UK drug regulators failing to protect patients from harmful weight loss

BMJDec 14 2023

UK organizations responsible for protecting the public from prescription-only drug adverts are putting patients at risk from the harms of weight loss drugs by not enforcing the law, reveals an investigation published by The BMJ today.

Legal responsibility for regulating adverts for medicines in the UK rests with the Medicines and Healthcare products Regulatory Agency (MHRA) on behalf of health ministers. But there is also a system of self-regulation with a number of bodies operating their own codes of practice, including the Advertising Standards Authority (ASA).

But The BMJ has found that the MHRA has not issued a single sanction for prescription drugs in the last five years. And among 16 cases where the MHRA took action by requesting changes to adverts for weight loss drugs between June 2022 and July 2023, all were triggered by external complaints, not internal mechanisms, and none resulted in sanctions.

James Cave, Editor in Chief of the Drug & Therapeutics Bulletin (DTB), a BMJ journal with a focus on drug safety, said that the lack of sanctions and internal monitoring provides only weak incentive for companies to abstain from advertising prescription drugs.

He became concerned about inadequate regulation after an online search for the prescription only weight loss medicine Wegovy (semaglutide) prompted what he considered to be "a whole list of adverts," even though he says long term adverse effects of Wegovy are not known.

A web search by The BMJ for the terms "Wegovy," "pharmacy, and "UK" had hundreds of thousands of hits, including a blog post by Pharmadoctor, a website which supports pharmacists to provide services for patients.

Pharmadoctor's blog post, entitled "All about Wegovy," stated that "Wegovy is a weekly weight loss injection made famous by celebrities such as Elon Musk and Boris Johnson. If Wegovy is suitable for you, your pharmacist will be able to provide it."

In October, Shai Mulinari, associate professor of sociology at Lund University, and Piotr Ozieranski, senior lecturer of social and policy sciences at the University of Bath, filed a complaint to the MHRA alleging illegal prescription drug promotion.

In it they said they were "appalled" that the company was marketing Wegovy "directly to the public" and that the "All about Wegovy" blog post was linked to prominently from the patient facing home page.

The post states, "Whether it's Wegovy or another treatment, your Pharmadoctor partner pharmacist can discuss weight loss options" and provides the price of the drug and a link to find local pharmacists.

The MHRA responded saying that after its investigation reference to Wegovy on Pharmadoctor's patient home page "has been removed in line with our guidance." But only a link and the word "Wegovy" had been removed from the patient facing home page, while the blog post remained online.

Pharmadoctor CEO Graham Thoms told The BMJ that Pharmadoctor only aimed to inform patients about Wegovy and that it had kept the blog post online because the MHRA hadn't required it be taken down.

But Cave said the MHRA's approach to focus on websites is "completely out of date." People don't enter websites via the home page, "they simply use a search engine," he said. The Pharmadoctor post was among the first results when searching for "Wegovy," "pharmacy," and "UK."

In the past year, Cave has filed over a dozen complaints about the advertising of semaglutide to the MHRA and the ASA, but he was disappointed with the results.

"These companies just wriggle and squirm their way out of any complaint from ASA and MHRA and carry on regardless," he said. Cave also criticized the organizations' apparent reliance on complaints from individuals to highlight online advertisements that break rules.

The MHRA told The BMJ that it actively monitors advertisements for prescription medicines, but it did not respond to a question about how many people are tasked with this.

A spokesperson for the ASA said that it too takes advertising of prescription medicine seriously and has scaled up its monitoring of online advertisements with the help of AI.