1. Drug Promotion And Dealing With The ‘Reps’ Neena Lakhani

2. Introduction Drug Promotion NHS Standards ABPI Code of Practice Company Representatives The ‘meeting’ Evaluating Product Information

3. Drug promotion by pharmaceutical companies Journal advertisements Mailings Sponsored meetings Gifts Direct-to-consumer advertising Company representative visits

4. NHS Standards Commercial Sponsorship – Ethical Standards for the NHS (Nov 2000) who is the guidance aimed at? sponsorship, inducements and hospitality research and development potential conflict of interest

5. Advertising Regulation Advertising is controlled by both: Medicines and Health Regulatory Agency (MHRA) - Statutory (legal) Association of the British Pharmaceutical Industry (ABPI) - Self- regulation

6. ABPI Code of Practice Applies to 80 UK pharmaceutical companies Covers all areas of promotion by the pharmaceutical industry Not legally binding

7. Code for Representatives ABPI Code of Practice - covers oral information, as well as written Must be adequately trained Must not give misleading information Must not offer inducement to gain interview Must not cause inconvenience Provision of hospitality

8. Guidance for Representatives Local policies may exist relating to: Appointment system for meeting clinicians Leaving samples of medicines Sponsorship of educational meetings Frequency of meetings

9. Why see reps? Freebies! Gather (and give) current and new information Sell company products Inform and educate professionals

10. Is the information credible? Can be misleading Promotes non-rational prescribing Decreases generic prescribing Increases awareness of new drugs but without the evidence Increases prescribing costs

11. Some useful facts Oral presentations Written literature

12. ‘The meeting’ What’s in it for me? Be selective By appointment with time limits Be in control Prepare standard questions Beware of bold statements & ‘glossys’

13. Your 5 Questions 1.What evidence/studies back up the claimed benefit/effect of the drug being promoted? 2.Is the study design valid? 3.Is the result statistically significant? 4.What are the Absolute Risk Reduction (ARR) and the Number Needed to Treat (NNT) to avoid one event over a certain time period? 5.Are the graphs telling the truth? If NO: do you want to continue?

14. Points to consider: SSafety TTolerability EEffectiveness PPrice One STEP better?

15. The way forward A policy for seeing reps –? No free lunches? Education meetings with different peer groups Challenge different reps promoting similar products Restrict sponsored events Brush up on critical appraisal skills Use PCT prescribing advisors for unbiased, evidence based information and educational outreach

16. On line activity Source the following article Evans, J. Establishing Rules of the Road for Pharmaceutical Representatives Fam Pract Manag. 2005 Mar;12(3):10-12. Join the Forum during the next week to discuss and reflect in issues raised the General Practitioner in the article

17. References Department of Health (2000). Commercial sponsorship – ethical standards for the NHS. http://www.dh.gov.uk/prod_consum_dh/group s/dh_digitalassets/@dh/@en/documents/digit alasset/dh_4076078.pdf (accessed July 2011) http://www.dh.gov.uk/prod_consum_dh/group s/dh_digitalassets/@dh/@en/documents/digit alasset/dh_4076078.pdf Evans, J. Establishing Rules of the Road for Pharmaceutical Representatives Fam Pract Manag. 2005 Mar;12(3):10-12.

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