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[e-drug] Critical appraisal of advertisements

E-drug: Critical appraisal of advertisements
---------------------------------------------
Dear All,

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!

Staffan Svensson
Dept of Clinical Pharmacology, Sahlgrenska University Hospital, 
Gothenburg, Sweden
"Staffan Svensson" <staffan.svensson@pharm.gu.se>
[Peter Mansfield of MaLAM might like to respond.  BS]
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