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Official websites use. Share sensitive information only on official, secure websites. The aim of the study was to analyse the proportion of evidence-based medication displayed in pharmacies and compare it between the different linguistic regions of the country, at different times of the year to determine the amount of proven effective medications indirectly recommended to the public in different parts of Switzerland. This is an observational study conducted by medical doctors in the department of internal medicine at the Spitalzentrum Biel, Switzerland. The observation took place from July to May From a total of pharmacies in Switzerland, 68 different pharmacies were selected across the 3 main linguistic regions and the medication on display in their windows were examined 4 times a year regarding their efficacy. The primary outcome is the proportion of medication displayed in pharmacy windows with a proven effectiveness in medical literature. The secondary outcome was the variability of the primary outcome over time seasonal changes , over the different linguistic regions of Switzerland and between chains and privately owned pharmacies. Swiss German cantons display significantly more non-evidence-based medications in winter. We found no statistical difference for other seasons or between chains and privately owned pharmacies. Pharmacies in Switzerland tend to display significantly more non-evidence-based drugs, thus indirectly recommending them to the public. In a time of necessary expansion of self-medication by the population, this could incite consumers to buy drugs without proven effectiveness. This is the first study to analyse the proportion of evidence-based medication displayed in pharmacy windows. The selected pharmacies were geographically disparate in the three main linguistic regions of Switzerland to reflect possible sociocultural differences. Due to logistical limitations, the pharmacy windows were not all photographed on the same day but over a period of 6—8 weeks. We did not determine the sample size needed for a statistically significant result before starting with the data collection. Health products in Switzerland medicinal products, dietary supplements and medical devices used to be categorised into five categories, ranging from controlled substances such as opioids and antibiotics requiring a prescription to vitamins and saline solutions sold over the counter OTC. In , the Swiss law regarding the sale of different health products according to these five categories A—E 1 2 was revised with the aim of simplifying the supply by pharmacists of certain health products normally requiring a prescription and provide consumers with a larger selection of OTC medications. The legal definitions of different health products or medications as well as their regulation by the Swiss federation are quite complicated. Broadly, the products sold to consumers can be categorised as follows: 4. Medicinal products or drugs : products of chemical or biological origin intended or claimed to have a medicinal effect on the human or animal organism, in particular in the diagnosis, prevention or treatment of diseases. Medicinal products with indications: medicinal products with an officially authorised indication in a specific field of application which are intended for use in accordance with the rules of the medical and pharmaceutical sciences. Complementary medicines with indications: medicinal products with an officially authorised indication in a specific field, such as homoeopathy, anthroposophical medicine or traditional Asian medicine and whose field of application is determined according to the principles of the corresponding therapy approach. Medical devices: products, including instruments, apparatus, equipment, in vitro diagnostics, software, implants, reagents, materials and other goods or substances which are intended or claimed to have a medical use and whose principal effect is not obtained with a medicinal product. Before any medicinal product can be imported, advertised and sold in Switzerland, the manufacturing company needs to apply for a licence from SwissMedic, the Swiss drug administration. Conditions for the granting of such a licence include a scientific review of all data concerning manufacturing, safety profile and clinical studies as well as a review of the packaging including information leaflet as well as a pharmacovigilance plan. It is forbidden to advertise a drug for any medical indication not backed by sound scientific data evaluated by the Swiss Medical Board. The advertisement of medicinal products requiring a medical prescription is illegal. A medical device is any product intended for medical use that is not labelled as a drug, from pacemakers to antibloating or slimming products. Medical devices must be labelled with the letters CE on the package, the visibility of the sign is not specifically regulated. These products also do not undergo an official authorisation procedure by the Swiss Medical Board. For most products, Switzerland has adopted the certification existing in the European Union based on bilateral agreements. The difference between a medicinal product, a dietary supplement and a medical device is often not immediately visible, and the public is not necessarily aware of the distinction between them. A medicinal product against constipation and a medical device sold for the same indication can be advertised side by side, despite the medical device not necessitating the same rigorous proofing required of a drug. The only distinguishing feature between the two, the mention of the word drug or the letters CE, can be hard for non-professionals to be aware of. While outright false advertising is forbidden for all medicinal products, dietary supplements and medical devices, implied indications are harder to regulate. Medicinal products, dietary supplements or medical devices with a proven effect for one indication can be sold to the consumer while implying properties for another indication, in which their efficacy is doubtful or even inexistent. When