NAIROBI – Drug companies routinely violate World Health Organization ethical guidelines when advertising and promoting their products in East Africa, according to a new study released Thursday.

The study from Health Action International Africa’s Kenya office studied 543 print advertisements examined in five East African countries. Of the brochures distributed at medical facilities, none met six standard criteria as set out by the WHO for ethical advertising of medicines. Only 16 percent of advertisements released to the general public did so.

While all the ads listed the brand names of the products for same, less than 40 percent of the ads mentioned major precautions associated with the drug or its approved indication. Ten percent did not even mention the active ingredient of the drug.

“There is widespread low compliance with international standards and promotion,” HAI Africa’s Carole Piriou, who organised the study, said at a meeting unveiling the study.

[Note: the study will be posted as soon as it becomes available electronically.]

Ethical advertising of medicines is important in East Africa and in developing countries around the world because access to unbiased information about medicines is often extremely difficult to come by, and consumers end up relying on pharmaceutical companies to learn about drugs. The guidelines are not legally binding.

Among the ads that the study found to have violated the WHO ethical guidelines was an anti-diarrhoea drug combining norfloxacin and tinidazole, which is generally not recommended. Another advertisement was for Appevite, a brand of cyproheptadine – mostly used as an anti-allergy medicine – that was cited as an appetite stimulant.

“Stimulating appetite is not an approved indication of cyproheptadine; its efficiency for that purpose was never demonstrated,” the study said.

The countries surveyed in the study were Kenya, Madagascar, Malawi, Uganda and Zambia. Of those countries, Madagascar and Zambia have no regulations at all on promoting medicines. Other nations often enforce their regulations poorly.

“Regulation exists in three countries of the five but the main problem is enforcement,” said Piriou.

A Kenyan official who attended the meeting was quick to acknowledge that problem.

“We see so many adverts with so many claims but they are not approved by us,” said Dr. Fred Siyoi, deputy registrar of the Pharmacy and Poisons Board, which falls under Kenya’s Ministry of Medical Services. “The penalties are a minimum and the profits people get by advertising far outweigh the penalties.”

“What we have done, we’ve tried to tell the media, ‘Don’t print anything or advertise anything unless you get our approval,’ but that’s what they are not doing,” Siyoi said.

Participants at the meeting said it was also difficult for consumers to get reliable information about medicines from doctors because many were rewarded for prescribing certain drugs. In Kenya, some pharmaceutical companies are known to refer to medical practitioners as “company compliant doctors,” who will not prescribe medicines from other companies.

Earlier survey data cited by HAI Africa has shown that many doctors turn to promotional materials for information about drugs, and that doctors who rely on such materials have been shown to prescribe drugs more often, and less appropriately.

Studies have also shown that health workers are often unaware – or are unwilling to say – how much their opinions are swayed by promotional materials. And so far, the only really effective means of cutting down on inaccurate or incomplete advertising is essentially to name and shame a company by distributing its ad among other drug manufacturers.

“It’s a place where there is a lot more to learn,” said HAI Africa pharmacist Christa Cepuch. “The interventions practiced in the past don’t really seem to be very effective.”

According to the study, 31 percent of the health care industry’s spending in 2003 went to marketing, compared to 13 percent toward research and development.

Industry representatives who attended the meeting acknowledged that companies must take the responsibility of making sure their drugs adhere to the WHO guidelines.

“As an industry, the company pharmacist or whoever oversees registration should be vetting the correctness or accuracy of the advertisement,” said Dr. William Mwatu, the medical and regulatory affairs director for GlaxoSmithKline’s East Africa office.