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4b. Policy: Providers and Promotion
Marketing and Promotion of the Pharmaceutical Industry: Snapshot of Current Practice Within, or With Possible Implications In, Low- and Medium-Income Countries
1Access to Medicine Foundation, Netherlands, The; 2MSCI Group - ESG Research
Problem statement: Developing countries often have more constrained regulatory enforcement, information systems, and consumer protection. These countries’ health care professionals and patients can be more dependent on medical information from and the self-regulation of companies themselves. Stakeholders, including the WHO, have highlighted concern over the possible risks this situation may pose for rational prescription and use of medicines.
Objectives: To use data from the Access to Medicine Index 2010, a bi-annual pharmaceutical industry benchmarking tool, to provide a baseline snapshot of current average and leading sector practice in the area of marketing and promotion (M&P) in index countries (ICs).
Design: A sub-analysis of 7 qualitative indicators relating to M&P. Data was obtained through public and engagement-based disclosure for the 2008 and 2009 financial years. Analysis focused on governance, policies, and operations in or with impact on ICs—88 countries based on the UN HDI list of low- and medium-income countries and for products targeting 33 high-priority diseases (in ICs).
Study population: 20 largest originator pharmaceutical companies in 2009
Policy change: By transparently measuring and benchmarking companies we aim to build a deeper and broader understanding of the current situation and practice in this area. The bi-annual nature of the survey and the use of consistent metrics will, in the future, allow evaluation of changes over time to facilitate policy development and evaluation both within and external to the industry.
Results: Currently 100% (20) of companies analysed commit to adherence with at least 1 recognised global M&P code and also have an employee code of conduct which includes M&P. Seven companies do not currently demonstrate evidence of the existence of mechanisms to monitor and ensure compliance in IC markets. Eight companies commit to demanding ethical marketing from their third parties. Of these, 4 currently ensure this by either making it contractual or by providing evidence of compliance mechanisms. Of the 12 companies with no commitment, 5 have general recommendations in place. At present, not one company analysed discloses or reports their approach, the nature of the M&P activities, or resources dedicated to M&P in ICs. During the period of analysis, no major litigation in the ICs was found regarding M&P activities. All companies disclose this information to a level legally mandated.
Conclusions: Currently, no company discloses any information regarding their M&P approach, activities, or financing in ICs. Internal governance of M&P appears less robust for companies’ IC operations, with robustness lower still for M&P occurring through third parties. Examples of leading practice are found, which may indicate growing company attention to these issues and stimulate more rapid sector-wide adoption. The index has an ongoing role in policy development and evaluation in this area by facilitating greater transparency, communicating clear stakeholder expectations, and evaluating behaviour change over time.
Funding sources: Bill & Melinda Gates Foundation, UK Department for International Development, Dutch Ministry of Foreign Affairs
CEMA-Community to Improve Knowledge and Skills in Evaluating Medicine Advertisements
1Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia; 2Magister of Medicine Management and Policy, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia; 3Agency for Women and Community Empowerment, Yogyakarta Province, Indonesia; 4Centre for Clinical Pharmacology and Medicine Policy Studies, Gadjah Mada University, Yogyakarta, Indonesia
Problem statement: Since objective information on medicine advertisements is often scarce, medicine advertisements may affect the community’s perception and health. The Critical Evaluation Medicine Advertisement by the community (CEMA-community) is a strategy that may empower a community in evaluating medicine advertisements. It was developed based on the previous study targeted at medical students with modifications on the content and the inclusion of local regulation on medicine promotion.
Objectives: To evaluate the effectiveness of CEMA-community to improve knowledge and skills of participants in critically evaluating medicine advertisements
Design: An intervention study used pre and post in time series with control group design
Setting: The study was conducted in collaboration with Family Empowerment and Welfare Organization (PKK) in Yogyakarta municipality, Indonesia.
