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Practice of using gifts as promotional materials for marketing of pharmaceutical products in Bangladesh: A survey conducted on general physicians and representatives from pharmaceutical companies  [cached]
Saki Sultana,Kamrul Hasan Khosru
Stamford Journal of Pharmaceutical Sciences , 2011,
Abstract: The present study was undertaken to find out the promotional strategies followed by the pharmaceutical companies, attitudes and responses of physicians towards these promotional activities and influence of using gifts as promotional materials on the prescribing behavior of the physicians. In the study we found that most pharmaceutical companies believe that pharmaceuticals should be promoted by their quality and availability, not by any other promotional strategies. 84.62% pharmaceutical companies believe that gifts provided by them motivate the physicians to prescribe their products whereas 87% physicians admit that they consider the image of the company and quality of the product while prescribing. We also found that 50.5% physicians preferred information more rather than attractive gifts but only 11.77% pharmaceutical companies agreed with this statement.
Gift Acceptance and Its Effect on Prescribing Behavior among Iraqi Specialist Physicians  [PDF]
Ehab Mudher Mikhael, Dhulfiqar Nidhal Alhilali
Pharmacology & Pharmacy (PP) , 2014, DOI: 10.4236/pp.2014.57080

Background: The interaction between physicians and medical representatives (MRs) through gift offering is a common cause for conflicts of interest for physicians that negatively influence prescribing behaviors of physicians throughout the world. This study aimed to evaluate the interaction between MRs and Iraqi specialist physicians through the acceptance of MRs gifts and the effect of such acceptance on physician’s prescribing patterns. Methods: A survey in a questionnaire format for specialist physicians was done during March-October 2013 in Iraq, Baghdad. The questionnaire involves four major parts regarding the approximate number of patients and medical representatives, gift acceptance, medical conferences, and prescribing pattern. Results: In Iraq specialist physicians were visited by 1 - 3 MRs/day. 50% of the Iraqi physicians like to get the educational information by attending conferences outside Iraq. Regarding Gift acceptance, 41% of participated physicians showed a general acceptance to promotional gifts, and 91% of physicians accept low cost gifts but only 41% of them accept high cost recreational gifts. Free samples were used by 59% of Iraqi physicians to treat some people. 77% of physicians prefer prescribing new medications, while more than 95% of participated physicians stated that they stop prescribing these new drugs either due to their ineffectiveness or due to their side effects. On the other hand physicians significantly change their prescribing behavior through shifting not only among generic drugs, but also from brand to generic drugs in their prescriptions. Gift acceptance is directly correlated with such shift and change in prescribing behavior. Conclusion: Iraqi physicians accept various types of gifts from pharmaceutical companies; this can influence physician prescribing pattern and result in early adoption to prescribe newly medications depending on promotional information even in absence of clinical evidence about the drug effectiveness or side effects, which may result in undesirable outcomes to the patient.

Characteristics of physicians receiving large payments from pharmaceutical companies and the accuracy of their disclosures in publications: an observational study  [cached]
Norris Susan L,Holmer Haley K,Ogden Lauren A,Burda Brittany U
BMC Medical Ethics , 2012, DOI: 10.1186/1472-6939-13-24
Abstract: Background Financial relationships between physicians and industry are extensive and public reporting of industry payments to physicians is now occurring. Our objectives were to describe physician recipients of large total payments from these seven companies, and to examine discrepancies between these payments and conflict of interest (COI) disclosures in authors’ concurrent publications. Methods The investigative journalism organization, ProPublica, compiled the Dollars for Docs database of payments to individuals from publically available data from seven US pharmaceutical companies during the period 2009 to 2010. We examined the cohort of 373 physicians in this database who each received USD $100,000 or more in the reporting period 2009 to 2010. Results These physicians received a total of $52,600,624 during this period (mean payment per physician $141,020). The predominant specialties were internal medicine and psychiatry. 147 of these physicians authored a total of 134 publications in the first quarter of 2011 and 77% (103) of these publications provided a COI disclosure. 69% of the 103 publications did not contain disclosures of the payment listed in the Dollars for Docs database. Conclusions With increased public reporting of industry payments to physicians, it is apparent that large sums are being paid for services such as consulting and peer education. In over two-thirds of publications where COI disclosures were provided, the disclosures by physician authors did not include industry payments that were documented in the Dollars for Docs database.
