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?: Summary of conclusions

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

Summary of conclusions

Doctors’ attitudes to promotion vary, and do not necessarily match their behaviour. Their opinions differ on the value of sales representatives, on whether they should be banned during medical training and on whether doctors are adequately trained to interact with them.

Most doctors think information from pharmaceutical companies is biased, but many think it is useful. Health professionals find small gifts from drug companies acceptable. Most believe that drug representatives or gifts do not influence them personally, but do influence many colleagues. Few patients know that doctors receive promotional gifts, and so few disapprove.

Doctors who rely on promotion tend to be older, less conservative, see more patients, are general practitioners rather than specialists, have less access to peers and have a more positive attitude towards medicines.

Opinions about DTCA are mixed. Most companies, the advertising industry and the media favour it, while doctors and others (e.g. government, NGOs and health professional organizations) generally oppose it. Consumers and patients are divided: some, especially the less educated, would welcome more information from whatever source, while others distrust commercial bias.