Unethical drug promotion by pharmaceutical industry as the main barrier to the rational use of medicines

The review surveys the problems of pharmaceutical promotion and public health. Global and domestic realities of pharmaceutical marketing are discussed. Various promotional activities of pharmaceutical industry are described with special emphasis on journal advertisements. Examples of unethical marketing practices of the global pharmaceutical companies are presented with details of the fines paid by the companies for unethical promotion of their products for «off-label» use or for long-term concealing of adverse drug reactions known by the companies long before they become freely available for the society. The review presents definition of «disease selling» as a technique extensively used by pharmaceutical industry to promote their products and increase income. Evidence of pharmaceutical promotion detrimental effects on physicians’ prescribing practices is presented in line with the evidence of funding distribution distortion: the global pharmaceutical expenditures for drug promotion are far exceeding research and development funding. The review describes, with few exceptions, the medical journal editors general lack of awareness of journal advertisements influence on prescribers’ knowledge, attitudes and medicine use. The review reveals promotional nature of advertisements as opposed to information delivery. It describes unethical marketing techniques including journal advertising used as an instrument of promotional idea delivery to physicians and the problem of promotional influence on prescribing. The review emphasizes that pharmaceutical industry self-regulation as well as medical journals peer reviewing process do not protect from misleading advertising. It concludes that pharmaceutical advertising, and advertising in medical journals as an example is not informative and threatens public health, requiring detailed regulation.