AUTH/3424/11/20: Anonymous v GlaxoSmithKline

Online articles about asthma inhalers

  • Received
    13 November 2020
  • Case number
    AUTH/3424/11/20
  • Applicable Code year
    2019
  • Completed
    16 September 2021
  • No breach Clause(s)
  • Additional sanctions
  • Appeal
    Respondent appeal

Case Summary

An anonymous, non-contactable complainant who described themselves as a health professional complained about an article in GP online which detailed how switching asthma inhalers could help the NHS cut carbon emissions. Above the title of the article, it was stated in the top left-hand corner of the webpage ‘Sponsored by GSK’ and the company’s corporate logo appeared in the top right-hand corner. GlaxoSmithKline UK marketed a number of inhalers for the treatment of asthma.

The complainant stated that from the initial statement at the top of the article, he/she was under the impression that GlaxoSmithKline had only sponsored the article. However, having read further it was clear that it had had greater involvement in being sole funders and initiators of the article. There was a statement at the very bottom of the article, in small text, that it had been initiated, funded and reviewed by GlaxoSmithKline and produced by a named party.

The complainant noted that the article contained a link to the webpage lowcarboninhalers.co.uk/ for health professionals which seemed to be heavily biased towards dry powder inhalers. The complainant noted that the webpage included headline claims such as ‘A high carbon MDI inhaler has a carbon footprint that is 18x higher than a low carbon DPI inhaler’. There were also three statements as to what could be done next and the complainant was concerned that none of the three statements were referenced to guidance. There was heavy emphasis on promotion of GlaxoSmithKline dry powder inhaler brands but without any prescribing information. No adverse event reporting statement was on the page. The complainant stated that it was clear from the bottom of the webpage that GlaxoSmithKline wanted an action to move patients to dry powder devices and thus the statement: ‘Will you now consider environmental factors when prescribing inhaled medication?’. This was supplemented by wording taken from the guidance issued by the British Thoracic Society (BTS) which referred to ‘switching’ in the first of three recommendations.

The complainant stated that, overall, it was one-sided promotion of the GlaxoSmithKline portfolio whilst disparaging pressurised metered dose inhalers. There was no mention of potential loss in control for a patient who was stable on an inhaler or potential wider issues such as review time for switching patients which did not provide fair and balanced content.

The detailed response from GlaxoSmithKline is given below.

The Panel noted GlaxoSmithKline’s submission that the article ‘How switching asthma inhalers can help the NHS cut carbon emissions’ hosted on the independent website, gponline.com, was non-promotional. The Panel noted that above the title of the article, it was stated in the top left-hand corner of the webpage ‘Sponsored by GSK’ and the company’s corporate logo appeared in the top right-hand corner.

The Panel noted that within the article, below the second paragraph, there was a grey highlighted box with the prominent company logo and the text:

‘Low carbon inhalers

#LowCarbonInhalers is a campaign funded by GSK aiming to raise awareness about how inhaler choice can play a role in reducing carbon emissions. For more information visit https://lowcarboninhalers.co.uk/.’

This grey highlighted box sat within a slightly larger grey outlined box at the bottom of which was the statement, in bold, black typeface, ‘This article was initiated, funded and reviewed by GSK’. As noted by the complainant, ‘Initiated, funded and reviewed by GSK’ was also at the bottom of the article, below the references, in normal typeface.

The Panel disagreed with GlaxoSmithKline’s submission that in this context the phrase ‘sponsored by GSK’, which appeared in the top left of the article, was routinely understood by readers to mean ‘brought to you by’, ie the company was responsible for the content. ‘Sponsored by’ was a vague term and a declaration of sponsorship should be unambiguous in relation to the nature of the company’s involvement and influence over the material.

In the Panel’s view, due to its position as described above, and that the grey outline box was relatively faint, it was unclear whether the statement ‘This article was initiated, funded and reviewed by GSK’ at the bottom of the outlined box referred to the linked article at https://lowcarboninhalers.co.uk, which appeared within the grey highlighted box immediately above, or to the article published on gponline.com.

In the Panel’s view, the statement ‘Initiated, funded and reviewed by GSK’ should have appeared at the top of the article so that readers were aware of the nature of the company’s involvement from the outset. It was not clear at the outset that the GP online article had been initiated by GlaxoSmithKline. The GlaxoSmithKline logo was insufficient in this regard.

The Panel ruled breaches of the Code including that GlaxoSmithKline had failed to maintain high standards. Both rulings were appealed by GlaxoSmithKline.

