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Should there be drug advertising? The African experiance Editor - We read the debate on drug advertising by Rhona MacDonald and Richard Smith in the studentBMJ last month with interest.1 2 In west Africa our choice has been made for us by the drug companies, most of whom will not support the BMJ's west Africa edition either by advertising or sponsoring meetings, including workshops on medical writing for doctors and other health professionals. These workshops were started in Nigeria in May 2001 followed by a rerun this year in Ghana with the aim of rekindling the art of writing among our colleagues so that we can increase the local content of the local edition of the BMJ. When we launched the BMJ 's west Africa edition in July 1996 the drug companies were very supportive with advertisements without which we could not have published beyond the first issue because one government in west Africa which encouraged us to print 10 000 copies - it took 5000 - has still not paid for these copies. About a year later, the same government decided to bulk purchase drugs from the drug companies who formed themselves into a consortium to share the booty. from then on most of the drug companies have stopped advertising. We have had to drastically cut our rates for the minority who still place advertisements. It is interesting that since the policy of bulk purchasing of drugs stopped there are signs that the drug companies might be coming back to advertise with us. In west Africa there are no laws (or if there are they are not enforced) to restrict prescription only drugs or even controlled drugs with the effect that drug companies do not see the need to educate people through doctors and health professionals. Their drugs can be bought in open markets, minor medicine shops, and on street corners. It is difficult to get doctors to subscribe even though the cost of the local BMJ is subsidised and in local currency. Our colleagues want their journals free of charge. We envy your position where you can decide whether to carry drug advertisements or not. We do not have such options yet we are striving to keep our local edition going. We look forward to the day when we can have the luxury to call the drug companies' bluff. joseph Ana managing editor, BMj west Africa edition gazeen.gazeen@virgin.net
Balance needed between the haves and have nots Editor - I found it rather amusing to discover that two BMJ editors are at odds with each other regarding drug advertisements in a medical student journal.1 2 I think that readers need to know the form and content of the advertisement before reaching any conclusions. Nevertheless, the issue highlighted clearly reflects the editors' experiences between the "haves" and the "have nots," between free economy and fair trading. Dr Smith implied that with today's globalisation, drug advertising in medical publications is no longer an option, and any opposition will eventually be futile. Dr MacDonald, however, defended the need to distance profiteering drug companies from one of the last independent medical publications which promotes medical student issues. however, she did not offer any realistic options in tackling the increasing financial burden in sustaining the publication of studentBMJ. Assuming that the advertisement will take the form of conventional drug publicity (promoting a particular drug) as in other journals, I think this is probably inappropriate for a medical student journal. firstly, it would be irrelevant because the majority of readers - medical students - have no authority to prescribe drugs. Secondly, it may also be unethical to inculcate brand consciousness for a particular drug among students at such an early stage of medical training. This will contradict one of the aims of medical education which promotes critical appraisal and evidence based medicine. Taken further, this may compromise the care of patients delivered by future doctors, who rely on the studentBMJ as one of their sources of education. Dr Smith implied that financial gains made from drug advertisements would allow some editorial independence. however, this is not true. for example, in South Africa major drug companies relaxed their patent rights which resulted in cheaper drugs for treating HIV and AIDS.3 If these companies had pressed ahead it is hard to envisage a journal as vocal as the BMJ criticising them in the same issue as their advertisements appeared. Dr MacDonald's concerns about the immoral practices and exploitation by drug companies are understandable. Nevertheless, we cannot fault these companies for their immense investment and contribution towards disease treatment and eradication. We must not forget that the eventual aim of all businesses is to make a profit. Therefore, drug company advertising is justifiable if it is not promoting a particular drug. If the publicity is represented by, for example, educational articles on clinical pharmacology with an acknowledgment of the drug company, this is perhaps more palatable. This would be more educational and relevant. We should never deny these companies the opportunity to be charitable if the conditions are right. kay Seong Ngoo fourth year medical student, university of Aberdeen ksngoo@doctorsworld.com
We award £20 for the letter of the month!
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