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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

Directions for future research

This review presents evidence about people’s attitudes to promotion, including whether doctors believe that promotion affects their prescribing. Some studies consider this as evidence of the impact of promotion6, but this is incorrect. The evidence in the review could be useful in designing interventions, but should not be used to describe the effects of the different forms of promotion on prescribing behaviour.

The main limitations of the studies presented here are an over-reliance on survey methods, on the use of convenience and accessible samples, and on describing the prevalence of attitudes rather than exploring their inter-relationship or relationships between attitudes and other characteristics. Qualitative studies are needed in this area.

Survey methods are extremely useful in finding out factual information about a group of people but are of less use in understanding how people think about issues, such as drug promotion. Many of the studies in this review seem to rely on participants who are easily accessible to researchers, rather than being guided by research questions. This has led to an over-emphasis on the views of trainee doctors, and their trainers, as opposed to practicing doctors; and the inclusion of patients more often than the general public. Some authors suggest that it is important to study doctors in training because this is where their attitudes are formed. However it seems more likely that this emphasis results simply from convenience. In addition, the studies described here tend to rely on small samples, and many studies have been conducted in one or two institutions. These are unlikely to represent doctors and patients in general. Some of this research also suffers from low response rates9,57.

Qualitative research, exploring in more depth people’s feelings and beliefs about medicines promotion would be an important step forward. We need to move beyond simple surveys of attitudes to more sophisticated understandings of how people react to promotion, and how they understand their own reactions. Cognitive and social psychology may be able to make important contributions in this area. For example, some studies suggest that doctors are more likely to think that ‘doctors in general’ are influenced by promotion than they are themselves. This may be similar to other situations in which individuals sometimes regard themselves as less vulnerable to a hazard (such as HIV) than other members of a similar group. Research is needed to explore this further: why and in what ways do doctors think that they are invulnerable to promotion, how do they explain their own and others’ vulnerability or lack of it? This points to a general need for research on promotion to learn from other disciplines and research on other topics. Attitudes to promotion should be seen as a specific case of other more general phenomena.

Qualitative research could also help to explore what survey respondents mean when they say that they or others are ‘influenced’ by promotion. Do they include informed (i.e. a positive meaning) or do they interpret the question to mean ‘unduly’ or ‘negatively’ influenced?

Ethnographic research, which examines medical sub-cultures, would also be extremely helpful in exploring attitudes to promotion. It appears that doctors vary substantially in their views of, and use of, promotion. How do these differences come about? What underlies them? Do they reflect overall different political and social views? Are they reflected in different social organizations (such as professional organizations, social networks, etc)? What brings about changes in these values? Do doctors move between them during their working lives? What factors enhance or impede this movement?


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Last updated: May 4, 2012