The UK’s advertising watchdog has dismissed complaints against a shocking cinema ad in which Pfizer sought to emphasise the dangers of buying counterfeit drugs by showing a man regurgitating a dead rat.

The Advertising Standards Authority (ASA) received 64 complaints about the 15-rated ad, which showed the rat appearing tail-first from the man’s mouth after he took a tablet from a packet and swallowed it, as a voice-over stated: “rat poison. Just one of the dangerous ingredients that may be found in fake medicines purchased from illegal websites. On-screen text stated “GET REAL. GET A PRESCRIPTION.”

Most of the complaints sent to the ASA described the ad as “unduly distressing, ” while 12 found it offensive and seven said it was misleading, because “some legally prescribed medicines also contained dangerous ingredients such as rat poison.” Three claimed it was likely to cause particular distress to people who took such legally prescribed medicines.

The ASA rejected all these complaints, concluding that the ad was intended to raise awareness of a serious issue and was designed to be hard-hitting, so the metaphor of regurgitating a rat was likely to justify that approach, for most people. It also noted that the ad could only be shown with 15- or 18-rated films.

Nor was the ad misleading, said the panel. Patient organisations were involved in the campaign and represented people who used warfarin. They were, it said, “likely to be aware of the associated dangers and the importance of drugs being prescribed and supervised by qualified medical professionals.”

Pfizer had told the complaints panel that the campaign sought to address a lack of public awareness of a potentially life-threatening issue and it believed it was socially responsible to do so. Up to 90% of prescription-only medicines purchased from unregulated websites are estimated to be counterfeit or sub-standard, but awareness of the issue is poor among members of the public, patients and healthcare professionals, it said.

Pfizer pointed out that it had worked closely on the campaign with the Medicines and Healthcare products Regulatory Agency (MHRA), the Patients Association, Men’s Health Forum and H.E.A.R.T UK, which had all endorsed it and made clear their support. The rat has been not included merely to attract attention but to represent published medical evidence about counterfeit medicines, it added.

Welcoming the ASA’s decision, Pfizer said it “certainly did not want to offend people, but the dangers of obtaining medicines from unregulated sources are very real and we needed to forcefully communicate that message."