Drug Promotion - What We Know, What We Have Yet to Learn - Reviews of Materials in the WHO/HAI Database on Drug Promotion - EDM Research Series No. 032: Introduction: Background to the project

Drug Promotion - What We Know, What We Have Yet to Learn - Reviews of Materials in the WHO/HAI Database on Drug Promotion - EDM Research Series No. 032
(2004; 102 pages)

Table of Contents

	Acknowledgements
	Executive summary
	Introduction
		Background to the project
		Development of the drug promotion database
		Database entries
		Potential data users
		Reviews of database material
		Methodology
	Review 1. What attitudes do professional and lay people have to promotion?
		1.1 Attitudes do not necessarily match behaviour
		1.2 Studies of the prevalence of different attitudes to promotion (excluding direct-to-consumer advertising)
		1.3 Do trainers and trainees think that sales representatives should be banned during medical training?
		1.4 Do doctors think they have enough training to deal with sales representatives?
		1.5 Do doctors think that sales representatives have a valuable role in medical education?
		1.6 What do health professionals think about the quality of the information provided by sales representatives and advertisements about drugs?
		1.7 What do other groups of people think of promotional information?
		1.8 What are doctors’ views of pharmaceutical company support of conferences and speakers?
		1.9 Do trainee doctors plan to see sales representatives in their future practice?
		1.10 What are professionals’ and patients’ attitudes to the appropriateness of gifts?
		1.11 Do health professionals feel that discussions with sales representatives affect prescribing?
		1.12 Do people feel that accepting gifts influences prescribing?
		1.13 Ethics and promotion
		1.14 Attitudes to direct-to-consumer advertising of prescription drugs
		1.15 Studies of differences in attitudes to promotion (excluding DTCA)
		Summary of conclusions
		Directions for future research
	Review 2. What impact does pharmaceutical promotion have on attitudes and knowledge?
		2.1 Reported use of promotion as a source of drug information
		2.2 Reported use of promotion as a source of information in adopting new medicines
		2.3 Impact of promotion on self-reported attitudes and knowledge
		2.4 Research designs that aim to avoid the limitations of self-report data
		Summary of conclusions
		Directions for future research
	Review 3. What impact does pharmaceutical promotion have on behaviour?
		3.1 Impact of promotion on individual prescribing practices
		3.2 Self-reported reasons for prescribing changes
		3.3 Prescribing by those who rely on commercial information
		3.4 Prescribing and exposure to promotion
		3.5 Exploring the impact of samples on prescribing
		Summary
		3.6 Impact of promotion on overall sales
		3.7 Impact of promotion and industry funding on requests for formulary additions
		3.8 DTCA and consumers’ decisions
		3.9 Impact of sponsorship on content of continuing medical education courses
		3.10 Impact of industry funding on research
		3.11 Does funding affect the research agenda?
		3.12 Do authors reveal funding sources?
		Summary of conclusions
	Review 4. What interventions have been tried to counter promotional activities, and with what results?
		4.1 Guidelines, codes and regulations for printed and broadcast material
		4.2. The ‘Fair Balance’ requirement
		4.3 Guidelines for sales representatives
		4.4 Guidelines for post-marketing surveillance
		4.5 Guidelines on conflict of interest in research
		4.6 Guidelines for package inserts and compendia
		4.7 Guidelines about gifts
		4.8 Guidelines for trainee doctors and for hospitals
		4.9 Knowledge of these guidelines and their effect on attitudes
		4.10 Education about promotion
		4.11 Monitoring/countering promotion
		4.12 Research as an intervention
		Summary of conclusions
		Directions for future research
	Final conclusions
	References

Background to the project

The impetus for a major project on pharmaceutical promotion originated at the May 1999 meeting of the WHO/Public-Interest Nongovernmental Organizations Roundtable on Pharmaceuticals. Unethical and inappropriate drug promotion has been a continuing concern of both NGOs and the WHO. At the 1997 Roundtable on WHO's Ethical Criteria for Medicinal Drug Promotion there was firm agreement that inappropriate promotion of medicinal drugs remains a problem both in developing and developed countries.

Although there is an abundance of information about drug promotion it had never been fully documented and as such organizations, governments, individuals and others were restricted in their ability to access the breadth of knowledge that had been accumulated, to analyse it, to learn from it and to expand on it. Therefore, the first phase of the promotion project was to collect, analyse and make publicly accessible as wide a range of material as possible that described, analysed, reported or commented on any aspect of pharmaceutical promotion.

This drug promotion project is a collaboration between the WHO Department of Essential Drugs and Medicines Policy (EDM) and Health Action International (HAI) Europe.