There is no literature in the database on the impact of promotion on the attitudes and knowledge of other people, such as consumers, pharmacists, nurses, or drugstore staff, all of whom may be important decision-makers about medicines. Future studies could include these groups. That the effects of promotion are likely to be great is suggested by long experience with promotion of breast-milk substitutes throughout the world93. Publications in this area are of course outside the scope of this database.
Promising research designs, such as that pioneered by Avorn et al., seem worth pursuing further. One possible approach would be to examine a treatment for which there is substantial scientific support, but little advertising, such as oral rehydration solution (ORS). If such a study also found that doctors claimed to be influenced more by scientific rather than commercial information, but tended not to prescribe ORS (because there is little or no commercial information about its benefits), Avorn et al.’s conclusions would be much strengthened. Such a study would also avoid the difficulty of excluding a drug from one’s prescribing repertoire: because in this case a treatment is being added rather than deleted. One of the advantages of this type of study is that it is relatively cheap: essentially it involved a telephone survey of 85 doctors.