Written drug promotion from pharmaceutical companies to general practitioners: adherence to regulations over two decades

Previous studies have questioned the integrity of drug promotional material from the pharmaceutical industry to medical professionals. Herein, we present the result of repeated monitoring of adherence to legal requirements regulating marketing mailings from pharmaceutical companies to Norwegian general practitioners over three separate time periods in 2004, 2012 and 2023-24. The claims made in the mailings were compared to the sources cited and evaluated in accordance with the governmental regulations. Pertinent information about conflicts of interest was registered and considered. A considerable decline in the number of mailings acquired over time was noted. The proportion of claims defined as correct and clinically relevant according to the legal definition was 48%, 56% and 78% in 2004, 2012 and 2023-24, respectively (p < 0.001 for trend). The most common deviations were claims with unclear or no clinical relevance, information extrapolated beyond the actual content of the referenced material, claims not covered in the cited reference, and general claims not providing any meaningful information about the drug. In some cases, the citation of sources was incomplete, or the reference unobtainable. The percentage of references with declared conflicts of interest was relatively stable at about 60% over the entire period. Concomitant with a decline in the number of drug mailings aimed at general practitioners, there has been an increase in compliance with legislative measures regulating this activity. Nevertheless, there are still significant instances of deviations from the legal requirements, warranting skepticism.