PHA-Exchange> peddling medicines

[Claudio]

From: Gopal Dabade 

DECCAN HERALD, Monday, March 13, 2006

http://www.deccanherald.com/deccanherald/Mar132006/panorama1843482006312.asp 

WHEN TOO MUCH IS A BAD THING
by
Dr Gopal Dabade

Are doctors influenced by the gimmicks on drug promotion of profit-making drug companies? A study done by WHO unequivocally declares that drug promotion strongly influences "prescribing behaviour" but doctors underestimate it. Company funding of doctors, educational events and research are important elements in this influence. The mighty question is whether drug promotion can be regulated? 

Most of us who visit our doctor are familiar with medical representatives – those neatly dressed, well-groomed, young men in neckties with a bagful of gifts and drug literature. These medical representatives are at the doctor's clinic to promote their companies' products. This is only one way that drug companies try to influence the doctor's prescription. There are other ways too such as giving away gifts, drug samples, sponsorship of conferences etc. Drug companies spend huge amounts of money on drug promotion to doctors. The result is that the consumer is burdened when he buys the drug. In the year 2002, almost $21 bn was spent by drug companies on drug promotion in the US . In developing countries like India medical representatives are frequently the only source of information on medicines. 

If drug promotion leads to better prescribing, more scientific use of medicines or improved cost-effectiveness then there would be no concern. But on the contrary heavy promotion of new drugs leads to widespread prescribing and use before the safety profile of these products is fully understood. 


Newer and more expensive medicines displace older, less costly ones without evidence of an improvement in outcome. 

Both WHO and NGO have been expressing concern about inappropriate drug promotion. At the 1977 Roundtable on WHO's Ethical Criteria for Medicinal Drug Promotion there was agreement that inappropriate promotion of medicinal drugs remains a major public health problem both in developing and developed countries. The only difference is that in a developing country like India the consumer has to pay through his nose and end up in debt just to pay drug bills. 

Attempts to control drug promotion have largely been unsuccessful because of the reliance on a combination of voluntary codes adopted by industry associations and medical organisations. 

On the surface, voluntary self-regulatory codes from the pharmaceutical industry may look like a sensible approach to controlling promotional activities of companies; and lacking government-industry adversaries. 

In a highly competitive industry, the desire of individual companies to prevent competitors from getting an edge could be harnessed to serve the public interest through a regime of voluntary self-regulation run by a trade association. 

In order to control promotion, government regulation, training of students, media exposure of abusive promotion, provision of reliable exposure to non-commercial medical information to medical doctors and the public are useful. Unfortunately none of these exists in India . 

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