of common advertising practices that justify these concerns. We also suggest the need for a deliberative body convened by the Association of American Medical Colleges and others to develop a set of voluntary guidelines that AMCs can use to avoid in the future, the problems found in many current AMC advertising practices.

Impact of modified risk tobacco product claims on beliefs of US adults and adolescents.

OBJECTIVE: Under US law, tobacco product marketing may claim lower exposure to chemicals, or lower risk of health harms, only if these claims do not mislead the public. We sought to examine the impact of such marketing claims about potential modified risk tobacco products (MRTPs). METHODS: Participants were national samples of 4797 adults and 969 adolescent US smokers and non-smokers. We provided information about a potential MRTP (heated tobacco product, electronic cigarette or snus). Experiment 1 stated that the MRTP was as harmful as cigarettes or less harmful (lower risk claim). Experiment 2 stated that the MRTP exposed users to a similar quantity of harmful chemicals as cigarettes or to fewer chemicals (lower exposure claim). RESULTS: Claiming lower risk led to lower perceived quantity of chemicals and lower perceived risk among adults and adolescents (all p<0.05, Experiment 1). Among adults, this claim led to higher susceptibility to using the MRTP (p<0.05). Claiming lower exposure led to lower perceived chemical quantity and lower perceived risk (all p<0.05), but had no effect on use susceptibility (Experiment 2). Participants thought that snus exposed users to more chemicals and was less safe to use than heated tobacco products or electronic cigarette MRTPs (Experiments 1 and 2). DISCUSSION: Risk and exposure claims acted similarly on MRTP beliefs. Lower exposure claims misled the public to perceive lower perceived risk even though no lower risk claim was explicitly made, which is impermissible under US law.

Challenges in the Regulation of Autologous Stem Cell Interventions in the United States.

The direct-to-consumer marketing of stem cells for unproven therapeutic uses has grown rapidly in the United States in recent years. This development is surprising since the marketing and distribution of human cell-based medical products is stringently regulated in the US. This essay describes ambiguities, gaps, and inconsistencies in the current regulatory system that have enabled such businesses to thrive. In addition to directly challenging the authority of the Food and Drug Administration (FDA) over autologous cell-based products in the courts, stem cell marketing firms have also identified and exploited regulatory loopholes, such as the same surgical procedure exception, which exempts from FDA oversight human cell-based products that are harvested and reimplanted in a single procedure. Many businesses also advertise stem cell clinical studies on a pay-to-participate basis, which requires patients to pay large sums to enroll in clinical research. This business model not only shifts many of the cost and risks of medical experimentation from providers to patients but may also indemnify sellers from fraud litigation. Lastly, stem cell advertisers borrow heavily from the language and concepts of science-based medicine in their marketing. The inaccurate promotion of autologous stem cell injections as a form of "personalized" medicine lends a veneer of credibility and precision that may encourage patients to undergo procedures of uncertain effectiveness and to sympathize with stem cell businesses in their efforts to evade oversight.

[The International Code of Marketing of Breastmilk Substitutes : History, Content, and Significance]. / Der Internationale Kodex zur Vermarktung von Muttermilchersatzprodukten : Entstehungsgeschichte, Inhalt und Bedeutung.

Breastfeeding is the physiological form of infant feeding and has many well-documented benefits. Low breastfeeding rates and short lactation periods have significant negative ecological, economic, and social impact. The promotion of breastfeeding supports the health of children and mothers and reduces costs to the health system. However, the promotion of breastfeeding is regularly undermined by inappropriate advertising of breast milk substitutes. To counteract this, the International Code of Marketing of Breastmilk Substitutes was adopted by the World Health Assembly (WHA) in 1981. Although the International Code of Marketing of Breastmilk Substitutes and its subsequent resolutions have been fully or partially incorporated into national law in 135 countries, the provisions of the Code are continually violated. These violations are almost always not punished at all or only insufficiently. For the promotion and protection of breastfeeding, it is essential that health workers are familiar with the Code and subsequent resolutions.This article presents and explains the history, content, and importance of the International Code of Marketing of Breastmilk Substitutes and gives an assessment of its implementation in practice.

Nutritional quality of packaged foods targeted at children in Brazil: which ones should be eligible to bear nutrient claims?

