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

14. US PROMOTIONAL SPENDING, 2004
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