Healthy Skepticism Library item: 4326

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Chetley A, Mintzes B.
Promoting health or pushing drugs?
Health Action International 1992
www.haiweb.org

Abstract:

Promotion covers many activities and practices. Some of it is direct to prescribers, some is indirect, some is meant for patients and consumers. Overall, it is a comprehensive attempt to persuade health workers and the general public to suspend their critical judgement about which medicines to use. The enormous sums spent on promotion are added to the price of drugs. There are indirect costs also: the overconsumption of drugs or the consumption of the wrong drugs at the wrong time. Regulatory authorities confirm that much industry promotion is misleading. The industry claims it can self-regulate promotion, but it has been saying that for nearly two decades, with little sign of success. Pharmaceutical companies all over the world regularly break their own codes of marketing. Industry codes are too weak; they do not prevent inappropriate practices and have few effective sanctions. Many advertisements make unsubstantiated claims; fail to provide adequate information and encourage irrational use of drugs. A worrying trend is the growth of advertising of prescription drugs directly to consumers in order to encourage patients to ask their doctors for particular drugs. In many countries, more than half the industry’s promotional budget is spent on sales representatives. The information they provide to doctors is often unbalanced and incomplete, yet they are the major source of information about new drugs. A significant proportion of health workers accept bribes from the industry. It is part of a systematic process of winning favour. A wide range of gifts help to endear the industry to doctors and encourage a sense of obligation among prescribers which has an insidious impact on prescribing choices. Pharmaceutical cmopanies have a pervasive presence in most of the world’s medical systems, sponsoring many courses for continuing medical education and an endless series of lectures and symposia. Some of these “educational” meetings are little more than rewards for uncritical prescribing. Evidence shows that most industry sponsored postmarketing studies make very little contribution to drug safety and rarely advance the knowledge about drugs. Their main purpose is to promote use. Irrational drug use with its adverse impact on public health is the main consequence of uncontrolled drug promotion. Patients suffer, some may even die, and costs continue to spiral. No industry code is free from loopholes or deficiencies. Unless they are strengthened and enforced, they will remain an obstacle to public health. Stronger national legislation can help enforce ethical drug promotion. Outright bans on some forms of promotion may be necessary. A first step toward setting an independent international standard, WHO’s Ethical Criteria need regular review and strengthening as well as national implementation and monitoring. Professional associations can introduce codes and guidelines to introduce some distance between the industry and health workers. Better independent information about drugs is needed. Decisions about controlling drug promotion have to be made with full public participation. The issue is too important to leave to the pharmaceutical industry and its self-serving codes.

Keywords:
*analysis/sales representatives/quality of information/regulation of promotion/WHO/World Health Organization/ continuing medical education/ CME/ corporate funding/ postmarketing research/gift giving/DTCA/direct-to-consumer advertising/ sponsored symposia & conferences/ bribery/ Ethical Criteria for Medicinal Drug Promotion/ doctors/ Health Action International/MaLAM/Medical Lobby for Appropriate Marketing/HAI/consumer groups/ETHICAL ISSUES IN PROMOTION: GIFT GIVING/ETHICAL ISSUES IN PROMOTION: PAYMENT FOR MEALS, ACCOMODATION, TRAVEL, ENTERTAINMENT/EVALUATION OF PROMOTION: DETAILING/EVALUATION OF PROMOTION: DIRECT-TO-CONSUMER ADVERTISING/INFLUENCE OF PROMOTION: ACCESS TO ESSENTIAL DRUGS/INFLUENCE OF PROMOTION: CONSUMERS AND PATIENTS/INFLUENCE OF PROMOTION: PRESCRIBING, DRUG USE/PROMOTION DISGUISED: CONFERENCES AND MEETINGS/PROMOTION DISGUISED: POSTMARKETING RESEARCH/PROMOTION DISGUISED: SUPPORT FOR CME/REGULATION, CODES, GUIDELINES: COMPLIANCE, SANCTIONS, STANDARDS/REGULATION, CODES, GUIDELINES: DIRECT GOVERNMENT REGULATION/REGULATION, CODES, GUIDELINES: FEEDBACK TO COMPANIES/REGULATION, CODES, GUIDELINES: INDUSTRY SELF-REGULATION/REGULATION, CODES, GUIDELINES: INTERNATIONAL CODES