E-DRUG: New WHO-HAI Report on Drug Promotion
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Title: Drug promotion: What we know and what we have yet to learn.
Authors: Norris, P., Herxheimer, A., Lexchin, J. & Mansfield, P.
Publisher: WHO (Department of Essential Drugs), Health Action
International
A major report into pharmaceutical promotion has been published by the
WHO Department of Essential Drugs and Health Action International Europe
(HAI-E), marking an important step forward in the drug
promotion/advertising/information debate.
Drug promotion: What we know and what we have yet to learn is part of a
collaborative project between WHO and HAI-E involving the analysis of
over 2700 journal articles, books and other materials contained in a
single database (http://www.drugpromo.info/>
). Research studies from the database were analysed and these form the
basis for the four reviews contained in the report. The authors are
world experts in pharmaceutical promotion.
Review 1 reports on the attitudes that both professionals and lay people
have to promotion and discusses whether attitudes actually match
behaviour, whether the training of doctors is sufficiently comprehensive
when it comes to promotion, advertising, sales representatives and
gifts, and attitudes to direct to consumer advertising (DTCA). The
review concludes that doctors' attitudes to promotion vary, but
significantly do not necessarily match their behaviour when confronted
with a range of promotional techniques. Most doctors think that
information from pharmaceutical companies is biased, but many think it
useful. Moreover, whilst most doctors consider themselves immune to
manipulation by drug representatives and their gifts, they do consider
that it will influence other doctors.
The second review considers the impact of pharmaceutical promotion on
knowledge concluding that doctors' knowledge is indeed influenced by
promotion. Evidence presented in the third review (the impact of
promotion on behaviour) suggests that increased promotion is associated
with increased sales, and influences prescribing more than is realised
by doctors, who rarely acknowledge any influence at all. However, it
reveals that doctors who rely on promotional material prescribe less
appropriately, more often and adopt new drugs more quickly. Drug
company sponsorship influences the areas of continuing medical
education, research interests and research outcomes. This in turn can
lead to secrecy, delays in publication, and conflict of interest
disclosure inaccuracies.
The final review presents an assessment of the interventions that have
been tried, in an attempt to counter promotional activities, and
considers how successful they have been. Industry self-regulation, the
most common form of promotional regulation, is found to be ineffective,
whilst at the same time government regulation is found to be more
successful. More needs to be done in the field of Doctors' education,
for that too is found to be a successful strategy to counter the
promotional activities of the pharmaceutical industry. In addition,
publicising examples of bad practice is considered a useful tool in
combating poor promotion practice.
What is as clear from the title of the report as from the analysis is
that we still have much to learn and more research is required. In each
area of analysis, the authors provide a qualitative discussion of the
future direction of research, and highlight the paucity of reliable data
for critical analysis. For example, the quantitative survey methods
employed in the studies analysed in the report contribute to a robust
factual basis for the accounts given. But qualitative data, about the
feelings and beliefs of those subject to influence by promotion, might
provide an even richer source of data to inform analysis and is an area
where sociologists, cognitive and social psychologists have a
significant role to play. The authors also suggest a need for research
focussed on other stakeholders in the medicines market, such as
consumers, pharmacists, nurses, or drug store staff, all of whom play an
important role in what drugs are used and when. In the area of the
impact of promotion on behaviour, one major gap is the lack of data on
the public health outcomes that result from the behaviour changes
influenced by promotion, and the scarce data on the impact of
promotional activities in developing countries.
The report can be downloaded from the HAI website
[http://www.haiweb.org/02_focus_d3_1.htm\]
or from WHO
[http://www.who.int/medicines/areas/rational_use/drugPromodhai.pdf\]
Tim Reed
Dr Tim Reed, Director
Health Action International (HAI) Europe
Jacob van Lennepkade 334T
1053 NJ Amsterdam
The Netherlands
Tel: +31 20 683 3684
Fax: +31 20685 5002
Email: tim@haiweb.org
Website: http://www.haiweb.org
Health Action International (HAI) is an independent, global network
working to increase access to essential medicines and improve their
rational use.