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Official websites use. Share sensitive information only on official, secure websites. This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4. The information provided in drug advertisements DAs often do not follow the recommended criteria and may promote irrational prescribing behaviors. This study was done to evaluate DAs using both criteria. A structured proforma was used to collect data. Altogether DAs were analyzed. All DAs mentioned generic name, brand name, active drug per dosage form and approved therapeutic uses. The DAs evaluated as per the HAI criteria for pictures and images showed that people portrayed did not seem to be Nepalese. Females and males were portrayed differently with females being laypersons and males being healthcare professionals. Nineteen DAs contained 33 references to scientific literature. Thirty references contained adequate citation information to be identified and were retrievable. Retrieved references were of high methodological quality and from peer-reviewed journals. The graph was not having statistical calculations and was not obscured by other visual material. None of the DAs fulfilled all the criteria. Additionally, lack of any information on harm in the large majority of DAs, and very limited backing of claims with references was also seen. Keywords: drug advertisements, ethical criteria, evaluation, health action international, Nepal. Point your SmartPhone at the code above. If you have a QR code reader, the video abstract will appear. Or use:. Different methods for promoting medicines are adopted by pharmaceutical industries. These include a combination of visual aids, drug advertisements DAs , leaflets and various audio-visual resources. Medical professionals also use these industry-produced sources for updating their current knowledge about new drugs for treating diseases. Medical representatives are hired for providing information to the medical professionals and marketing the products in person. Guidelines have been developed by DDA for the ethical promotion of medicine in This was developed to encourage the rational use of medicine to prevent unethical drug promotion practices in the country. Ethical drug promotion and authenticity of the DAs are important to promote the rational use of medicines. It has been found that the information provided in the DAs may not follow the code of ethics and can promote irrational prescribing behaviors. Hence, this study was done with an objective of evaluating the DAs in a scientific and critical manner for their adherence towards the mentioned HAI and WHO ethical criteria. A total of printed drug advertisements were analyzed. DAs were collected from all medical representatives visiting doctors in the out-patient departments during the specified duration of the study. There were advertisements available during the study period, out of which were selected as they met the inclusion criteria. The inclusion criterion was companies registered with DDA on 1st of October and exclusion criteria were drug advertisements related to herbal products for human use, advertisements related to medical devices and reminder advertisements. This proforma has been developed on the basis of the Health Action International HAI publication, understanding and responding to pharmaceutical promotion and the WHO ethical criteria for medicinal drug promotion. These were section presence of catchy terms, section therapeutic category of the drugs promoted, section type of claims, section information about advertisements as per WHO criteria, section evaluation of references, section evaluation of data, graphs and pictures presented in pharmaceutical advertisements as per HAI criteria. Table 2 shows some examples of the different types of catchy terms present in the DAs assessed. In section 3, the claims from DAs were assessed. A standard approach was used to code the advertisements. The DAs were independently analyzed by the first and second authors who then met, compared notes and arrived at a consensus, if required. Then, the consensus statement was examined by the third author. If there was any discrepancy, the opinion of the third author was also obtained. There was a total of DAs available, among which were chosen as per inclusion criteria. The list of selected DAs with the manufacturing companies and drugs involved has been provided in the Appendix 1. Appendix 2 mentions the generic names of the drugs and their categories. Figure 1 describes the therapeutic categories and their percentage in the assessed DAs. Deals with common therapeutic classes of drugs depicted. Antimicrobials, cardiovascular and anti-diabetic drugs were most commonly advertised. Table 2 provides examples of different types of catchy terms present in the DAs assessed. Figure 2 describes the types of visual depictions used in DAs. Graphical and pictorial presentations were analysed as per the HAI criteria mentioned in Table 1. Tables 3 and 4 depict the analyses as per the HAI criteria. 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 describes the types of pictures presented in DAs. The DAs also included the figures of medical instruments, doctors, and miscellaneous pictures like leaves, sunlight etc. 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. References were present in 19 out of DAs. The 19 DAs cited a total of 33 references. Randomized placebo control trial, in-vitro research study and websites were present as reference only in one DA each. Three of the references given in the DAs were not retrievable. The retrievable references provided scientific backup to the claims made by the advertisements. DAs citing only one reference were 15, whereas 4 of the DAs cited two or more references. None of the DAs cited non-randomized controlled trial, case-control studies, case report, editorial and books as references. None of the DAs made any controversial and false claims. All retrieved references were of high methodological quality and all references were from peer-reviewed medical or pharmacy journals. None of the studies were financed by the companies who had used the reference in their DAs. There were no retrieved references from supplement issues of journals. The DAs evaluated as per the HAI criteria for pictures and images showed that they did not represent the racial and ethnic composition of the people of Nepal. Images of women were present in DAs as patients. Only