QUALITY OF DRUG ADVERTISEMENTS QUALITY OF DRUG ADVERTISEMENTS FOLLOWING THE DEREGULATION OF MASS FOLLOWING THE DEREGULATION OF MASS MEDIA IN INDONESIAMEDIA IN INDONESIA

Sri Hidayati, Siti Munawaroh, Sulanto Saleh-DanuInternational Network for Rational Use of Drugs – Yogyakarta/ Indonesia

Background: Deregulation of Mass MediaBackground: Deregulation of Mass MediaEnactment of Press Law No: 40/1999, publishing permit is Enactment of Press Law No: 40/1999, publishing permit is

not required anymorenot required anymoreLiquidation of Ministry of Information which previously Liquidation of Ministry of Information which previously

controlled the mass media (2000)controlled the mass media (2000)

Growing number of printed and electronic mass mediaGrowing number of printed and electronic mass media

Quality of drug advertisements?Quality of drug advertisements?

Newspaper Newspaper 167 titles167 titles >1000 titles>1000 titlesMagazine Magazine 231 titles231 titles >500 titles>500 titlesTelevisionTelevision 7 channels7 channels 41 channels41 channelsRadioRadio 803 stations803 stations >1200 stations>1200 stations

ObjectivesObjectives To evaluate ethical practices of drug To evaluate ethical practices of drug

advertisementsadvertisements To evaluate the regulatory status of drug To evaluate the regulatory status of drug

advertisements in Indonesiaadvertisements in Indonesia To explore concerns of the regulatory body To explore concerns of the regulatory body

to the ethical aspect of drug advertisementsto the ethical aspect of drug advertisements

MethodsMethodsDesign: Design: Data collection:Data collection: • Observation of drug advertisements in mass media Observation of drug advertisements in mass media

in 2 phases, before (1996) and after (2003) the in 2 phases, before (1996) and after (2003) the deregulation of mass mediaderegulation of mass media

• Interview with key person in National Agency on Interview with key person in National Agency on Drug and Food Control (NA-DFC)Drug and Food Control (NA-DFC)

Descriptive explorative studyDescriptive explorative study

Indicators:Indicators: • Percentage of drug advertisements mentioning:Percentage of drug advertisements mentioning:Generic nameGeneric nameIndicationIndicationContraindicationContraindication

Drug priceDrug price The manufacturer’s The manufacturer’s

name and addressname and address Drug registration numberDrug registration number

• Existence of regulation and monitoring system for Existence of regulation and monitoring system for drug adsdrug ads

Source and Number of Ads ObservedSource and Number of Ads ObservedSourceSource BeforeBefore AfterAfter

2 radio stations in 2 days of 2 radio stations in 2 days of broadcastingbroadcasting

1515 9090

2 TV channels in 2 days of 2 TV channels in 2 days of broadcastingbroadcasting

2323 253253

1 daily newspaper for one 1 daily newspaper for one monthmonth

3131 5151

2 monthly magazines for one 2 monthly magazines for one yearyear

219219 275275

Billboards in main streets and Billboards in main streets and displays in 50 pharmacies in displays in 50 pharmacies in one purposively selected cityone purposively selected city

2929 782782

TotalTotal 317317 14511451

1992 19961994 2003

Health Health LawLaw

23/199223/1992

Health Health LawLaw

23/199223/1992

Ministerial Ministerial DecreeDecree

386/1994386/1994

Ministerial Ministerial DecreeDecree

386/1994386/1994

DEREGULATION:DEREGULATION:Press Law 40/1999Press Law 40/1999DEREGULATION:DEREGULATION:Press Law 40/1999Press Law 40/1999

BEFORE BEFORE DEREGULATIONDEREGULATION

BEFORE BEFORE DEREGULATIONDEREGULATION

1999

AFTER AFTER DEREGULATIONDEREGULATION

AFTER AFTER DEREGULATIONDEREGULATION

Chronological events

Findings: REGULATORY STATUSFindings: REGULATORY STATUS

Health Law No. 23/1992: Health Law No. 23/1992: Drug information should be objective, complete, and not misleading

Ministry of Health Decree No. 386/1994:Ministry of Health Decree No. 386/1994: Detailed rules in promotion of non-prescribed drugs

Advertisements are regularly monitored by observing Advertisements are regularly monitored by observing advertisements sampled from mass media.advertisements sampled from mass media.

