Vehicles move past a billboard that was part of Eli Lilly’s obesity awareness campaign in India.
Bhawika Chhabra / Reuters
Pharma giants are bankrolling obesity awareness campaigns globally. In an analysis, Swissinfo examines thorny questions about whether drug advertising bans are still enforceable – or even relevant.
• Pharmaceutical firms such as Eli Lilly are running obesity awareness campaigns in countries including Switzerland.
• Regulators are investigating if these campaigns breach bans on advertising prescription-only medicines to the public.
• Swissmedic has launched an investigation, while France has fined both Eli Lilly and drugmaker Novo Nordisk for indirect promotion.
Summary generated by AI
In early March, a digital billboard in the train station at Zurich airport caught my eye. It consisted of just a few words on a light green-blue screen: “Adipositas ist nicht Ihre Schuld” (obesity is not your fault) along with a website link, a QR code and a call to consult your doctor. A couple of seconds later, a slide in red appeared with the logo of the US firm Eli Lilly, one of the two major makers of obesity treatments.
Over the next month my colleague spotted similar billboards in the French-speaking part of Switzerland, some of which were found next to ads for McDonald’s. Company-sponsored posters, TV commercials and online campaigns on obesity have appeared in other countries from France to India.
It’s pretty unusual to see pharmaceutical company logos on advertising billboards in Switzerland. Here, as in almost every other high-income country aside from the US and New Zealand, advertisements for prescription-only medicine to the public are banned.
Having seen many drug commercials in the US in my life, I know how annoying and harmful they can be. StudiesExternal link in the US show that while drug ads can make patients aware of new treatments, they can also drive demand for expensive brands and lead to overprescription.
An obesity campaign billboard found in the French-speaking part of Switzerland with the message “when the body resists weight loss”.
Aylin Elci, Swissinfo
The billboards found in Switzerland, which were part of a month-long campaign Eli Lilly ran around World Obesity Day on March 4, aren’t like the in-your-face ads you see in the US though. They don’t mention any specific product or show anyone using an injection pen, taking a pill or spouting the miracle results of any prescription drug.
The websiteExternal link referred to on the billboard mentions medication along with other weight-management strategies but doesn’t reference Eli Lilly’s own drugs.
In an email to Swissinfo, the company wrote the “non-promotional, science-based educational activities are designed to increase awareness of a disease, its burden, and the importance of seeking appropriate medical assistance”.
When awareness becomes advertising
Companies are allowedExternal link to sponsor disease awareness campaigns in Switzerland, Japan and many other countries in the world if they are complete, balanced and objective. This means that they can refer to prescription-only medicine as long as they mention all the other prevention and treatment approaches out there and the positive and negative aspects objectively.
Article 2 of the OrdinanceExternal link on Advertising for Medicinal Products defines advertising as “all information, marketing and incentive measures aimed at promoting the prescription, dispensing, sale, consumption or use of medicinal products”. This applies to all print, television and electronic media.
If a company doesn’t mention any prescription medicine, it could still be in violation of the rules if it indirectly references a prescription-only medicine. This is where things get tricky.
“It’s a very fine line between raising awareness of diseases, which has a positive aspect, and advertising for prescription-only medicines,” said Celine Weber, a lawyer in the life sciences team at law firm Walder Wyss in Zurich. “Nowadays it’s very hard not to have an indirect reference to a medicine, especially when you are one of the only companies, if not the only company, offering a medicine for a specific condition.”
For transparency reasons companies put their logo or name on any campaign they sponsor. But simply mentioning a company name or using brand colours and graphic elements in connection with a specific disease can often constitute an unauthorised indirect reference to a particular product, said a spokesperson for Swissmedic, which is responsible for enforcing advertising rules for therapeutic products.
Regulators are starting to take a closer look at these campaigns. Swissmedic has launched an investigation into Eli Lilly’s obesity campaign to see if they are in breach of the advertising ban. Last year Spain’s ministry of health investigated an obesity awareness campaign by Danish drugmaker Novo Nordisk to determine if it constituted indirect advertising for prescription-only medicine.
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Swiss regulator and media clash over weight-loss drugs
The campaign included, among other things, billboards with the words “obesity can kill”, a TV spot, and a website that offered suggested questions to ask your doctor, accordingExternal link to Spanish paper El País. No specific Novo Nordisk product was mentioned.
In March, Eli Lilly pausedExternal link an obesity awareness campaign in India, launched a year ago, in response to a regulatory notice regarding advertising rules. In early May, the French medicines regulator finedExternal link both Eli Lilly and Novo Nordisk, ruling that the messaging – even without naming specific drugs – amounted to indirect promotion of prescription drugs for obesity.
A healthy dose of health awareness
It’s easy in all of this to forget why countries ban advertising in the first place: to protect people from false or misleading information that could lead to excessive or inappropriate use of products, according to Swissmedic.
“The Swiss legislator aims to protect public health, ensure transparency and provide the public with factual information on the responsible use of medicinal products,” Swissmedic spokesperson Lukas Jaggi told Swissinfo last year. “Medicinal products should be used on the basis of medical needs and not for commercial interests.”
Companies naturally see a business opportunity with awareness-raising campaigns. The more awareness and knowledge of health conditions, the more likely people are to seek treatment. This should benefit patients but would also likely fill the coffers of big companies making those treatments. This raises a question of whether the public can and will even trust companies as messengers of health-related information.
There are real concerns about people misusing the latest obesity drugs. Although doctors remain gatekeepers for prescription drugs, stories abound of people, who aren’t diagnosed as obese, taking them for cosmetic reasons or other unapproved conditions.
Even if disease awareness campaigns aren’t classified as advertisements, they can still be controversial. In Spain, Novo Nordisk’s “Speaking openly” about obesity campaign (“Hablar sin filtros”) drew public criticism in part because of the negative way it portrayed obesity. Some people on social media called it tasteless, insensitive and a form of body shaming.
The biggest threat to proper use of medicine though is arguably not companies but widespread misinformation and influencers on the internet. There are thousands, if not millions, of TikTok posts and YouTube videos of people sharing their experiences with specific weight-loss injections and pills, which can be viewed from anywhere in the world.
+ Swiss government wants to keep ads for unhealthy products away from children
“People have access to a lot more information nowadays than 20-30 years ago when the doctor knew everything,” said Weber. “But there is also a lot of unqualified information.”
Many diseases including obesity are still not well understood and are associated with stigma and shame. Eli Lilly said the aim of the campaign in Switzerland was to increase public understanding of obesity as a chronic and serious disease, and the importance of seeking appropriate medical assistance.
But are they and other companies the ones who should be increasing this understanding? If companies don’t, who will?
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Additional reporting by Aylin Elçi and Carla Wolff Gonzalez. Edited by Virginie Mangin/ts