looking at scientific studies regarding the effect of magnesium to prevent or treat muscle cramps; however, there is no statistically significant evidence to confirm this. At present, there are no data about the percentage of medications with a proven effect by evidence-based medicine EBM standards 10 in pharmacy windows and we thought consumers should be made aware of this. The aim of the study was to analyse the proportion of medications medicinal products, dietary supplements and medical devices which could be mistaken for a medicinal product with proven efficacy according to EBM standards in the displays of Swiss pharmacies at different seasons in the three main linguistic regions of the country and thus determine the percentage of medications with a proven efficacy recommended to the public in different parts of Switzerland. From a total of pharmacies in operation in Switzerland in January , 11 68 different pharmacies were selected randomly across the country online supplemental file 1 and classified according to the 3 main linguistic regions of Switzerland German-speaking, French-speaking and Italian-speaking region online supplemental file 2 , and between pro-pharma cantons where general practitioners can have their own pharmacy and may sell the needed drugs directly to the patients and non-pro-pharma cantons 12 online supplemental file 3. There is an equal proportion of independent and chain pharmacies in this study. Pharmacies without front windows, for instance, in shopping malls, were excluded from the study. As we did not compare two different groups of medications and did not know what outcome and what influencing factors to expect, we could not predetermine a sample size. However, we collected sufficient data to be able to show statistically significant results. The names of the medications visible on display were written down and centralised in our database on an Excel table online supplemental file 4. All medicinal products drugs and dietary supplements were included. Beauty products such as soaps, shampoos, deodorants and toothpastes as well as medical devices eg, splints were excluded. We chose to only register medications displayed in the pharmacy windows as we were interested in the evidence-level of medication indirectly recommended to the public through this type of advertisement. To determine whether a medication could be considered as EBM or not, the authors screened different databases PubMed, Cochrane, UptoDate, Compendium, Google Scholar and others 13 for publications concerning the active pharmaceutical ingredients APIs contained in the different medications displayed. For instance, if a pharmacy displayed five medications in its window, two of which contained the same API, we still registered five displayed medications but regrouped the two generics to one API. All the publications found on the different databases were combined for each API and reviewed by the whole research team. The level of evidence supporting the efficacy of each medication was determined according to existing EBM categories, 10 14 defined by the Centre for Evidence-Based Medicine CEBM and listed in tables 1 and 2. EBM evidence levels are based on the type and quality of clinical studies confirming the security and effectiveness of a medical practice or guideline. GRADE levels are meant to tell health providers how definitive and certain a specific guideline or recommendation is based on EBM evidence levels. For this study, the two internationally used grading systems EBM and GRADE were combined into an original grading system composed of five categories described in table 3. The categories created for this study aim to reflect these internationally recognised guidelines. Medications classified in categories 1 and 2 were considered as evidence based, those classified in categories 3, 4 and 5 as non-evidence based. Since the GRADE levels consider medications with only one randomised control trial RCT or several peer-reviewed studies to be of moderate evidence level, category 3 was classified as non-evidence based, since more studies might very well impact the confidence in the effect of those medications. For all the displayed medications with visible information or advertisement for a treatment indication, we classified the medication according to this indication, whereas for those without information on the display we classified them according to the indication given by the Swiss compendium. Given several high-quality RCTs and a high evidence level, ibuprofen and other non-steroidal anti-inflammatory drugs were classified as a category 1 in this study. The window display of each selected pharmacy was photographed four times a year once between July and August , once between October and November , once between the end of December after Christmas and January , and once between April and May There are four seasons in Switzerland, and certain illnesses are more typical for some seasons than others eg, common cold in autumn and winter, hay fever in spring, sports injuries in summer. We tried to capture the changes in promoted medications according to the change in seasonal weather and related illnesses. The pharmacist or pharmacy owners were not involved in the design or execution of the study and were not informed the photographs were being taken. Of the 68 selected pharmacies, 31 were in the French-speaking region, 5 in the Italian-speaking region, 32 in the German-speaking region of Switzerland, 31 in pro-pharma cantons, 37 in non-pro-pharma cantons, respectively. Thirty-one were privately owned pharmacies, 37 belonged to chains. We photographed a total of medications on display, corresponding to different APIs. Of those medications, 17 met exclusion criteria being more cosmetic products than medications online supplemental file 5. The remaining medications different APIs online supplemental file 1 are regrouped in table 4 according to season and level of evidence. Overall, there is a higher amount of non-evidence-based drugs compared with evidence-based drugs When analysed by season, we found that in autumn, In spring, the tendency was