Drug adverts must be controlled

It is important to note that no drug is risk-free and that there is a thin line between a drug and poison, the difference is the information given at the time of use.  Even when the drug’s benefits are overwhelming, it doesn’t mean that the product is void of health risks.

Given their potential risks, all aspects of drugs must be regulated, including the information used during advertising and promotion—a drug is as good as information about it. Accordingly, NDA is mandated to control drug advertising and promotion in Uganda.

The National Drug Policy and Authority (NDPA) Act Cap 206 stipulates that a person shall not make any publication or advertisement for drugs without the approval of the NDA. The NDPA Act emphasises that any advertisement or promotion relating to drugs shall be reliable, accurate, truthful, informative, balanced, up-to-date, capable of substantiation, and in good taste; and shall not contain misleading or unverifiable statements or omissions that may induce medically unjustifiable drug use, or which may give rise to undue risks. The basic principle behind this regulation is to protect the public from misleading information that may result in inappropriate medicine use.

Despite the need to regulate drug promotion, Direct to Consumer Pharmaceutical Advertisement (DTCPA) is increasingly becoming one of the most common health communication practices amidst controversy. It involves pharmaceutical companies’ efforts to promote their products (primarily prescription drugs) directly to patients.

In Uganda, the NDPA Act prohibits DTCPA. However, some pharmaceutical companies continue to promote their prescription products to patients. Recently, NDA released a public notice strongly warning social media influencers to desist from promoting drugs. Additionally, NDA has been conducting enforcement activities targeting mega-phones advertising drugs.

In collaboration with Uganda Communications Commission (UCC), NDA has issued cautions to media houses that broadcast unauthorised drug adverts. These have raised concerns among some members of the public who believe that the public has a right to any information! Some people have argued that it is necessary to provide drug-related information to patients in order to involve them in health-related decisions and as part of the informed consent process. 

Indeed, DTCPA is based on the principle of social transformation in medical practice, which advocates for the empowerment of patients to participate actively in health-related decisions. While this is a well-intended approach, it has the potential to jeopardise the doctor-patient relationship and can worsen inappropriate drug use, promote self-medication, and compound associated challenges like antimicrobial resistance.

Pharmaceutical companies are using DTCPA as a strategy to increase the volume of drugs sold and thus generate more revenue. However, despite the clinical effectiveness of less expensive alternatives, the growing practice of DTCPA is increasingly driving demand for expensive products. Patients are led to believe that if they so choose the more expensive products, they will have better treatment outcomes. Regrettably, this serves as a medium for some households to incur catastrophic or impoverishing healthcare costs.

Drugs used to treat serious conditions are characteristically complex and may be difficult to explain or comprehend in a brief brochure or advertisement clip. Such medications have multiple side effects. It is unrealistic to expect non-medical personnel to comprehend the implications of taking a prescription drug based on a skewed and summarised advertisement.

Although it is a requirement to provide balanced information about the product, pharmaceutical companies structure advertisements in such a way that the audience’s attention is diverted away from any cautions about the product. Some of these advertisements contain misleading information.

Contemporary media has provided new space for drug dealers to promote their products easily and cheaply. Social media advertising presents a new dilemma to drug regulators. From social media influencers to open spaces, monitoring adverts, promotional publications, and their claims on social and mainstream media is a daunting task.

Whereas the pharmaceutical business should generate revenue, its ultimate responsibility is to promote and protect patient health. All marketing strategies should be patient-centred and free of ethical violations. Also, there is no doubt that patients must be involved in healthcare decisions. However, better alternatives to DTCPA such as disease awareness programmes—which allow patients to interact with their doctors without focusing on a specific product—may be implemented.

Stringent measures will be undertaken to ensure compliance with drug promotion guidelines as a way of protecting Ugandans. Only vetted drug-related information should be published.

Energy drinks promoters, herbalists, and traditional healers shouldn’t make misleading treatment claims. Broadcasters should adhere to the drug advertisement and promotion guidelines. This is not intended to frustrate anyone’s business interests but rather to protect the public from risks associated with inappropriate medicine use.

 Abiaz Rwamwiri & David Walusimbi, National Drug Authority