Increasing attention is being paid to the relationship between health professionals and the pharmaceutical industry, and the role of drug promotion in prescribing, dispensing and drug use decisions.(Anon, 2001; Wazana, 2000) Education of medical and pharmacy students has a crucial role to play in preparing future practitioners to respond appropriately to drug promotion and to ensure that their own interactions with the pharmaceutical industry meet a high ethical standard and are consistent with regulatory norms. This is the first study to examine the extent to which medical and pharmacy students are being educated about drug promotion.
With the global withdrawal of rofecoxib (Vioxx®) in September 2004, potential negative public health implications of promotion received extensive media attention. Rofecoxib was no more effective than alternative non-steroidal anti-inflammatory drugs in treating the symptoms of arthritis (Garner, Fidan, Frankish and Maxwell 2005). It was largely promoted as safer. However, the first study to establish gastro-intestinal benefits, published in 2000, also found an increased risk of heart disease (Bombardier, 2000). Additional evidence of cardiac toxicity eventually led to the product’s global withdrawal. Rofecoxib’s success is a testament to the triumph of marketing over science: a drug that was no more effective, riskier and much more expensive than alternatives reached and maintained blockbuster status - with over 80 million prescriptions worldwide - although during four of its five years on the market evidence existed of an unfavourable balance of benefit versus risk. A U.S. congressional investigation describes the ‘spin’ used by sales representatives to avoid presenting evidence concerning cardiac risks to the health professionals they visited (Waxman, 2005). In an extrapolation based on clinical trial evidence and the rate of rofecoxib use, David Graham, a senior FDA official, estimated a U.S. death toll of 35,000 and 45,000 (Graham, 2005).
In terms of the public health consequences of drug promotion, rofecoxib’s success is undoubtedly an extreme case. However, it highlights the need to ensure that health professionals are adequately prepared to evaluate promotional claims, and to assess and understand interactions with the pharmaceutical industry. Health Action International (HAI) and WHO carried out an international survey of medical and pharmacy faculties on initiatives to educate students about drug promotion. The aim was to undertake an ‘environmental scan’ to find out what students are being taught and any evaluation of the effectiveness of this education. The survey covered all aspects of drug promotion, including the role of advertisements, samples, gifts and the use of opinion leaders on medical and pharmacy practice, research, ethical issues, regulation, and how to evaluate marketing materials in order to make the right decisions for patient care (Garner, 2005).