E-drug: Critical appraisal of advertisements
I have recently become responsible for a 5-week course in clinical
trial methodology, at a course named the "Biomedical Drug Programme".
As a subject of discussion, I showed the students an advertisement
recently published in the Swedish Medical Journal (L?kartidningen),
for GlaxoSmithKline's bupropion - Zyban (r). Have a look at
http://www.clinpharm.gu.se/bvlp/epid/buprop1.htm (click images to enlarge).
The headline reads "Patients at risk that should stop smoking may now
be treated effectively with a pill that affects [literally: works in]
the brain". The task was to analyze this statement. I handed out the
only available ad reference that seemed to have anything to do with
the statement; A Controlled Trial of Sustained-release bupropion...,
Jorenby et al, N Engl J Med 1999;340:685-91.
Conclusions from our discussion were as follows:
"Patients at risk": the NEJM article does not deal with patients at
high risk, on the contrary, these were specifically excluded. The ad
headline does not specify what risk the patients should be at, but it
is implicit that high risk patients are the ones to treat.
"should stop smoking": the treatment is voluntary, shouldn't it be
"that want to stop smoking"?
"a pill that affects the brain": all drugs for nicotine (or any other
kind of ) dependence affect the brain, right?
"may now treated effectively": this trial, where there does indeed
seem to be some effect of bupropion, measures the efficacy (as
measured in a randomized controlled trial), as opposed to the
effectiveness (as measured in everyday practice), of the medication.
The Swedish word "effektivt", "effectively" does not discern between
efficacy and effectiveness, and the phrasing thus gives the
impression that bupropion is proven to work well in usual practice.
"treated effectively with a pill": the treatment was not only the
medication but also a large number of counselling sessions by
telephone and person-to-person. In all, there were 22 counselling
sessions. It is doubtful whether such intense counselling is
available in usual care.
It would be interesting to get further comments from e-drug people
regarding this ad!
Dept of Clinical Pharmacology, Sahlgrenska University Hospital,
"Staffan Svensson" <email@example.com>
[Peter Mansfield of MaLAM might like to respond. BS]
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