AUTH/3386/9/20 - Health professional v GlaxoSmithKline

Alleged promotion of low carbon inhaler to the public

  • Received
    14 September 2020
  • Case number
    AUTH/3386/9/20
  • Applicable Code year
    2019
  • Completed
    19 February 2021
  • No breach Clause(s)
  • Additional sanctions
  • Appeal
    No appeal

Case Summary

An anonymous health professional complained about a website regarding low carbon inhalers produced by GlaxoSmithKline UK Limited.

The complainant stated that the wording on the website intended for the public was all in relation to discussions with the treating health professional about inhaler choice. The first statement underneath the ‘what can you do section’ read: ‘Discuss with your nurse, doctor or pharmacist whether a low carbon inhaler is appropriate for you’. The complainant alleged that patients were thus being encouraged to speak to their health professionals about their treatments which might well result in a change to a specific treatment.

The complainant alleged that the webpage disparaged the use of a pressurised metered dose inhaler (pMDI) and was not fair and balanced. For example, there were big, emboldened headlines such as ‘A high carbon MDI inhaler has a carbon footprint that is 18x higher than a low carbon DPI [dry powder inhaler] inhaler’. However, there was no balanced detail of some of the reasons why a pMDI might be preferred to a DPI by patients such as ability to use the devices or patient choice (eg spacer). The webpage was one-sided and did not take into account patient choice or other factors in choosing appropriate devices which could cause patients to lose control of their disease and drive patients to ask their health professionals for a specific device.

The complainant alleged that a lot of statements amounted to product claims as opposed to factual information, for instance, ‘Do you think about your inhaler’s carbon impact?’.

The complainant noted that there was no adverse event reporting box identified on the page.

The complainant noted that a statement, ‘Use this decision aid with your doctor or nurse to choose the right inhaler for you’, linked to a patient decision aid from the National Institute for Health and Care Excellence (NICE) and page 3 of which showed a GlaxoSmithKline Ellipta device amongst other inhalers. The complainant alleged that this was disguised promotion of a GlaxoSmithKline product.

The guide also discussed many of the important factors needed when choosing a device so it was not aligned to the content on the webpage itself which was heavily focused on carbon footprint and nothing else. In the complainant’s view, the webpage could not be classed as disease awareness as there was no mention of symptoms etc but merely all around products (indirect mentions) and as GlaxoSmithKline had inhaler devices including a heavy interest in DPIs, the complainant was concerned as to whether the website was simply for promoting its products to patients.

The complainant alleged that the website was not appropriate for the general public, let alone patients, as it simply put a great deal of emphasis on being positive towards DPIs asking for patients to potentially get their inhaler changed.

The complainant noted that references/links at the bottom of the page took readers to other websites but there was no pop-up to let readers know they were going to another webpage. The complainant alleged that high standards had not been met on a website aimed at members of the public/patients.

The detailed response from GlaxoSmithKline is given below.

The Panel noted that the webpage included a link to a patient decision aid from the National Institute for Health and Care Excellence (NICE) and stated ‘Use this decision aid with your doctor or nurse to choose the right inhaler for you’. A link to the inhaler decision aid user guide also appeared beneath followed by the statement ‘Do not stop using your inhaler. Always talk to your doctor, nurse or pharmacist for advice about your inhaled medication’ in capital letters in bold black font. Below this the webpage described the carbon footprint of pMDIs and DPIs. Near the bottom of the webpage it stated, in bold black font, ‘MDIs/sprays may still be the appropriate option for some patients. Please consult your doctor, nurse or pharmacist to discuss which inhaler is best for you’.

The Panel noted that the website landing page provided by GlaxoSmithKline did not mention a specific prescription-only medicine and noted GlaxoSmithKline’s submission that the website itself did not mention any specific inhaler or medicine. The Panel noted GlaxoSmithKline’s submission that there were numerous low carbon inhalers available in the UK from a variety of manufacturers and included all inhalers that were not driven by propellant. The Panel noted that the NICE patient decision aid, to which users of the website were directed, included 10 different DPIs; two were manufactured by GlaxoSmithKline (Accuhaler and Ellipta) and the other eight were produced by other manufacturers. Six of these 10 DPIs (including Accuhaler and Ellipta) had a small picture of the device whilst the other four just listed the device name. The Panel further noted that the NICE decision aid in question listed ‘That my inhaler has a low carbon footprint’ as one of the five factors that patients should think about when discussing with their health professional which type of inhaler might be appropriate. The NICE patient decision aid also discussed other important factors needed when choosing a device. The accompanying NICE patient decision aid user guide explained that the decision aid was not an evaluation of the medicines and devices available; it did not provide guidance on the choice of medicine – this should be discussed and decided prior to using the aid.

The Panel noted that the website was aimed at members of the public; the header of the webpage stated ‘This GSK site is intended for UK Members of the Public. The Panel considered that the reference to DPIs on the website and within the NICE decision aid could be to any one of a number of different inhalers available. In the Panel’s view, the website in question did not promote prescription-only medicines to the general public nor did it encourage readers to ask their health professional for a specific prescription-only medicine. No breaches of the Code were ruled.

In the Panel’s view, the website was non-promotional and thus it could not be disguised promotion. No breach of the Code was ruled.

The Panel noted the complainant’s concern that the references/links at the bottom of the page took readers to other websites but there was no pop-up to let readers know they were going to another website. In the Panel’s view, it was sufficiently clear from the description of the item coupled with the URL that each of the reference links took the reader to the relevant third party websites/documents. The Panel therefore ruled no breach of the Code.

In the Panel’s view, as the material at issue was not intended specifically for patients taking a specific prescription-only medicine, a statement about reporting side-effects was not required. The Panel therefore ruled no breach of the Code. The Panel, however, noted GlaxoSmithKline’s submission that the webpage included a link to ‘Report an adverse event’ at the bottom of the page which took users to a form to complete that went directly to the safety department.

The Panel noted its rulings above and considered that there was no evidence to show that GlaxoSmithKline had not maintained high standards. No breach of the Code was ruled including of Clause 2.