ASA Adjudication on Pfizer Ltd

Ad

A cinema ad, about the dangers of purchasing prescription-only medicines over the Internet, showed a man in a kitchen. He took a tablet from a packet and swallowed it. Shortly afterwards he reached into his mouth and pulled out a tail; he appeared to gag as a dead rat gradually emerged from his mouth, tail first. The voice-over stated "Rat poison. Just one of the dangerous ingredients that may be found in fake medicines purchased from illegal websites. The man held the rat out in front of him; it dropped to the floor as he turned to the sink and appeared to vomit. On-screen text stated "GET REAL. GET A PRESCRIPTION"; a web address was shown below.

Issue

1. 12 complainants objected that the ad was offensive;

2. Most of the complainants objected that the ad was unduly distressing;

3. Seven of the complainants also objected that the ad was misleading, because they understood that some legally prescribed medicines also contained dangerous ingredients such as rat poison, and

4. Three of the complainants also objected that the ad was likely to cause particular distress to people who took those legally prescribed medicines that contained dangerous ingredients.

CAP Code

Response

Pfizer said that there had been a large increase in counterfeit medicines seized at EU borders in the past two years.  Those being targeted by counterfeiters included people reliant on life-saving medication, which put vulnerable patients at risk.  Some counterfeit medicines included low levels of the active ingredient, or none at all, which could result in no health benefit being delivered or harm to the patient; those that contained too much of the active ingredient, or toxic substances, could also be potentially harmful or life-threatening.  

It was estimated that between 50 and 90% of prescription-only medicines purchased from unregulated websites were counterfeit or sub-standard.  Their research suggested that in the UK more than 330,000 men each year were likely to purchase prescription-only medicines from illicit sources, in particular from unregulated websites; in doing so, they risked misdiagnosis or underlying medical conditions remaining undetected.  Pfizer were concerned that awareness of the issue was poor among members of the public, patients and healthcare professionals.  As a major ethical pharmaceutical company they believed they led the way in raising awareness of the risks posed by counterfeit medicines; they did so by working closely with key patient organisations and the Medicines and Healthcare products Regulatory Agency (MHRA).  They sent copies of the research to which they had referred, including documents prepared by the European Commission Taxation and Customs Union, The European Alliance for Access to Safe Medicines and the World Health Organisation International Medical Products Anti-Counterfeiting Taskforce.    

1. & 2. The campaign sought to address a lack of public awareness of a potentially life-threatening issue and Pfizer believed it was socially responsible to do so.  They said each of the organisations involved in the ad, which included the MHRA, the Patients Association, Mens Health Forum and H.E.A.R.T UK, had endorsed it and made clear their support for the campaign.  Pfizer acknowledged that the ad was hard-hitting but they, and the other organisations involved, felt it was unlikely to cause serious or widespread offence.  They said it was estimated that 4.1 million individuals had seen the ad and in that context the number of complaints received was low; they had received positive feedback from many patients, consumers and members of the medical profession.       

Pfizer said the concept for the ad was based on the case of a woman who died in 2006 after taking contaminated medicines bought online.  The rat was intended as a metaphor to reflect that rat poison had been found in contaminated counterfeit medicines.  The ad was designed to be hard-hitting with the intention it would be effective and provoke a change in behaviour, a similar approach to other public education campaigns.  They considered the visual representation in the ad was proportionate to the underlying issue; the rat was not included merely to attract attention but to represent published medical evidence about counterfeit medicines.

They said they had gone to significant lengths to ensure the ad was restricted to appropriate audiences to avoid causing fear and distress to younger people.  They provided copies of the British Board of Film Classification (BBFC) certificate, which stated that the ad had been approved for those aged 15 and over.   They also sent a letter from the Cinema Advertising Association (CAA), which had also classified the ad in the 15 years and above category. Pfizer said they had complied with the restrictions and had ensured that the ad was shown only with films with a corresponding age category.