VIOLATION Sanction for promotional violation: written Sanction for promotional violation: written

reprimand, instruction to stop the promotion, reprimand, instruction to stop the promotion, withdraw the promotional materialwithdraw the promotional material

Promotional violation at National level in 2002: 675 Promotional violation at National level in 2002: 675 cases, 139 were categorized as breaching the lawcases, 139 were categorized as breaching the law. .

Result: DECLINING QUALITY OF INFORMATION IN ELECTRONIC MEDIA

10

100

0

100 100

0

14

86

47

10

91

0

20

40

60

80

100

120

Gen.names

Indication Cont. Indic. Name ofmanuf.

address ofmanuf.

Price

24

100

0

100 100

0

515157

2

14

78

0

20

40

60

80

100

120

Gen. name Indication Cont. Indication name of manuf. address ofmanuf.

Price

%

Before After

In electronic media (radio In electronic media (radio andand television), the quality of information television), the quality of information in drug advertisements after deregulation declined, as shown by the in drug advertisements after deregulation declined, as shown by the falls of all indicators’ valuesfalls of all indicators’ values

RADIO

TELEVISION

28

44

4

51 51

0

67

39

80

98 100

0

20

40

60

80

100

Gen. names Indication Contra Indic. Name ofmanuf.

Address of manuf.

Price

24

85

0

88 88

0

36

98

45

90

40

20

20

40

60

80

100

Generic name Indication Contraindication Name of manufacturer Address of manufacturer Price

Before After

Result: IMPROVEMENT IN PRINTED MEDIA

In printed media (newspaper, In printed media (newspaper, magazine and billboard), a marked magazine and billboard), a marked improvement has been achieved improvement has been achieved after deregulation as shown by the after deregulation as shown by the rise of percentage of all indicators, rise of percentage of all indicators, except the address of manufacturer.except the address of manufacturer.

NEWSPAPER BILLBOARD

28

44

4

51 51

0

6251

93

31

1

94

0

20

40

60

80

100

Generic names indication Contraindication Name ofmanufacturer

Address ofmanufacturer

price

MAGAZINE

DiscussionsDiscussions Regulations have been available for a decade, but Regulations have been available for a decade, but

the quality of drug information in drug ads is still far the quality of drug information in drug ads is still far from expectedfrom expected

Factors contributed: the weak monitoring system, Factors contributed: the weak monitoring system, weak enforcement for sanction in cases of violation.weak enforcement for sanction in cases of violation.

Monitoring should ideally be conducted with Monitoring should ideally be conducted with standardized forms referring both to the regulation standardized forms referring both to the regulation and information approved during registration.and information approved during registration.

Efforts are needed to encourage critical attitude to Efforts are needed to encourage critical attitude to drug advertisements among general public.drug advertisements among general public.

Conclusions The loosening of publishing/broadcasting permit The loosening of publishing/broadcasting permit

unlikely affects the quality of drug advertisementsunlikely affects the quality of drug advertisements Strong regulations on drug promotion are Strong regulations on drug promotion are

available (Law and Decree), but the enforcement available (Law and Decree), but the enforcement and control system are weak and control system are weak

The quality of drug advertisement is more The quality of drug advertisement is more dependent on the power of regulation dependent on the power of regulation implementation. Therefore, stronger enforcement implementation. Therefore, stronger enforcement and sanctions is urgently neededand sanctions is urgently needed

“Terima Kasih”(Thank You)