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: Review 1. What attitudes do professional and lay people have to promotion?: 1.1 Attitudes do not necessarily match behaviour

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

1.1 Attitudes do not necessarily match behaviour

Several studies show that finding out what people think about promotion may not be a good way to predict their behaviour. For example, Peay and Peay’s 1984 paper¹ suggests a doctor’s view of the worthiness of an information source may not be reflected in how often s/he uses it. Sales representatives and other commercial sources were not evaluated highly, but sales representatives were the most frequent source of first information about medicines, and were one of the most frequently mentioned sources of information needed to prescribe. Other commercial sources were also often mentioned as sources of first information about a drug. Similarly, Gambrill and Bridges-Webb found that 56% of the Australian doctors in their study reported that they used sales representatives as a regular source of information, but only 17% ranked them as the most useful². McCue et al.³ surveyed general practitioners (GPs), internists and surgeons in North Carolina, about their attitudes towards and use of different sources of information about new drugs. Although only 27.7% of the respondents viewed drug sales representatives as accurate and accessible sources of information about new drugs, they were used more frequently than other sources. This study had a low response rate.