International variation in prescribing antihypertensive drugs: Its extent and possible explanations
Atle Fretheim, Andrew D Oxman
BMC Health Services Research , 2005, DOI: 10.1186/1472-6963-5-21
Abstract: National prescribing profiles were determined based on information on sales and indications for prescribing. We sent a questionnaire to academics and drug regulatory agencies in Canada, France, Germany, UK, US and the Nordic countries, asking about explanations for differences in prescribing patterns in their country compared with the other countries. We also conducted telephone interviews with medical directors of drug companies in the UK and Norway, the countries with the largest differences in prescribing patterns.There is considerable variation in prescribing patterns. In the UK thiazides account for 25% of consumption, while the corresponding figure for Norway is 6%. In Norway alpha-blocking agents account for 8% of consumption, which is more than twice the percentage found in any of the other countries. Suggested factors to explain inter-country variation included reimbursement policies, traditions, opinion leaders with conflicts of interests, domestic pharmaceutical production, and clinical practice guidelines. The medical directors also suggested hypotheses that: Norwegian physicians are early adopters of new interventions while the British are more conservative; there are many clinical trials conducted in Norway involving many general practitioners; there is higher cost-awareness among physicians in the UK, in part due to fund holding; and there are publicly funded pharmaceutical advisors in the UK.Two compelling explanations the variation in prescribing that warrant further investigation are the promotion of less-expensive drugs by pharmaceutical advisors in UK and the promotion of more expensive drugs through "seeding trials" in Norway.In many countries there is a substantial potential for savings if less expensive drugs, particularly thiazides, are prescribed rather than the more expensive drugs for hypertension [1]. The potential savings in the UK are £132 million ($200 million) per year (£2.22 ($3.36) per inhabitant; figures from the year 2000). The US
Japanese Practicing Physicians' Relationships with Pharmaceutical Representatives: A National Survey  [PDF]
Sayaka Saito,Kei Mukohara,Seiji Bito
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0012193
Abstract: Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs) have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors.
Impact of pharmaceutical promotion on prescribing decisions of general practitioners in Eastern Turkey
Serhat Vancelik, Nazim E Beyhun, Hamit Acemoglu, Oksan Calikoglu
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-122
Abstract: A cross-sectional, exploratory survey was performed among 152 GPs working in the primary health centers and hospitals in Erzurum province of Eastern Turkey in 2006. A self-administered structured questionnaire was used. The questionnaire included questions regarding sociodemographics, number of patients per day, time per patient, frequency of sales representative visits to GPs, participation of GPs in training courses on prescribing (in-service training, drug companies), factors affecting prescribing decision, reference sources concerning prescribing and self-reported and self-rated effect of the activities of sales representatives on GPs prescribing decisions.Of 152 subjects, 53.3% were male and 65.8% were working at primary health care centers, respectively. Mean patient per day was 58.3 ± 28.8 patients per GP. For majority of the GPs (73.7%), the most frequent resource used in case of any problems in prescribing process was drug guides of pharmaceutical companies. According to self-report of the GPs, their prescribing decisions were affected by participation in any training activity of drug companies, frequent visits by sales representatives, high number of patient examinations per day and low year of practice (p < 0.05 for all).The results of this study suggest that for the majority of the GPs, primary reference sources concerning prescribing was commercial information provided by sales representatives of pharmaceutical companies, which were reported to be highly influential on their decision-making process of prescribing by GPs. Since this study was based on self-report, the influence reported by the GPs may have been underestimated.Drug expenditure has been one of the main concerns of health care managers; thus, its containment is one of the primary goals of health care authorities. Therefore, identifying prescribing-associated factors is of paramount interest from health, as much as social and economic standpoints [1-4]. The effects of various factors on pres
A cross-sectional evidence-based review of pharmaceutical promotional marketing brochures and their underlying studies: Is what they tell us important and true?
