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Gupta D, Singh Matreja P, Patrick S, Thomas M, Agarwal P, Singh P. Assessment of knowledge, attitude and practice of fixed-dose combinations amongst attending physicians and residents: a cross-sectional evaluation. Drugs Context 2024; 13:2024-2-1. [PMID: 38699064 PMCID: PMC11065134 DOI: 10.7573/dic.2024-2-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Background Fixed-dose combinations (FDCs) were brought into the market with the intent of providing benefits primarily to patients and physicians. Nevertheless, despite their multiple advantages, they have their own set of drawbacks, especially regarding irrational FDCs. If physicians continue to prescribe them, prohibiting their sale would become all the more challenging. This cross-sectional survey study was planned to comprehend the level of knowledge, attitude and practice of physicians regarding such FDCs at a tertiary care teaching institute of western Uttar Pradesh, India. Methodology A pre-validated questionnaire was communicated electronically to all the attending physicians. For data analysis, descriptive statistics were applied and a χ2 test was performed for inter-group comparison. Results Amongst the 108 respondents, participation was almost comparable from both medical and surgical branches, with most participants being junior residents (58%). Even with sound knowledge of FDCs, only 46.30% of them were aware of banned FDCs. Similarly, only 6.48% could correctly identify the disadvantages associated with the use of FDCs, and 33.18% could correctly recognize irrational FDCs. This finding was consistently reflected in their attitude and practice and only 15.74% of respondents cross-referenced FDCs with the available literature. Furthermore, despite 88.89% of respondents checking for rationality of FDCs before prescribing them, a compendium of irrational FDCs is routinely prescribed. Conclusion To amend these shortcomings in prescribing of irrational FDCs, some recommendations are proposed by the authors herein.
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Affiliation(s)
- Dhyuti Gupta
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, UP, India
| | - Prithpal Singh Matreja
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, UP, India
| | - Shilpa Patrick
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, UP, India
| | - Meenu Thomas
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, UP, India
| | - Pooja Agarwal
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, UP, India
| | - Preeti Singh
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, UP, India
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Aggarwal M, Chakrabarti AS, Chatterjee C. Movies, stigma and choice: Evidence from the pharmaceutical industry. HEALTH ECONOMICS 2023; 32:1019-1039. [PMID: 36727570 DOI: 10.1002/hec.4653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 10/22/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
Do movies reduce stigma, increasing healthcare product choices offered by firms? We provide causal evidence on this question in the context of Indian pharmaceutical markets. For unpacking these effects, we use an exogenous shock to the market due to the release of a Bollywood blockbuster movie - My Name is Khan (MNIK) where the protagonist, superstar Shahrukh Khan, suffers from Asperger's Syndrome (AS). Using a difference-in-differences design, we find a positive and statistically significant effect of MNIK (between 14% and 22% increase in variety sold and prescribed) on product differentiation and choices in the market for antipsychotic medicines used to clinically treat AS. Results are consistent using alternative controls, a placebo treatment-based test and with a variety of other robustness checks. Our findings document likely for the first-time, supply side responses to edutainment and suggests potential associated welfare effects in healthcare markets characterized by sticky demand. Implications for global health and public policy given worldwide concerns around a mental wellness epidemic with Covid-19 are discussed.
