Drug promotion strongly influences prescribing behaviour, but doctors underestimate this influence. Company funding of doctors, of educational events and of research are important elements in this influence.
Of various interventions to control or counter the influences of promotion, the only ones that have been found effective are government regulation, training of students (both before and after graduation), media exposure of abusive promotion, and free and abundant provision of reliable non-commercial therapeutic information to professionals and the public.
Research and policy questions to be addressed include the development of effective methods of educating doctors about drug promotion, the impact of guidelines on promotional gifts, and the development of effective guidelines for managing conflicts of interest in research. The effects of different regulatory frameworks also urgently need to be compared. Governments and other organizations that introduce policies to regulate promotional activities need good evidence of the advantages and drawbacks of different systems.
Some promising research designs, such as that pioneered by Avorn et al. to determine how far prescribers’ beliefs are influenced by promotional information, should be applied in different contexts. It could be used to examine a treatment for which there is strong 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, using a modest telephone survey, would be relatively cheap. Research should also study actual prescribing patterns rather than relying on self reports. Studies should utilize a time series analysis to examine prescribing before and after visits by sales representatives looking for changes associated with these visits. It would be especially useful to explore prescribing in areas where there is a strong consensus about first-line therapy, for example strep throat and hypotension, to see if prescribing for these problems is influenced by representatives.
Finally, qualitative studies are essential to provide an understanding of prescribers’ and patients’ behaviour and their attitudes to commercial and non-commercial information. These would involve using focus groups from each population in multiple settings, for example, developed and developing countries, specialists and general practitioners, male and female doctors and patients. They should be done through semi-structured face-to-face interviews so that different trains of thought could be explored in sufficient detail to gain an in-depth understanding of behaviour and attitudes.