The Appeal Board noted that the article at issue comprised one-page, and the declaration of sponsorship appeared at the outset above the title and the nature of this sponsorship appeared after two paragraphs and again at the bottom of the page. There was no mention of who had written the article and this information would have been helpful. The Appeal Board considered that it might have been clearer if the extent of GlaxoSmithKline’s involvement appeared at the outset above the title alongside the declaration of sponsorship; however in the context of the article in GP online, the Appeal Board did not consider that readers would be in any doubt that GlaxoSmithKline had sponsored the article. Further, it considered that, on the balance of probabilities, the company’s involvement and influence over the material would be understood by the readers of GP online.

The Appeal Board ruled no breaches of the Code. The appeal on both points was successful.

In relation to the low carbon inhalers GlaxoSmithKline website, the Panel noted that the landing page, as provided by GlaxoSmithKline stated that it was intended for UK health professionals. The webpage included ‘#LowCarbonInhalers How can inhaler choices play a role in reducing carbon emissions?’ and ‘Learn which inhalers have a high carbon footprint to inform you when choosing an inhaler with your respiratory patient’ followed by a prominent link to the NICE inhaler decision aid which according to GlaxoSmithKline provided further information on the factors patients and health professionals should consider before choosing a device. The Panel noted that the complainant did not make any allegations in relation to the content of, or the link to, the NICE decision aid. The complainant’s concern was limited to whether statements in relation to the NICE decision aid on the website in question should have been referenced.

The Panel noted the complainant’s allegation that the website overall was one sided promotion of the GlaxoSmithKline dry powder inhaler portfolio without any prescribing information or adverse event reporting statement. The Panel noted GlaxoSmithKline’s submission that it built the website in response to the urgent need to reduce carbon emissions in the NHS. The website was created to provide factual information for health professionals on the carbon footprint of the two broad categories of inhalers; pressurised metered dose inhalers (pMDIs) and dry powder inhalers (DPIs).

The Panel noted GlaxoSmithKline’s submission that it marketed both pMDIs (Evohaler) and DPIs (Accuhaler and Ellipta) covering multiple products and that many other companies provided both pMDIs and DPIs. The Panel further noted GlaxoSmithKline’s submission that no specific GlaxoSmithKline medicines were mentioned directly or indirectly on the website.

In the Panel’s view, the website in question described the carbon footprint of the two broad categories of inhalers, pMDIs and DPIs, and although GlaxoSmithKline marketed both these inhaler types, so did a number of other companies. The Panel did not consider that the complainant had established that the website promoted a specific GlaxoSmithKline medicine or device and therefore that prescribing information for any specific medicine or adverse event reporting statement was required. The Panel further noted GlaxoSmithKline’s submission that the bottom of the webpage included an invitation to report adverse events if readers wished to do so. The Panel therefore ruled no breaches of the Code including that the website did not constitute disguised promotion as alleged.

The Panel noted that the website had a section titled ‘HCP solutions – What can you do?’ which included three statements that the complainant was concerned were not referenced to guidance. The Panel noted GlaxoSmithKline’s submission that none of the information the complainant quoted referred to a published study and so did not require referencing under the Code and that all the information was substantiated by publications from national professional bodies, which were listed at the bottom of the website and could be provided upon request. The Panel had no evidence before it that the three statements in question were not capable of substantiation and thus it ruled no breach of the Code in that regard.

In relation to the allegation that there was no mention of potential loss in control for a patient who was stable on an inhaler or potential wider issues such as review time for switching patients which did not provide fair and balanced content, the Panel noted GlaxoSmithKline’s submission that the website stated ‘BTS [British Thoracic Society] encourages all prescribers and patients to consider switching pMDIs to DPIs whenever they are likely to be equally effective’ which was to remind the health professional to consider efficacy/loss of control. The Panel further noted, as submitted by GlaxoSmithKline, that the webpage stated in bold font: ‘MDIs however may still be the appropriate option for some patients and play an important role where there is clinical need and a DPI is not appropriate’ and that this was included in the ‘Recommendations’ section as a recommendation from the BTS.

In the Panel’s view, the complainant had not discharged his/her burden of proof to establish that the content of the website was not fair or balanced as alleged and no breach of the Code was ruled.

In relation to the allegation that the website disparaged metered dose inhalers, the Panel noted GlaxoSmithKline’s submission that the website contained factual information regarding the relative carbon footprint of a category of products. The Panel further noted GlaxoSmithKline’s submission that it manufactured and promoted both DPIs and pMDIs and that the majority of its sales by volume were from pMDIs. In the Panel’s view, highlighting a particular attribute that one product had relative to another was not necessarily unacceptable provided that such information was accurate, balanced, fair, not misleading and otherwise complied with the Code. In the Panel’s view, the complainant had not established that the website in question disparaged the medicines, products and activities of other pharmaceutical companies as alleged and no breach of the Code was ruled. The Panel ruled no breach of the Code as the website had been certified.

The Panel ruled no breach of the Code as it did not consider that the company had failed to maintain high standards in relation to the allegations about the low carbon inhalers website.