Doctors’ attitudes to pharmaceutical promotion

1. Professional and lay attitudes to promotion

Doctors’ attitudes to promotion vary, and do not necessarily match their behaviour. Their opinions differ on the value of sales reps, 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 drug companies is biased, but many think it is useful. Health professionals find small gifts from drug companies acceptable. Most believe that drug reps 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 direct-to-consumer advertising of prescription medicines (DTCA) are mixed. Most drug companies, the advertising industry and the media favour it, while doctors and others (e.g. government, NGOs and health professional organisations) generally oppose it. Consumers and patients are divided: some, especially the less educated, feel starved of information from professional sources and would welcome more from whatever source, while others distrust commercial bias.

2. Effects of pharmaceutical promotion on attitudes and knowledge

Promotion influences doctors’ attitudes much more than they realise. They often us it as a source of information about new drugs, and for drugs used outside their usual therapeutic field. Doctors in private practice, or who graduated long ago, are the heaviest users of promotion as a source of drug information.

3. Effects of pharmaceutical promotion on behaviour

Increased promotion is associated with increased drug sales, promotion influences prescribing more than doctors realise, and doctors rarely acknowledge that promotion has influenced their prescribing. Doctors who report relying more on promotion prescribe less appropriately, prescribe more often, and adopt new drugs more quickly.

Samples stimulate prescribing.

Doctors who receive drug company funds tend to request additions to hospital formularies. Drug company sponsorship influences the choice of topics for continuing medical education and the choice of research topics and the outcome of research. It leads to secrecy, delay in publication for commercial reasons, and conflict of interest problems for contributors to guidelines. Researchers often do not disclose funding from drug companies.

DTCA leads to increased requests from patients for drugs. Doctors who prescribe a requested drug are often ambivalent about the drug.

4. What has been tried to counter promotional activities, with what results?

Effective:
Government regulation of promotion is more effective than industry self-regulation
Educating doctors about drug promotion influences attitudes and can improve skills
Publicising deceptive promotion

Ineffective:
Industry self-regulation
Review by journal editors
Guidelines/regulations for sales reps or for advertisements
Government control of post-marketing surveillance

What needs research:
Which methods of educating doctors on drug promotion can change their behaviour
The influence of guidelines on the acceptance of gifts
The influence of guidelines on managing conflicts of interest in commercially funded research

Department of Essential Drugs & Medicines Policy, WHO
Ref. http://www.drugpromo.info/