In America, science is as polarized as politics. Corporate scientists, like at pharmaceutical companies, are criticized for working at unethical companies while academic scientists are criticized for 'chasing funding' rather than helping people.
Like many stereotypes, those images started with a kernel of truth. So if you ask most people if the pharmaceutical industry can self-police its advertising policies, they will reply it is not possible, an outside force must do it. But then if you ask people who are skeptical of medicine, they will say the FDA is also controlled by pharmaceutical companies.
Most countries have an established system for self-regulation of pharmaceuticals advertising.
Sweden holds itself up as a model for self-regulation of pharmaceutical advertising. The Swedish pharmaceutical industry's trade organization appoints an information examiner to monitor marketing to ensure it doesn't violate established ethical guidelines. There is also a board appointed by the industry that deals with complaints and misleading advertising results in a fine.
Yet an analysis of all the advertising for antidepressants published in The Swedish Medical Journal between 1994 and 2003 found that 34 per cent of all advertisements had been judged as misleading by the industry's self-regulation system. Meanwhile, antidepressant drug revenue in Sweden went from EUR 18 million to over EUR 100 million.
So the system works, right? It's better to ask forgiveness than permission, boundaries are fuzzy so someone will push them, and the culprits who went beyond the boundaries were caught.
"The figure should really have been even higher because we discovered that a large amount of misleading advertising had passed through the review process unnoticed. For example, many advertisements that were not picked up contained exaggerated claims about the effects of the drugs," says Shai Mulinari of the Department of Gender Studies at Lund University in Sweden and co-author of a paper in PLoS One.
That one third of all advertising failed the review process means the system is perceived as toothless, he said. "The consequences of being convicted were marginal. In total, only 0.009 per cent of sales revenue went to fines for unethical marketing."
Fines are higher now but Mulinari still believes there is reason to look more closely at how well the industry's self-regulation of advertising really works. According to their paper, it took an average of 15 weeks from the publication of the unethical advertising to the announcement of a verdict. During that time, the advertisement could have been published in the journal 15 times. Another problem identified by the researchers was that only 12 percent of the reports were initiated by doctors and only 8 per cent by the Medical Products Agency. In other cases, it was business competitors who reported one another or the reports were initiated by the industry's information examiner.
That's still a sign that works. If you are considering a product and want to know about its flaws, it is always wise to ask a competitor. That competitors find and report flaws before doctors or a bureaucracy means the accountability is still there, just not where scholars expect.
Citation: Zetterqvist AV, Mulinari S (2013) Misleading Advertising for Antidepressants in Sweden: A Failure of Pharmaceutical Industry Self-Regulation. PLoS ONE 8(5): e62609. doi:10.1371/journal.pone.0062609