The CAA said they had received four complaints.  When the Copy Panel considered the ad they believed the scene with the man pulling a dead rat from his mouth was similar to those that could be seen in a 15-rated film and took the view that the danger of unregulated and counterfeit medicines being available online was serious and had potentially fatal consequences; it therefore deserved to be addressed in a manner that would be remembered. The Copy Panel had paid particular regard to CAP Code clause 9.1 when they restricted the ad to be shown only with 15- or 18-rated films.   Although they acknowledged that some offence or revulsion might be caused to some audience members, they believed the intended social good of the ad justified its impact. They believed it was relevant that one of the films the ad was shown with was Slumdog Millionaire, a well publicised 15-rated film that had attracted large audiences and included horrifying images such as a young child being deliberately blinded with hot liquid and a spoon.

3. Pfizer acknowledged that some legally prescribed medicines might contain dangerous ingredients including warfarin, which was widely used in the UK as an anticoagulant for cardiovascular and other conditions and was another recognised type of chemical rat poison.  However, the safe use of warfarin, which was no longer used as a rat poison because modern alternatives were more potent, required a prescription, supervision and monitoring by a healthcare professional; that was a reflection of the potential dangers associated with medicine if it was not properly prescribed and used, as the ad was intended to highlight.  Pfizer believed the ad was unlikely to mislead audiences.

The CAA pointed out most therapeutic medicines contained some form of toxin.  It was important such medicines were obtained using a prescription to ensure that the constituents were of a suitable purity, proportion and consistency and the drugs were manufactured to British pharmaceutical standards.  They believed the warfarin used in rat poison was likely to be of a different quality to that used in licensed medicinal products.  Many people who were prescribed warfarin would be aware that it was also a constituent of some rat poisons.

4. Pfizer and the other organisations involved in the campaign believed the ad was not likely to cause particular distress to patients who had been prescribed warfarin.  Indeed, many patients who took warfarin were represented by the patient organisations who were involved with the campaign.  

The CAA said that the Panel did not consider it reasonable to restrict the commercial on the grounds that some members of the audience might feel that the image of regurgitating a rat might apply specifically to them.

Assessment

1. & 2. Not upheld

The ASA noted the ad was intended to raise awareness of a serious issue and was designed to be hard-hitting so as to achieve the desired impact.  We also noted the CAP Code stated that, without good reason, ads should not cause fear and distress or include shocking claims or images simply to attract attention.  

We considered that the ad included images that some people might find offensive or distressing.  Because the ad was designed to highlight an important issue, the dangers of which could result in damage to health or in fatality, we considered the metaphor of regurgitating a rat was likely to justify, for most people, the approach.  We noted the ad was restricted to being shown with 15 or 18 rated films and considered that was sufficient to minimise the number of younger people who saw it.  We considered that the aim of the ad justified the use of hard-hitting imagery.  We concluded that it did not cause fear and distress without good reason and was unlikely to cause serious or widespread offence.       

On these points, we investigated the ad under CAP Code clauses 5.1 (Decency) and 9.1 (Fear and distress) but did not find it in breach.   

3. Not upheld

We understood some prescription medicines contained an ingredient that might also be used in rat poison.  We considered that people were likely to realise that the aim of the ad was to raise awareness of the dangers of buying medicines from unregulated sources.  We considered they were unlikely to infer that only medicines bought from unregulated sources contained potentially dangerous ingredients.    We concluded that the ad was not misleading.

On this point, we investigated the ad under CAP Code clause 7.1 (Truthfulness) but did not find it in breach.

4. Not upheld

We noted patient organisations were involved in the campaign and represented people who used warfarin.  We acknowledged that patients prescribed medicines that contained potentially dangerous ingredients, including warfarin, might feel that the ad had particular significance to them.  We considered however that they were likely to be aware of the associated dangers and the importance of drugs being prescribed and supervised by qualified medical professionals.    We concluded that the ad did not cause undue fear and distress to people who took prescribed drugs that contained potentially dangerous ingredients.    

On this point, we investigated the ad under CAP Code clause 9.1 (Fear and distress) but did not find it in breach.

Action

No further action necessary.

Adjudication of the ASA Council (Non-broadcast)