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

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 Growing number of printed and electronic mass media Quality of drug advertisements? Newspaper 167 titles >1000 titles Magazine 231 titles >500 titles Television 7 channels 41 channels Radio 803 stations >1200 stations

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

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

Source and Number of Ads Observed SourceBeforeAfter 2 radio stations in 2 days of broadcasting TV channels in 2 days of broadcasting daily newspaper for one month monthly magazines for one year Billboards in main streets and displays in 50 pharmacies in one purposively selected city Total

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

Findings: 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 sampled from mass media.  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 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. Promotional violation at National level in 2002: 675 cases, 139 were categorized as breaching the law.

Result: DECLINING QUALITY OF INFORMATION IN ELECTRONIC MEDIA 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 RADI O TELEVI SION

Result: IMPROVEMENT IN PRINTED MEDIA  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. NEWSPAPER BILLBOARD MAGAZINE

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.

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

“Terima Kasih” (Thank You)