1 7. Promotion of medicines Pharmacy Admin and Practice 4

2 OUTCOMES- Promotion of medicines Interpret drug promotion activities of pharmaceutical industries Analyze the requirement of WHO ethical criteria for medicinal drug promotion Point out the importance of Equal Time Presentation

3 Drug Promotion Advertisements for medicines Sales representatives / drug detailers Free samples Use of opinion leaders Sponsored conferences and seminars Promotional research funded by companies to stimulate sales Gifts Use of the Internet to promote medicines Industry-funded pharmacy or scientific journals Industry-funded research published in peer-reviewed journals

4 Med-reps and irrational medicine use in sub- Saharan Africa 4/msg00048.php Fellow e-druggers, I feel saddened to report of several instances where prescriptions for some particular slow-moving medicines are received in pharmacies from medical prescribers only when the med-reps visit the doctors in their consulting rooms. What is prescribed at any point in time depends much on which company's rep came around, and a discerning mind can almost always ascertain which product rep was around from the most recent prescription patterns.

5 There seems to be an over-reliance on sometimes-biased information (intended to maximize product sales) from pharmaceutical promoters and marketers, and the medics feel too arrogant in many cases to clarify or obtain information from resident Pharmacists, although most of the latter too may be guilty of not being up- to -date on current drug issues. Often, there is some element of pecuniary consideration involved-the reps are most probably more effective than resident Pharmacists because they not only offer information but also pass on their companies good-will, which is quite an obvious added advantage in a financially desperate environment. May I further add that this observation is not limited to my institution alone. Olutayo Adetokunbo Moronkeji, B. Pharm., MPSN, MNIM, CEDP (Hons.) Deputy Chief Pharmacist, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), NIGERIA.

6 BMJ: Say no to the free lunch Are you a pig or a weasel? Or do you consider yourself above all that? When the BMJ published a special issue on the links between doctors and drug companies in 2003, the cover showed pigs in white coats lunching and golfing with weasel drug reps. The power of drug companies to buy influence over every key group in health care-doctors, charities, patient groups, journalists, politicians-has clearly shocked a UK parliamentary committee (p 855). It should shock us all. Can we console ourselves that companies' lavish spending on research and marketing, which far outstrips spending on independent research and drug information, leads to truly innovative treatments? No, says the committee's report. Can we rely on regulatory bodies to keep the industry in check? No, again.

7 Issues of intense concern Drug promotion – effectively monitored in only 52 of 102 countries for which relevant data are available Too often, medical representatives of pharmaceutical companies are the primary source of drug information for prescribers Most prescribers are not trained to evaluate such information critically Continuing education in good prescribing is unavailable Access to Medicine Information Center?

8 Responsible drug promotion encouraged Through advocacy, promotion of adherence to the WHO Ethical Criteria for Medicinal Drug Promotion, and support for development of national guidelines for drug promotion and national measures to prevent and monitor perverse incentives for prescribers and dispensers. mon.shtml

9 Evaluation of the implementation of WHO ethical criteria (WHO - EC) for medicinal drug promotion in Indonesia Most of adverts in medical journals as well as in the public magazines do not comply with the ethical criteria, e.g. do not include the generic name of active ingredient, do not include precautions or warnings. Similar results for public advertisements broadcasted on radio and television programs. Most respondents, either medical practitioners or medical representatives, did not know about the WHO Ethical Criteria for Medicinal Drug Promotion nor the existing regulation on pharmaceutical promotion. This study shows the obvious lack in the dissemination of the WHO Ethical Criteria for Medicinal Drug Promotion, and in the enforcement and monitoring of the existing regulation despite their formal promulgation.

10 Teaching critical appraisal of medicinal drug promotions in a medical school Objective: To determine the effect of teaching critical appraisal of medicinal drug promotion on the ability of medical students to identify violations of existing guidelines for drug promotion. Generic labelling Safety and efficacy claims Pharmacological information Documentation of claims

11 Role of WHO Rational Use of Medicines Special activities: Promoting rational Drug Use: A CD-ROM Training ProgramPromoting rational Drug Use: ICIUM - International Rational Drug Use ConferenceICIUM - International Rational Drug Use Conference

12 Role of WHO Ethical Criteria for medicinal drug promotion - What attitudes do people (professional and lay) have to promotion? - What impact does pharmaceutical promotion have on attitudes and knowledge? - What impact does pharmaceutical promotion have on behaviour? - What interventions have been tried to counter promotional activities, and with what results?

13 Who Developed The Website and Database? The development of this website was co- ordinated by the WHO Department of Essential Drugs & Medicines Policy and Health Action International Europe. WHY? There continues to be an imbalance between commercially produced drug information and independent, comparative, scientifically validated and up-to-date information on drugs for prescribers, dispensers and consumers.

14 WHAT ARE THE OBJECTIVES OF THE WEBSITE Document the volume of inappropriate drug promotion in developing and developed countries; Document the impact of inappropriate promotion on health; Identify topics that are not covered by present studies; Formulate recommendations for needed research; Provide information about tools that can be used to teach health professionals about drug promotion; Provide tools to monitor drug promotion; Promote networking of groups and individuals concerned about promotion by providing links through the website.

15 Hospital policy on pharmaceutical promotion Many prescribers-medical reps are primary source of information on new medicines Promoting drugs-Biased? Train to analyze content of promotional material WHO criteria-basis for developing measures and guidelines on drug promotion Reliable, accurate, truthful,informative, balanced, up-to-date, capable of substantiation and in good taste

16 Equal Time Presentation Reps are required to submit their material in advance Hospital pharmacist actively reviews material Meeting arranged at which rep is invited to present info to all doctors, followed by EQUAL TIME PRESENTATION by the pharmacist to comment on the materials presented Meeting opened for questions and discussion-debate merits of a new medicine – for a BALANCED perspective on that medicine

17 Role of PTC EQUAL TIME PRESENTTAION BAN MEDICAL REPS ENTIRELY (COULD BE NON PRODUCTIVE) PREVENT DISPLAY OF INAPPROPRIATEPOSTERS, ADVERTISING MEDIICNES AIMED AT CONSUMERS

18 IMPORTANT WEBSITE sp?keyday=day%201 TB: Global Issues in TB Drug Provision Multi-Country Participatory Evaluation of the Implementation of the WHO Ethical Criteria for Medicinal Drug Promotion: Networking Tools for Monitoring and Evaluation Developing Tools for Monitoring and Evaluating Unethical Drug Promotion in Thailand The Interface between Policy, Politics, and Practice