Pharmaceutical Promotion in Latin America Carlos Berríos AIS LAC 20 May 2009 WHA

Contents The problem The problem Main sources of misinformation Main sources of misinformation Poor regulation Poor regulation Physicians, main marketing agent Physicians, main marketing agent Addressing the problem Addressing the problem RegulationRegulation EducationalEducational What we need What we need

3 New products to promote

4 Hospital physicians´ perception of the influence of Pharmaceutical Promotion (Steinman,2001) Professionals underestimate the of Pharmaceutical Promotion

Promotional practices downplay safety (I) Unclear indication - what type of pain? Does not mention risks other than gastrointestinal problems! No bibliography references could be retrieved No information on precautions, contraindications, price… Nicaragua, 2003

Promotional practices downplay safety (II) No indication mentioned No active ingredient mentioned Medicine approved for hormone replacement therapy but promoted for weight control and skin improvement No information on precautions, contraindications, price… Costa Rica, 2007

7 Public health consequences Therapy failure Therapy failure Harm due to adverse reactions Harm due to adverse reactions Antimicrobial resistance Antimicrobial resistance Increased expenditure in health: Increased expenditure in health: Inappropriate use of public fundsInappropriate use of public funds Out-of-pocket payment by consumersOut-of-pocket payment by consumers Reduced trust in health services Reduced trust in health services

Pharmaceutical Promotion Regulation Results of 7 countries - HAI LAC survey: Results of 7 countries - HAI LAC survey: DTCA not allowedDTCA not allowed Promotion to Prescribers controlledPromotion to Prescribers controlled Criteria for advertising establishedCriteria for advertising established Free samples and promotional events restrictedFree samples and promotional events restricted Control and sanctions foreseenControl and sanctions foreseen But, in practice: Poor implementation But, in practice: Poor implementation In Nicaragua, MoH created a Pharmaceutical Promotion Department: Pre-approval and monitoring In Nicaragua, MoH created a Pharmaceutical Promotion Department: Pre-approval and monitoring

Education and training PROBLEM: Early contact between pharmaceutical representatives and students Early contact between pharmaceutical representatives and students Conflict of interest of some university lecturers Conflict of interest of some university lecturers Pharmaceutical Promotion not included in Medicine and Pharmacy schools curricula Pharmaceutical Promotion not included in Medicine and Pharmacy schools curriculaINITIATIVES: HAI Nicaragua developed teaching module HAI Nicaragua developed teaching module Implemented since 2005Implemented since 2005 Adapted in 6 universities (4 Argentina, 2 Colombia): DURG – LA initiativeAdapted in 6 universities (4 Argentina, 2 Colombia): DURG – LA initiative Teaching in Ecuador and BrazilTeaching in Ecuador and Brazil

The Manuals Value High quality reference document to be used in teaching High quality reference document to be used in teaching Increase awareness about the need to include pharmaceutical promotion teaching in university curricula Increase awareness about the need to include pharmaceutical promotion teaching in university curricula Strengthen current teaching experiences Strengthen current teaching experiences Promote similar teaching in other universities in Latin America Promote similar teaching in other universities in Latin America