[afro-nets] Peddling Medicines

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Peddling Medicines
------------------

Deccan Herald, Monday, March 13, 2006

http://www.deccanherald.com/deccanherald/Mar132006/panorama1843482006312.asp 


WHEN TOO MUCH IS A BAD THING
by Dr Gopal Dabade

Are doctors influenced by the gimmicks on drug promotion of
profit-making drug companies? A study done by WHO unequivocally
declares that drug promotion strongly influences "prescribing
behaviour" but doctors underestimate it. Company funding of doc-
tors, educational events and research are important elements in
this influence. The mighty question is whether drug promotion
can be regulated?

Most of us who visit our doctor are familiar with medical repre-
sentatives ­ those neatly dressed, well-groomed, young men in
neckties with a bagful of gifts and drug literature. These medi-
cal representatives are at the doctor's clinic to promote their
companies' products. This is only one way that drug companies
try to influence the doctor's prescription. There are other ways
too such as giving away gifts, drug samples, sponsorship of con-
ferences etc. Drug companies spend huge amounts of money on drug
promotion to doctors. The result is that the consumer is bur-
dened when he buys the drug. In the year 2002, almost $21 bn was
spent by drug companies on drug promotion in the US . In devel-
oping countries like India medical representatives are fre-
quently the only source of information on medicines.

If drug promotion leads to better prescribing, more scientific
use of medicines or improved cost-effectiveness then there would
be no concern. But on the contrary heavy promotion of new drugs
leads to widespread prescribing and use before the safety pro-
file of these products is fully understood.

Newer and more expensive medicines displace older, less costly
ones without evidence of an improvement in outcome.

Both WHO and NGO have been expressing concern about inappropri-
ate drug promotion. At the 1977 Roundtable on WHO's Ethical Cri-
teria for Medicinal Drug Promotion there was agreement that in-
appropriate promotion of medicinal drugs remains a major public
health problem both in developing and developed countries. The
only difference is that in a developing country like India the
consumer has to pay through his nose and end up in debt just to
pay drug bills.

Attempts to control drug promotion have largely been unsuccess-
ful because of the reliance on a combination of voluntary codes
adopted by industry associations and medical organisations.

On the surface, voluntary self-regulatory codes from the pharma-
ceutical industry may look like a sensible approach to control-
ling promotional activities of companies; and lacking govern-
ment-industry adversaries.

In a highly competitive industry, the desire of individual com-
panies to prevent competitors from getting an edge could be har-
nessed to serve the public interest through a regime of volun-
tary self-regulation run by a trade association.

In order to control promotion, government regulation, training
of students, media exposure of abusive promotion, provision of
reliable exposure to non-commercial medical information to medi-
cal doctors and the public are useful. Unfortunately none of
these exists in India.