WHO Health Systems Library
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Drug Promotion - What We Know, What We Have Yet to Learn - Reviews of Materials in the WHO/HAI Database on Drug Promotion - EDM Research Series No. 032
(102 pages)

Table of Contents
View the documentAcknowledgements
View the documentExecutive summary
Open this folder and view contentsIntroduction
close this folderReview 1. What attitudes do professional and lay people have to promotion?
View the document1.1 Attitudes do not necessarily match behaviour
View the document1.2 Studies of the prevalence of different attitudes to promotion (excluding direct-to-consumer advertising)
View the document1.3 Do trainers and trainees think that sales representatives should be banned during medical training?
View the document1.4 Do doctors think they have enough training to deal with sales representatives?
View the document1.5 Do doctors think that sales representatives have a valuable role in medical education?
View the document1.6 What do health professionals think about the quality of the information provided by sales representatives and advertisements about drugs?
View the document1.7 What do other groups of people think of promotional information?
View the document1.8 What are doctors’ views of pharmaceutical company support of conferences and speakers?
View the document1.9 Do trainee doctors plan to see sales representatives in their future practice?
View the document1.10 What are professionals’ and patients’ attitudes to the appropriateness of gifts?
View the document1.11 Do health professionals feel that discussions with sales representatives affect prescribing?
View the document1.12 Do people feel that accepting gifts influences prescribing?
View the document1.13 Ethics and promotion
View the document1.14 Attitudes to direct-to-consumer advertising of prescription drugs
View the document1.15 Studies of differences in attitudes to promotion (excluding DTCA)
View the documentSummary of conclusions
View the documentDirections for future research
Open this folder and view contentsReview 2. What impact does pharmaceutical promotion have on attitudes and knowledge?
Open this folder and view contentsReview 3. What impact does pharmaceutical promotion have on behaviour?
Open this folder and view contentsReview 4. What interventions have been tried to counter promotional activities, and with what results?
View the documentFinal conclusions
View the documentReferences

1.13 Ethics and promotion

Seventy-four per cent of the emergency medicine residents surveyed by Keim et al.10 felt that sales representatives sometimes crossed ethical boundaries by giving gifts. Fourteen per cent of internal medicine residency programme directors reported observing unethical activities by sales representatives10. These included detailing in clinical areas, making false claims, giving monetary gifts, and conducting unauthorised studies.

A study by Poirier et al.39 of people who make decisions about formularies in US private hospitals, found that most (93%) felt that providing non-monetary benefits to doctors to influence formulary decisions or product use was unethical. The respondents included chairs of pharmacology and therapeutics committees, directors of pharmacy, and pharmacists involved in evaluating drugs for inclusion in formularies. More pharmacists than doctors rated providing meals to influence decisions as unethical (22% versus 12%).

A US study by La Puma et al.40 examined payments to doctors to participate in post-marketing research on new medicines. Most of the doctors they surveyed (64%) felt it was acceptable to be paid a fee for each patient enrolled in post-marketing research. Most patients (56%) felt that this was unacceptable. Fewer doctors than patients felt that patients should be informed if the doctor was being paid a fee per patient enrolled (75% versus 86%).

CONCLUSION: Only four studies have addressed this issue and each of them looked at different aspects of the question, making it hard to draw any conclusions. From one study it appears that doctors think that it is more ethical to accept fees for enrolling patients in clinical trials than do patients.

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Last updated: May 4, 2012