reversed, with This was due mainly to the large number of antiallergic medication on display in the springtime, highly effective antihistaminic drugs being available OTC, thus allowing their advertisement. During the rest of the seasons, there was no statistically significant difference in the proportion of evidence-based medications displayed between the three linguistic regions of Switzerland. EBM, evidence-based medicine. Self-medication has steadily risen in recent years, partly in response to rising healthcare costs and partly through the growing realisation of the population of their responsibility for a more active role in their own health. This means that a growing part of the population is seeking to treat symptoms without understanding where these might come from. Because of the expansion of the list of OTC medication and the increase in their advertising, self-medication is being promoted everywhere. Considering the low health literacy even in highly developed nations, the understanding of human health, bodily functions and illnesses is not high enough to allow a reliable complete self-diagnosis, let alone management of medication intake. Through misleading advertisement and greater access to OTC drugs, the general population is encouraged to treat itself for minor ailments. Minor ailments, however, is a relative term, and what would be considered an emergency by some can be considered minor by others. This could potentially prevent patients from seeking adequate care for too long while they try to help themselves with unproven treatments. With more and more people self-medicating and a high proportion of questioningly effective drugs being advertised in pharmacies and not necessitating any type of professional evaluation to be bought, the risk for adverse effect is high. How can we improve this delicate situation? The authors believe that, to avoid adverse effects and unnecessary treatment, patients should be encouraged to expand their health literacy and understand their bodies and symptoms better. While this intervention would be the most efficient, it is unrealistic to expect governments to fund any health literacy programmes in a time of economic recession. In addition, a label on all medications sold OTC showing their level of evidence just as electrical appliances have been rated from A to F according to their level of energetic efficiency to promote buying less wasteful appliances would allow patients to make informed decisions about the medications they choose to buy. As a side note, we found that as the seasons progressed, less and less medications were put on display, but most pharmacies displayed not only medications or cosmetic products but also sound medical advice, recommendations for vaccinations eg, for influenza or tickborne encephalitis and others, which we consider an invaluable contribution to primary medical care but could not be analysed concomitantly to the drugs investigated in this study. We have not found any study like our own when databases were researched for pharmacy, displays, windows, evidence based, efficacy, drugs, medication, marketing, OTC. Several studies researched the link between in-store counselling in pharmacies and self-medication, 23 and some others analysed the public health impact of pharmacies regarding health services provided. Their aim was to determine what factors might influence public health orientation and product marketing orientation between different pharmacies in Finland. Contrarily to our findings, they recorded a significantly higher product marketing orientation in large pharmacies belonging to chains as well as in pharmacies located close to rivals. However, they did not analyse whether the efficacy of the advertised medication was evidence based. It would also be quite interesting to have more studies like our own from other European countries where the law regarding advertisement for medications and the classification of which medication is available OTC or requires a prescription might be different. This might show other factors impacting displayed medications. When judging the marketing of products considered non-evidence based, we need to remember that even evidence-based drugs were rated following RCTs most often funded by the pharmaceutical industry, these studies and publications being an important part of their marketing strategy as well. When analysed over the whole year, the efficacy of When analysed according to season and linguistic region, pharmacies in Swiss-German cantons displayed significantly more non-evidence-based drugs than pharmacies in the French-speaking region or the Italian-speaking region of Switzerland. There was a surge of evidence-based medication on display in spring, mostly antihistaminic drugs, and non-steroidal analgesics. With this tendency to display significantly more non-evidence-based drugs, pharmacies indirectly recommend them to the public. In a time of necessary expansion of self-medication by the population, this could incite consumers to buy and use drugs without a proven effectiveness. For logistical reasons, the pharmacies were not evenly distributed in the whole country, several regions of Switzerland were thus not analysed, and the results of the study might not be applicable there for instance eastern Switzerland. Similarly, our sample of 68 pharmacies out of might limit the applicability of the results to the regions that were not analysed. Another impact of logistics was that the pharmacy windows were not all photographed on the same day but over a period of 6—8 weeks by different people. This could impact the type of drugs being advertised, with pharmacies changing their window display more regularly than four times a year. However, by photographing these windows during the middle of each season, we hope to have caught the most representative displays of drugs for each one. Another point was that the medications on display are to a certain degree regulated by the pharmaceutical industry and not necessarily by the pharmacists working there, independently of the store being privately owned or not. Contributors: TK: project administration, data curation, visualisation, writing—original draft preparation, writing—review and editing, guarantor; MP: data curation, visualisation; TC: data curation; SDA: data curation; EC: data curation; AG: data curation; AP: data curation; RJ: data curation; AS: data curation; NW: data curation; OW: data curation; CB: formal analysis, draft correction; DG: conceptualisation, methodology, supervision, data curation, draft correction, guarantor. Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Supplemental material: This content has been supplied by the author s. Any opinions or recommendations discussed are solely those of the author s and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. All data relevant to the study are included in the article or uploaded as online supplemental information. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. BMJ Open. Does the advertisement in Swiss pharmacy windows rest on evidence-based medicine? Find articles by Melisa Potterat. Find articles by Thibault Corpataux. Find articles by Simone Daniele Ackermann. Find articles by Edouard Chaix. Find articles by Andrea Gibilisco. Find articles by Aurelia Portmann. Find articles by Judith Roberts. Find articles by Amandine Schaller. Find articles by Nicolas Wenger. Find articles by Oliver Wolffers. Find articles by Charles Beguelin. Find articles by Daniel Genne. No commercial re-use. See rights and permissions. Published by BMJ. Level of evidence Type of evidence 1A Systematic review with homogeneity of randomised controlled trials 1B Individual randomised controlled trial 2A Systematic review of cohort studies 2B Individual cohort studies including low quality randomised controlled trial 3A Systematic review of case—control studies 3B Individual case—control study 4 Case series and poor quality cohort or case—control studies 5 Expert opinion without explicit critical appraisal or based on physiology bench research. Open in a new tab. Code Quality of evidence Definition Implications for practice A High Further research is very unlikely to change our confidence in the estimate of effect. Several high-quality studies with consistent results In special cases: one large, high-quality multicentre trial Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present B Moderate Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. One high-quality study Several studies with some limitations Generally, clinicians should follow a recommendation but should remain alert to new information and sensitive to patient preferences C Low Any estimate of effect is very uncertain. One or more studies with severe limitations Clinicians should be flexible in their decision-making regarding appropriate practice, although they may set bounds on alternatives; patient preference should have a substantial influencing role D Very low Any estimate of effect is very uncertain. Expert opinion No direct research evidence No systematic empirical evidence One or more studies with very severe limitations Clinicians should consider all options in their decision-making and be alert to new published evidence that clarifies the balance of benefit versus harm; patient preference should have a substantial influencing role. Category Quality of evidence Definition 1 High evidence At least one meta-analysis or Several placebo-controlled double-blind randomised control trials 2 High to moderate Medication with several active pharmaceutical ingredient of which at least one fulfils the definition for category 1: At least one meta-analysis or Several placebo-controlled double-blind randomised control trials 3 Moderate Only one placebo-controlled double-blind randomised trial or Several peer-reviewed studies 4 Moderate to low Medication with several active pharmaceutical ingredient of which none fulfil the definition for category 1 5 Low to very low One or more studies with severe limitations Expert opinion No direct research evidence. All displayed medications according to season and level of evidence. Provenance and peer review: Not commissioned; externally peer reviewed. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Systematic review with homogeneity of randomised controlled trials. Individual cohort studies including low quality randomised controlled trial. Case series and poor quality cohort or case—control studies. Expert opinion without explicit critical appraisal or based on physiology bench research. Further research is very unlikely to change our confidence in the estimate of effect. Several high-quality studies with consistent results In special cases: one large, high-quality multicentre trial. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. One high-quality study Several studies with some limitations. Generally, clinicians should follow a recommendation but should remain alert to new information and sensitive to patient preferences. Any estimate of effect is very uncertain. One or more studies with severe limitations. Clinicians should be flexible in their decision-making regarding appropriate practice, although they may set bounds on alternatives; patient preference should have a substantial influencing role. Expert opinion No direct research evidence No systematic empirical evidence One or more studies with very severe limitations. Clinicians should consider all options in their decision-making and be alert to new published evidence that clarifies the balance of benefit versus harm; patient preference should have a substantial influencing role. At least one meta-analysis or Several placebo-controlled double-blind randomised control trials. Medication with several active pharmaceutical ingredient of which at least one fulfils the definition for category 1: At least one meta-analysis or Several placebo-controlled double-blind randomised control trials. Only one placebo-controlled double-blind randomised trial or Several peer-reviewed studies. Medication with several active pharmaceutical ingredient of which none fulfil the definition for category 1. One or more studies with severe limitations Expert opinion No direct research evidence.

Biel-Bienne buying Ecstasy