Evaluation of Drug Advertisement Quality in Indonesia Following Media Deregulation

1. QUALITY OF DRUG ADVERTISEMENTS FOLLOWING THE DEREGULATION OF MASS MEDIA IN INDONESIA Sri Hidayati, Siti Munawaroh, Sulanto Saleh-Danu International Network for Rational Use of Drugs – Yogyakarta/ Indonesia

2. Background: Deregulation of Mass Media • Enactment of Press Law No: 40/1999, publishing permit is not required anymore • Liquidation of Ministry of Information which previously controlled the mass media (2000) • Growing number of printed and electronic mass media Quality of drug advertisements?

3. Objectives • To evaluate ethical practices of drug advertisements • To evaluate the regulatory status of drug advertisements in Indonesia • To explore concerns of the regulatory body to the ethical aspect of drug advertisements

4. Methods Design: Data collection: Descriptive explorative study • Observation of drug advertisements in mass media in 2 phases, before (1996) and after (2003) the deregulation of mass media • Interview with key person in National Agency on Drug and Food Control (NA-DFC) Indicators: • Percentage of drug advertisements mentioning: • Drug price • The manufacturer’s name and address • Drug registration number • Generic name • Indication • Contraindication • Existence of regulation and monitoring system for drug ads

5. Source Before After 2 radio stations in 2 days of broadcasting 15 90 2 TV channels in 2 days of broadcasting 23 253 1 daily newspaper for one month 31 51 2 monthly magazines for one year 219 275 Billboards in main streets and displays in 50 pharmacies in one purposively selected city 29 782 Total 317 1451 Source and Number of Ads Observed

6. DEREGULATION: Press Law 40/1999 Chronological events Health Law 23/1992 BEFORE DEREGULATION AFTER DEREGULATION Ministerial Decree 386/1994 2003 1999 1992 1994 1996

7. Findings: REGULATORY STATUS • Health Law No. 23/1992: Drug information should be objective, complete, and not misleading • Ministry of Health Decree No. 386/1994:Detailed rules in promotion of non-prescribed drugs • Advertisements are regularly monitored by observing advertisements sampled from mass media. • VIOLATION • Sanction for promotional violation: written reprimand, instruction to stop the promotion, withdraw the promotional material • Promotional violation at National level in 2002: 675 cases, 139 were categorized as breaching the law.

8. Result: DECLINING QUALITY OF INFORMATION IN ELECTRONIC MEDIA RADIO TELEVISION In electronic media (radio and television), the quality of information in drug advertisements after deregulation declined, as shown by the falls of all indicators’ values

9. Result: IMPROVEMENT IN PRINTED MEDIA BILLBOARD NEWSPAPER MAGAZINE • In printed media (newspaper, magazine and billboard), a marked improvement has been achieved after deregulation as shown by the rise of percentage of all indicators, except the address of manufacturer.

10. Discussions • Regulations have been available for a decade, but the quality of drug information in drug ads is still far from expected • Factors contributed: the weak monitoring system, weak enforcement for sanction in cases of violation. • Monitoring should ideally be conducted with standardized forms referring both to the regulation and information approved during registration. • Efforts are needed to encourage critical attitude to drug advertisements among general public.

11. Conclusions • The loosening of publishing/broadcasting permit unlikely affects the quality of drug advertisements • Strong regulations on drug promotion are available (Law and Decree), but the enforcement and control system are weak • The quality of drug advertisement is more dependent on the power of regulation implementation. Therefore, stronger enforcement and sanctions is urgently needed

12. “Terima Kasih” (Thank You)