BMJ  2003;326:1211 (31 May), doi:10.1136/bmj.326.7400.1211

Letter

Journals should select drug advertisements more carefully

EDITOR—Until the ALLHAT study (antihypertensive and lipid lowering treatment to prevent heart attack trial) was published,¹ there was little, if any, evidence of the clinical benefit of amlodipine in treating hypertension. Nevertheless, as testimony to the marketing success of Pfizer, amlodipine has become the world's biggest selling antihypertensive drug.

Pfizer is obviously keen to publicise the results from ALLHAT. Several medical journals, including the BMJ, have recently printed an advertisement for amlodipine in which it is claimed: "with the results of the ALLHAT study, lowering blood pressure with [amlodipine] in high risk hypertensive patients is now proven to be equivalent to a diuretic in stroke outcome."

Although the advertisement is factually correct, unsurprisingly, it does not mention the comparative cost of amlodipine. According to prices in the latest British National Formulary, it costs about 16 times more to treat hypertension with amlodipine than it does with bendrofluazide, the most commonly prescribed thiazide diuretic in the United Kingdom. If equivalent efficacy is accepted, this makes amlodipine about 1/16th as cost effective. Given that hypertension is the commonest treatable chronic medical condition in the United Kingdom, a treatment strategy based on amlodipine would be wasteful.

Most would agree that those who prescribe have a duty to consider cost effectiveness, especially when there is a choice of effective treatments.² It is therefore disappointing that major medical journals, particularly those that have championed transparency in the health service-industry partnership, are prepared to accept advertisements that contain information that may be considered misleading. We suggest that reputable journals should take account of any potentially misleading content in deciding which advertisements to publish.

james.oliver{at}ed.ac.uk

Clinical Pharmacology Unit, Western General Hospital, Edinburgh EH4 2XU

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Competing interests: JTO holds an educational research grant from Pfizer. SRM has no competing interests.

References

1. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288: 2981-97.[Abstract/Free Full Text]
2. Gillon R. Medical ethics: four principles plus attention to scope. BMJ 1994;309: 184-8.[Free Full Text]

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