males were portrayed as surgeons and physicians in the DAs. Elderly people were not portrayed and there were no symbols and metaphors used. Other images were of leaves, sunlight and medical instruments like sphygmomanometer and glucometer. The graph was not obscured by other visual material and the information was meaningful. Abbreviations: Das, drug advertisements; S. DAs are an important source of drug information for healthcare professionals. There are many new and old drugs marketed for treating diseases. Besides single-drug formulations, many FDCs are also available in the market. Similar findings were observed in other studies conducted in various countries. This is similar to other studies done elsewhere. Thirty-nine DAs were having pictorial presentations of body organs followed by 18 DAs with pictures of women and 17 DAs with pictures of healthy people. Eighty-four DAs had pictures in our study, among which only 14 had irrelevant pictures which was very less as compared to another study having The evaluation of pictures and images as per the HAI criteria showed that the racial and ethnic composition did not correspond to the people of Nepal. Only females were portrayed in drug advertisements as patients. This study has a greater number of images portraying females, which is different compared to a study from India, where males were portrayed more often than females. Images can also be a means for drug advertisers to promote their medicines. A study from the US has showed that picture of a man was used as a doctor and picture of a woman was used as a patient. Commonly, males were shown as employers, and females were shown as employees doing typical female jobs like office assistants and food servers in the restaurants. Data and graphical presentations are commonly used to the support the claims shown in DAs. A study showed that DAs tended to promote antidepressants as focused on the female gender and depression as detached from any social context. This was done purposefully to promote gender-biased treatments. This finding contrasted with a study done in Bangladesh, which showed that there were This is not good as DAs should have authentic references which can help doctors verify the authenticity of the claims made, if they so desire. These findings were different compared to other studies where a higher percentage of claims made by DAs were supported by appropriate references. Analysis as per WHO ethical criteria showed that all DAs had mentioned the generic names, brand names, active drug per dosage forms and their approved therapeutic uses. This was much lower as compared to studies from India which showed a much greater percentage of drug advertisements contained information about adverse effects. This finding was consistent with the findings from previous studies done in Nepal and Brazil. The number of DAs analyzed was low and were from obtained from only one teaching hospital. It could have been better if DAs from other centers and hospitals could have been collected for the same purpose. We analyzed DAs to which we could obtain access which may not provide a representative picture about DAs in Nepal. Using both criteria for assessing the DAs was the strength of this study. The drug regulatory authority should make it mandatory for the industry to follow the said guidelines for providing the physicians with complete information about the drug. There have been very few studies done in Nepal on this issue and this study may help frame the necessary guidelines for improving the standards of drug advertisements. For critically appraising DAs, data and graphs, texts and references and images should be analysed. Often social dimensions are relevant as in the representation of the relationship of doctors and their patients or how females, elderly and the children are represented in DAs. Additionally, lack of any information on harm in the large majority of advertisements, and the very limited backing of claims with scientific evidence were also areas of concern. As a library, NLM provides access to scientific literature. J Multidiscip Healthc. Find articles by Nisha Jha. Find articles by Yunima Sapkota. Find articles by Pathiyil Ravi Shankar. Received Apr 29; Accepted Jul 15; Collection date Open in a new tab. 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. 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. 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. 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 References to the scientific literature as appropriate. Catchy Term Medicine 1. Bounce back to life Lorazepam 2. 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 Periods are normal. Periods pain is not. Mefenamic acid For the healthier rhythm of heart Atorvastatin Suitable contraceptive for lactating mothers Desogestrel For healthy heart of diabetics Empagliflozin Rebreathe the joy of life Montelukast Takes care throughout pregnancy Calcium Real pain relief Diclofenac Complete relief from allergy Levocetirizine Let your patients have a break-free treatment Ornidazole Make a positive impact with the positive expert Cephalexin Statin with highest intensity and potency Rosuvastatin. Abbreviation: S. Criteria Comments 1. Do the people portrayed in the advertisements reflect the racial and ethnic composition of people of Nepal? 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. Are the ways that men and women are portrayed as workers, facial expressions, body language, etc. As in number 2, only men were portrayed as Health Care Providers and only females as patients. How are the elderly portrayed in advertisements? Not portrayed 5. Are symbols or metaphors used in advertisements? 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. Yes No 1. Do citations contain all of the information necessary to identify references? Are references of high methodological quality? Do journal references come from peer-reviewed medical or pharmacy journals? Did the company finance the research reported in the reference? Generic name 2. Brand name 3. Active drug per dosage form 4. 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 References to the scientific literature as appropriate 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. 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. With regard to references the authors examined the original citation and looked at it critically. 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.