2 Understanding and Responding to Pharmaceutical Promotion A Practical GuideWHO/HAI Educational Manual formedical and pharmacy students20 May 2009WHABarbara MintzesHealth Action InternationalUniversity of British Columbia
3 WHO/HAI joint initiative Education on drug promotion Drug promotion databaseSurvey of medical & pharmacy facultiesCurriculum developmentPilot testingTraining and implementation
4 Review of research evidence Norris et al 2005 Promotion strongly influences prescribing and medicine useHealth professionals underestimate this influenceThe pharmaceutical industry is a frequent information source on new drugsFunding 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)92315682020AmericasEuropeWestern PacificEastern MediterraneanAfricaSouth-East Asia
6 Key educational aims Percent n=228 Critical appraisal of drug promotion77%Greater use of independent information sources76%Improved prescribing or dispensing after graduation64%Expose students to different perspectives52%
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?pharmacymedicalHalf day or less20%37%4 to 9 hours25%31%10 hours or more55%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
11 Aims of this projectModel curriculum on drug promotion for pharmacy and medical studentsCompanion to ‘Guide to Good Prescribing’Improved therapy and ethical choicesUltimately, better patient health
12 WHO/ HAI Collaborative Project Authors from South Africa, Ecuador, Russia, USA, Canada, Australia, New ZealandInitially in English, Spanish, and RussianWorking draft available for pilot and review
13 What topics are covered? Promotion of medicines and patient healthTechniques that influence the use of medicineAnalysing drug advertisementsPromotion to consumersEthical conflicts of interestRegulation of drug promotionUsing unbiased prescribing informationPromotion, professional practice and patient trust
14 US PROMOTIONAL SPENDING, 2004 TheUS PROMOTIONAL SPENDING, 2004Gagno 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 usePrescriptions for gabapentin by diagnostic categorySteinman, M. A. et. al. Ann Intern Med 2006;145:
17 What information should an advertisement contain? IndiWhat information should an advertisement contain?Indian Journal of Dermatology, Venereology, Leprology, 2005
18 Common influence techniques Unconscious influencesHow they are used in pharmaceutical salesTrust 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 likeUse of attractive, friendly representatives.Helping those who help usUse of gifts, including free samples of expensive medicines.
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
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