Doctor v Janssen-Cilag: Tramacet NNT comparison found misleading (AUTH/1868/7/06)

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Key facts

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Case number	AUTH/1868/7/06
Parties	Doctor v Janssen-Cilag
Product	Tramacet (tramadol hydrochloride 37.5mg + paracetamol 325mg)
Material	Electronic advertisement (Code 7007) on www.doctors.net
Main issue	Misleading comparative NNT table due to omission of co-codamol 60/1000 NNT data
Key data points	Tramacet NNT 2.6; co-codamol 60/600 NNT 4.2; co-codamol 60/1000 NNT 2.2 (omitted)
Applicable Code year	2006
Breach clauses	Clauses 7.2 and 7.3
Sanctions	Undertaking received
Complaint received	17 July 2006 (PDF also states 18 July 2006)
Case completed	29 August 2006 (PDF also states 30 August 2006)
Appeal	No appeal
Related issue noted by Panel	Free stethoscope offer queried under supplementary information to Clause 18.2; taken up separately as AUTH/1879/7/06

Reviewed by Dr Anzal Qurbain (FFPM) — ABPI Final Signatory

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A doctor complained about an electronic advertisement for Tramacet (tramadol hydrochloride 37.5mg + paracetamol 325mg) shown on www.doctors.net.
The ad compared “numbers needed to treat” (NNT) for Tramacet and other step-two analgesics using the Oxford league table approach.
The ad listed NNTs including: Tramacet (75/650) 2.6; co-codamol (60/600) 4.2; paracetamol (600) 4.6; tramadol (100) 4.8; tramadol (75) 5.3; tramadol (50) 8.3 (lower NNT = more effective).
The complainant alleged the co-codamol comparator dose was not the most effective or most commonly used (60/1000). If 60/1000 had been used, its NNT would be 2.2, which would not show Tramacet as favourably.
Janssen-Cilag accepted that co-codamol 60/1000 was a recommended prescription dose and should have been included; it removed the ad the day the issue was identified.
During review, the Panel also noted the ad invited readers to claim a free stethoscope and queried compliance with the promotional aid value limit (taken up separately as AUTH/1879/7/06).

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The Panel ruled the comparison was misleading because it omitted NNT data for co-codamol 60/1000.
Breaches were ruled for Clauses 7.2 and 7.3 (as acknowledged by Janssen-Cilag).

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