OBJECTIVES: This study aimed to assess the nutritional quality of food products marketed at children, with and without nutrient claims, using two different approaches. METHODS: Analyses were performed based on a data set with food composition and labelling data from every packaged food marketed at children sold in a major Brazilian supermarket (n=535). Foods were classified as 'healthier' and 'less healthy' according to the UK/Ofcom nutrient profile model and to the NOVA classification based on the level of food processing. Pearson's χ2 test was used to compare proportions between models. Agreement was assessed using Cohen's κ-statistic (P<0.05). RESULTS: The NOVA model was stricter than the UK/Ofcom model, classifying more products as 'less healthy' (91.4%) compared with the nutrient profile-based model (75.0%; P<0.001). Agreement between models was 79.4% (k=0.30), because 72.9% (n=390) of products were categorised as 'less healthy' by both models, and 6.5% (n=35) as 'healthier'. Half of the food products marketed at children from the database (270; 50.5%) bore nutrient claims. From these products with nutrient claims, 95.9% (92.8-98.0) were classified as 'less healthy' by the NOVA model, whereas this percentage was 74.1% (68.4-79.2) according to the UK/Ofcom model (P<0.05). CONCLUSIONS: The high number of foods with low nutritional quality being marketed at children via product packaging and nutrient claims should be of concern to policy makers wanting to improve children's diets and to tackle childhood obesity. The implementation of nutritional quality criteria to ensure that foods targeted at children should be eligible to bear nutrient claims on their labels could avoid a situation where claims mask the overall nutritional status of a food.

Unwarranted claims of drug efficacy in pharmaceutical sales visits: are drugs approved on the basis of surrogate outcomes promoted appropriately?

AIMS: This study compares physicians' recall of the claims of benefits on cardiovascular disease and diabetes made by pharmaceutical sales representatives for drugs approved on the basis of a surrogate outcome, i.e., an off-label claim, compared with those approved on the basis of a serious morbidity or mortality (clinical) outcome. METHODS: Physicians in primary care practices in Montreal, Vancouver, Sacramento and Toulouse, who saw sales representatives as part of their usual practice and served a non-referral population, were contacted in blocks of 25 from a randomized list of all physicians practising in the relevant metropolitan area. We compared how frequently physicians reported that sales reps made claims of serious morbidity or mortality (clinically meaningful) benefits for drugs approved on the basis of surrogate outcomes vs. drugs approved on the basis of clinical outcomes. RESULTS: There were 448 promotions for 58 unique brand name cardiovascular and diabetes drugs. Claims of clinically meaningful benefit were reported in 156 (45%) of the 347 promotions for surrogate outcome drugs, constituting unwarranted efficacy claims, i.e., off-label promotion. Claims of clinical benefit were reported in 72 of the 101 promotions (71%) for drugs approved on the basis of clinical outcomes, adjusted OR = 0.3 (95% CI 0.2, 0.6), P < 0.001. CONCLUSIONS: Claims of efficacy made in sales visit promotions for drugs approved only on the basis of surrogate outcomes extended beyond the regulator-approved efficacy information for the product in almost half of promotions. Unapproved claims of drug efficacy constitute a form of off-label promotion and merit greater attention from regulators.

Food Marketing to Children Online: A Content Analysis of Food Company Websites.

Since 2006, many U.S. food and beverage companies have pledged to market healthier foods to children to help combat the childhood obesity epidemic. Despite this, companies' expenditures on online advertising have increased of late. To explore this seemingly contradictory situation, the authors conducted a content analysis of approximately 100 food and beverage brand websites, examining a multitude of online marketing practices across a variety of different products, as well as the relationship between marketing techniques and the nutritional profile of promoted foods. This is the first study to examine if nutrition varied by marketing technique. Few brands maintained child-oriented websites, but the brands that did have child-oriented websites included a large number of games promoting particularly obesogenic food products. Somewhat surprisingly, games with many brand identifiers were paired with slightly less obesogenic foods. These findings present a mixed picture of the threat posed by online child-oriented food marketing.

Exposing and addressing tobacco industry conduct in low-income and middle-income countries.

The tobacco industry's future depends on increasing tobacco use in low-income and middle-income countries (LMICs), which face a growing burden of tobacco-related disease, yet have potential to prevent full-scale escalation of this epidemic. To drive up sales the industry markets its products heavily, deliberately targeting non-smokers and keeps prices low until smoking and local economies are sufficiently established to drive prices and profits up. The industry systematically flaunts existing tobacco control legislation and works aggressively to prevent future policies using its resource advantage to present highly misleading economic arguments, rebrand political activities as corporate social responsibility, and establish and use third parties to make its arguments more palatable. Increasingly it is using domestic litigation and international arbitration to bully LMICs from implementing effective policies and hijacking the problem of tobacco smuggling for policy gain, attempting to put itself in control of an illegal trade in which there is overwhelming historical evidence of its complicity. Progress will not be realised until tobacco industry interference is actively addressed as outlined in Article 5.3 of the Framework Convention on Tobacco Control. Exemplar LMICs show this action can be achieved and indicate that exposing tobacco industry misconduct is an essential first step.