Healthy Skepticism Library item: 7015
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
Shankar R.
Medicinal promotion and doctors: a Nepalese perspective
PLoS Medicine 2006 Nov 15
http://medicine.plosjournals.org/perlserv/?request=read-response&doi=10.1371/journal.pmed.0030451
Abstract:
I read with interest the article by Mansfield PR et al. regarding educating health professionals about drug and device promotion (PLoS Med 2006;3:e451). Teaching about drug promotion is becoming increasingly important in Nepal, a developing country in South Asia. During their pharmacology training at the Manipal College of Medical Sciences (MCOMS), Pokhara, medical students are taught to critically analyze drug advertisements and other promotional material against the WHO Ethical criteria for medicinal drug promotion [1]. Students are evaluated in critical analysis of drug promotional materials during the pharmacology practical examination. The students are also taught to critically evaluate drug promotion by medical representatives (MRs) using the medium of role-plays [2].
The four recommendations made by the authors are important but developing countries like Nepal may face problems in their implementation. Educating all health professionals about decision making and evaluation of evidence and promotion is recommended. Our department runs a drug information center (DIC) in the teaching hospital and we are trying to use the DIC to promote evidence-based medicine (EBM). However, there are no formal courses on evaluating the evidence. Doctors do not have an adequate knowledge of statistics to arrive at evidence-based decisions.
The second and the third objectives may have problems in their implementation. Conferences in Nepal continue to be heavily sponsored by the pharmaceutical industry. MRs have unrestricted access to doctors in our hospital and in most other hospitals in Nepal. One-to-one visits, personal gifts and other methods of sponsorship are the norm. Academic detailing is absent. I am personally ambivalent about banning one-to-one detailing. Many health professionals in Nepal and South Asia are in private practice or work in small hospitals. It is an unfortunate fact that MRs may be their only source of information about medicines. Banning MRs may deprive them of this source, however biased it may be. Exposure to misleading presentation, fostering false beliefs, debunking these beliefs and explaining the misleading techniques is an effective technique and we had used it in our department during teaching critical evaluation of medicinal drug promotion.
We have had mixed success regarding educating health professionals to avoid promotion or look at it critically. We have been able to influence students during the first two years of their training. The influence of our training gets considerably eroded once students are in the clinical phase. Enlisting the support of clinicians, making them aware of irrational promotion and using their services to teach doctors in training is vital if we have to make progress.
Education regarding the most reliable sources of information is lacking in South Asia. Health organizations, professional associations and other bodies should develop information sources which are readily accessible to prescribers. Western information sources may have many limitations in developing countries.
There are no medical student organizations in Nepal which have taken up the issue of pharmaceutical promotion. The issue in fact does not figure of the medical students’ agenda. The curriculum of Kathmandu University, Nepal recommends teaching students to assess promotional materials. However, many medical schools do not address the vital issue of drug and device promotion. The Nepalese pharmaceutical industry is coming of age. The pharmaceutical giants from the Southern neighbour, India are also active in Nepal. It is time that medical professionals got their act together to ensure a “proper” relationship with the industry!
References:
1) Giri BR, Shankar PR (2005). Learning how drug companies promote medicines in Nepal. PLoS Med 2(8):e256.
2) Shankar PR, Dubey AK, Subish P (2006). Critical evaluation of drug promotion using role plays. Med Educ;40:472.
