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Understanding and Responding to Pharmaceutical Promotion

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2 Understanding and Responding to Pharmaceutical Promotion
A Practical Guide WHO/HAI Educational Manual for medical and pharmacy students 20 May 2009 WHA Barbara Mintzes Health Action International University of British Columbia

3 WHO/HAI joint initiative Education on drug promotion
Drug promotion database Survey of medical & pharmacy faculties Curriculum development Pilot testing Training and implementation

4 Review of research evidence Norris et al 2005
Promotion strongly influences prescribing and medicine use Health professionals underestimate this influence The pharmaceutical industry is a frequent information source on new drugs Funding of key opinion leaders, continuing education, and research predicts content favourable to the sponsor’s drug

5 Education on drug promotion Survey of identified educators, medical, 91 pharmacy = 228 (46% response rate) 92 31 56 8 20 20 Americas Europe Western Pacific Eastern Mediterranean Africa South-East Asia

6 Key educational aims Percent n=228
Critical appraisal of drug promotion 77% Greater use of independent information sources 76% Improved prescribing or dispensing after graduation 64% Expose students to different perspectives 52%

7 Those who allocated less time (one half day or less) were less likely to judge the education to be successful. How much time spent? pharmacy medical Half day or less 20% 37% 4 to 9 hours 25% 31% 10 hours or more 55% 28%

8 - a respondent from India
“…Whatever rational things we want to inculcate in them, that should be done in the student period itself. Once they taste big money then habits develop and later die hard.” - a respondent from India

9 “It is time for medical schools to. end a number of long-accepted
“It is time for medical schools to end a number of long-accepted relationships and practices that create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy.” - Institute of Medicine. Conflict of Interest in Medical Research, Education, and Practice, April 2009

10 Pilot educational manual

11 Aims of this project Model curriculum on drug promotion for pharmacy and medical students Companion to ‘Guide to Good Prescribing’ Improved therapy and ethical choices Ultimately, better patient health

12 WHO/ HAI Collaborative Project
Authors from South Africa, Ecuador, Russia, USA, Canada, Australia, New Zealand Initially in English, Spanish, and Russian Working draft available for pilot and review

13 What topics are covered?
Promotion of medicines and patient health Techniques that influence the use of medicine Analysing drug advertisements Promotion to consumers Ethical conflicts of interest Regulation of drug promotion Using unbiased prescribing information Promotion, professional practice and patient trust

The US PROMOTIONAL SPENDING, 2004 Gagno MA, Lexchin J. PLoS Medicine, 2008

15 - Steinman MA, Annals of Internal Medicine 2006
“Gabapentin [Neurontin] was promoted by using education and research, activities not typically recognized as promotional. “independent” continuing medical education, “peer-to-peer” selling by physician speakers, and publications…” - Steinman MA, Annals of Internal Medicine 2006

16 Prescriptions for gabapentin by diagnostic category
Unapproved use Prescriptions for gabapentin by diagnostic category Steinman, M. A. et. al. Ann Intern Med 2006;145:

17 What information should an advertisement contain?
Indi What information should an advertisement contain? Indian Journal of Dermatology, Venereology, Leprology, 2005

18 Common influence techniques
Unconscious influences How they are used in pharmaceutical sales Trust in experts “Professor Z recommends medicine B” Trust in peers “Medicine X is the most frequently prescribed medicine for indication Y” Trust in people we like Use of attractive, friendly representatives. Helping those who help us Use of gifts, including free samples of expensive medicines.

19 Orlowski et al. Chest 1992

20 Sample exercise – Debate
Divide students into debating teams of 4 to 6 people. Team 1: There is no ethical conflict in physicians and pharmacists accepting money from pharmaceutical companies.   Team 2: It is ethically unacceptable for physicians and pharmacists to accept money from pharmaceutical companies.

21 In Conclusion “At the heart of this manual is the patient. …This begins with the individual sitting in front of you in a consultation – a person who is often worried, sometimes frightened, but almost always trusting that the health professional will provide advice based on the best available information.” - Dee Mangin, chapter 9, 2009

22 Thank you

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