Study population: Women who are involved in the family welfare movement team of the PKK organization
Method: The CEMA-community method consisted of two sessions: the first was a brief lecture lasting 45 minutes, and the second involved small-group discussions using printed and audiovisual medicine advertisements in problem-oriented approach for 60 minutes. An activity guide was provided. Recorded radio and television advertisements were displayed by means of portable computer. Data on knowledge were obtained by questionnaires. Data on skills were assessed by the number of inappropriate claims participants could identify the advertisements. All data were collected before intervention, right after intervention, and 2 and 4 weeks after intervention. Effectiveness of the approach was shown by the significance of the increasing level of knowledge and skills after intervention. In-depth interviews with participants indicated feasibility of the approach.
Policy: The CEMA-community strategy can be used to empower the communities in critically evaluating medicine advertisements through any possible channel.
Outcome measure(s): Scores of knowledge and skills in assessing medicine advertisements
Results: Participants’ knowledge and skills in the CEMA-community group improved significantly (Wilcoxon test, p< 0.05) right after intervention and was maintained at the 2 and 4 weeks follow-up. Score of knowledge in the CEMA-community group (means: 13.9±2.52, 18.0±2.72, 19.0±3.10, 18.3±3.74, respectively before intervention, right after intervention, and 2 and 4 weeks after intervention) improved significantly (Mann-Whitney, p<0.05) as compared to the control group. Similarly, scores of skills in the CEMA-community group (means: 7.8±6.05, 16.5±10.01, 32.6±12.89, 32.2±13.06, respectively before intervention, right after intervention, and 2 and 4 weeks after intervention) also improved significantly (Mann-Whitney, p<0.05) as compared to the control group.
Conclusion: CEMA-community was effective in increasing knowledge and skills to critically evaluate medicine advertisements. CEMA-community also feasible to be implemented among Yogyakarta PKK organization members.
Funding source(s): Information not provided
“Under the Radar”: Nurse Prescribers and Pharmaceutical Industry Promotions
1MGH Institute of Health Professions, United States of America; 2Brigham and Womens Hospital
Problem statement: Multiple studies have shown that physicians’ prescribing decisions are affected by non-scientific factors such as patients’ requests for medications as well as pharmaceutical company promotions (i.e., gifts, meals, and continuing education programs). Although there has been extensive research on the effect that pharmaceutical promotions have on physician prescribing, there has been a paucity of empirical data on nurse prescribing behaviors in relation to pharmaceutical marketing.
Objectives: To assess nurse interactions with pharmaceutical industry promotions and evaluate the effect of an educational intervention on the perception of industry sponsored drug information and self-reported prescribing behaviors
Design: Randomized baseline, post 1 and post 2 intervention without control
Setting: National online survey of public and private sector nurse prescribers
Study population: Nationally representative randomized sample of 263 nurse prescribers at baseline and 208 at post-intervention
Intervention: Web-based educational intervention on pharmaceutical marketing, conflicts of interest, and evidence-based prescribing
Outcome measure(s): Change in perceptions and attitudes regarding pharmaceutical marketing; self-reported changes in prescribing behaviors
Results: Almost all of the respondents (96%) reported regular contact with pharmaceutical sales representatives, and the majority (71%) reported receiving information on new drugs directly from pharmaceutical sales representatives some or most of the time. A large portion (66%) gave out drug samples regularly to their patients, and 73% felt that samples were somewhat or very helpful in learning about new drugs.
Post-intervention there was a statistically significant (p<.01) increase between baseline and post 1 for prescribers who reported challenging information provided by pharmaceutical representatives, the use of evidence-based drug information, and the use of generic drugs. There was also a statistically significant decrease (p<.01) in the acceptability of the use of sample medications, the reported use of highly marketed drugs and the favorable perception of the reliability of information provided at industry sponsored meal and continuing education events.
Conclusions: Nurse prescribers had extensive contact with the pharmaceutical industry’s sponsored promotional activities. The educational intervention resulted in a significant change in attitudes and self-reported prescribing behaviors. The findings of this study demonstrate that nurse prescribers and/or nurses who recommend drugs for their patients are shown to be as susceptible to pharmaceutical industry promotions as their physician colleagues. This finding is significant because nurses represent the largest segment of the global health care workforce and therefore can have substantial influence on rational medication selection.
Funding source(s): Attorneys General Consumer and Prescriber Grant Program