Roberto Cardarelli, John C Licciardone, Lockwood G Taylor
BMC Family Practice , 2006, DOI: 10.1186/1471-2296-7-13
Abstract: Physicians in five clinics were asked to consecutively collect pharmaceutical promotional brochures and to send them all to a centralized location. The brochures for any class of medication were collected on a continuous basis until 20 distinct promotional brochures were received by a central location. Once the brochure was received, the corresponding original study was obtained. Two blinded reviewers performed an evidence-based review of the article, comparing data that was printed on the brochure to what was found in the original study.Among the 20 studies, 75% of the studies were found to be valid, 80% were funded by the pharmaceutical company, 60% of the studies and the corresponding brochures presented patient-oriented outcomes, and 40% were compared to another treatment regimen. Of the 19 brochures that presented the data as graphs, 4 brochures presented a relative risk reduction while only 1 brochure presented an absolute risk reduction. 15% of the promotional marketing brochures presented data that was different from what was in the original published study.Given the present findings, physicians should be cautious about drawing conclusions regarding a medication based on the marketing brochures provided by pharmaceutical companies.The pharmaceutical industry spent over $11 billion in pharmaceutical marketing, excluding medication samples, in 2004, with more than $7 billion directed to clinicians [1]. This creates the potential for an ethical dilemma because such marketing may influence physician prescribing behavior without necessarily benefiting the patient [2-6]. Such marketing also creates the potential for inappropriate prescribing practices, which contribute to escalating national health care costs[7].There is an ongoing debate on the effects of pharmaceutical marketing on health care delivery. For example, while diuretic and beta-blocker medications are considered the first line antihypertensive therapies (both medications being relatively inexpensive
Generic drug prescribing in central Saudi Arabia : Perceptions and attitudes of physicians.  [cached]
Alghasham Abdullah
Annals of Saudi Medicine , 2009,
Abstract: Background and Objectives: Physicians play a key role in generic drug prescribing, but their behavior is affected by many determinants. We examined physician practices and attitudes and other factors influencing the prescription of generic drugs. Methods: A self-administered questionnaire was used to collect information from a random sample of physi-cians from different settings in central Saudi Arabia. Data were analyzed to describe all variables and test any significant difference between groups of physicians. Results: The study included 772 physicians from different affiliations. The majority of physicians (n=741, 96%) reported that they knew enough about the therapeutic value of generic drugs. The majority (75%) reported that they knew the price differences, and this knowledge helped 72% of them to switch to generic prescription medication. Most physicians (79%) support generic substitution, but they indicated that there are certain clini-cal situations where they prefer to use brand name drugs. Physicians reported receiving visits and samples more frequently from representatives of brand name companies. Physicians did not report a significant difference in pressure from patients to prescribe either generic or brand drugs. Most physicians had a positive attitude towards the government role in assuring the quality of local drug products (80%) and in enforcing physicians to prescribe generic drugs (85%). Conclusion: Physicians face competing forces to prescribe either brand name or generic drugs. The majority support generic drug substitution. There are multiple factors that support prescription of generic drugs.
Luminita Mihaela Ion
CES Working Papers , 2013,
Abstract: The proper prescription of medicines by specialists from healthcare, especially physicians, it’s a major challenge of the healthcare services concerning the financial implications respectively the effects upon the patient's health status. The assurance of a proper and adequate prescription for the patients is influenced by a series of factors which act upon the prescription decision of the medicines, as: the medicine features (quality-price, availability), the patient’s situation, the prescriber, respectively the professional environment. The estimate of a physician behaviour concerning the action of prescribing to the patients leads to the discovery of the major role that the intention has on the behaviour. The present study aims at carrying out a thorough research on drug prescribing behaviour to patients, trying to identify the motivations which underlie the action of prescribing.
Characteristics of primary health care units with focus on drug information from the pharmaceutical industry and adherence to prescribing objectives: a cross-sectional study
Daniel Carlzon, Lena Gustafsson, Anna L Eriksson, Karin Rignér, Anders Sundstr?m, Susanna M Wallerstedt
BMC Pharmacology and Toxicology , 2010, DOI: 10.1186/1472-6904-10-4
Abstract: A cross-sectional study was performed in all 25 primary health care units in G?teborg, Sweden. A questionnaire on characteristics of practice settings [(i) size of unit, (ii) profession of head, (iii) use of temporary physicians, (iv) drug information from the pharmaceutical industry, (v) producer-independent drug information, and (vi) education on prescribing for newly employed physicians] was sent to the heads of the units. A national sales register for prescribed drugs (Xplain) was used for evaluation of adherence to the six regional prescribing objectives concerning proton pump inhibitors (PPIs), angiotensin converting enzyme inhibitors (ACEIs), statins and antidepressants.Twenty-two out of 25 primary health care units responded to the questionnaire (response rate 88%). A physician as head and presence of producer-independent drug information was positively correlated with adherence to the prescribing objectives (median number of prescribing objectives adhered to (25th - 75th percentile): 2.5 (1-3.25) vs 1 (0-2), P = 0.013; 2 (1-3) vs 0, P = 0.043, respectively. Presence of drug information from the pharmaceutical industry and education on prescribing for newly employed physicians was negatively associated with adherence to the prescribing objectives: 1 (0-2) vs 3.5 (2.25-4.75), P = 0.005; 1 (0-2) vs 3 (1.5-4), P = 0.034, respectively.Several characteristics of the primary health care units correlated with adherence to prescribing objectives for rational drug use. Further research on this topic is needed and would constitute valuable information for health care decision makers.The prescribing of drugs is an important issue for the individual patient, since risks and benefits of the treatment directly affect the patient. In Sweden, prescribed drugs are reimbursed by the society. Hence, prescribing of drugs is also a key question from a public expense perspective. Financing of drugs is a vast problem, since costs for drugs are increasing and resources are limited
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