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Affiliation(s)
| | - Anindya S Chakrabarti
- Economics Area, IIM Ahmedabad, Ahmedabad, India, Science Policy Research Unit, Business School, University of Sussex, Brighton, UK
| | - Chirantan Chatterjee
- Science Policy Research Unit, Business School, University of Sussex, IIM Ahmedabad & Hoover Institution, Stanford University, Brighton, UK
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Vliegenthart-Jongbloed K, Jacobs J. Not recommended fixed-dose antibiotic combinations in low- and middle-income countries - the example of Tanzania. Antimicrob Resist Infect Control 2023; 12:37. [PMID: 37076936 PMCID: PMC10116708 DOI: 10.1186/s13756-023-01238-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Fixed-dose combinations (FDC) are medicine formulations that combine two or more ingredients in fixed ratios in a single dose form. Although advantageous in tuberculosis and malaria (efficacy, adherence, protection against resistance), only a few antibiotic FDC (FDC-AB) have been developed along full microbiological, pharmacological and clinical validation and safety studies. The World Health Organization (WHO) database of Access, Watch and Reserve (AWaRe) antibiotics contains, since 2021, a list of "Not Recommended" FDC-AB (n = 103) which are rejected for use in clinical practice. BODY: The share of non-recommended FDC-AB in global antimicrobial use (2000-2015) was < 3% but substantially higher in middle income countries. The share increases over time, but recent data particular concerning sub-Saharan Africa are rare. Along three non-recommended FDC-AB listed in the Tanzanian National Essential Medicine List (ampicillin-cloxacillin, flucloxacillin-amoxicillin and ceftriaxone-sulbactam) we discuss the concerns and reasons behind use of these products. Non-recommended FDC-AB have poor rationale (ratios of both ingredients), lack evidence of efficacy (pharmacological, microbiological and clinical), have difficulties in dosing (underdosing of the single ingredients, absence of pediatric dosing) and risks of safety (additive toxicity). They are expected to fuel antimicrobial resistance (unnecessary broad spectrum coverage) and are incompatible with antimicrobial stewardship. The specific context of low- and middle-income countries contributes to their increased use: at the side of prescriber and supplier are the lack of diagnostics, poor training in antibiotic prescribing, patients' preferences, role-model of senior prescribers and pharmaceutical promotion. International market mechanisms include economic motivation for development, branding and promotion, poor access to the single antibiotic forms and weak national regulatory capacity. CONCLUSION AND IMPLICATIONS There is an urgent need for monitoring consumption of non-recommended FDC-AB in low- and middle-income countries, particular in Sub-Saharan Africa. A multinational and multisectoral antimicrobial stewardship strategy is needed in order to abolish the use of non-recommended FDC-AB.
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Affiliation(s)
- Klaske Vliegenthart-Jongbloed
- Haydom Lutheran Hospital, Haydom, United Republic of Tanzania.
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands.
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Aggarwal M, Chakrabarti AS, Chatterjee C, Higgins MJ. Research and market structure: Evidence from an antibiotic-resistant pathogenic outbreak. RESEARCH POLICY 2023. [DOI: 10.1016/j.respol.2022.104633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bhaskarabhatla A, Anurag P, Chatterjee C, Pennings E. How Does Regulation Impact Strategic Repositioning by Firms Across Submarkets? Evidence from the Indian Pharmaceutical Industry. STRATEGY SCIENCE 2021. [DOI: 10.1287/stsc.2020.0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We study coercive institutional pressures as an impetus for firms to reposition across intraindustry boundaries. Integrating the literatures on strategic repositioning and submarkets, we predict that firms respond to regulations limiting the profitability of a submarket by repositioning and shifting demand to proximate, unregulated submarkets within the industry. We expect repositioning to be more pronounced for firms with greater ability to shift demand across submarkets. Evidence from pharmaceutical firms’ responses to partial price regulation in India supports our hypotheses. Repositioning firms increase prices and sales in the unregulated submarket, consistent with a Dorfman–Steiner-type model of endogenous and costly demand shifting toward the unregulated submarket. We contribute to the literature on strategic repositioning and highlight challenges of regulating industries with internal boundaries and insulated niches.
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Affiliation(s)
- Ajay Bhaskarabhatla
- Erasmus School of Economics, Erasmus University Rotterdam, 3000 DR Rotterdam, Netherlands
| | - Priyatam Anurag
- Indian Institute of Management Lucknow, Uttar Pradesh 226013, India
| | | | - Enrico Pennings
- Erasmus School of Economics, Erasmus University Rotterdam, 3000 DR Rotterdam, Netherlands
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Lexchin J. Drug Promotion in India Since 2000: Problems Remain. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:392-403. [PMID: 32538245 DOI: 10.1177/0020731420932109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pharmaceutical companies engage heavily in promoting their products worldwide, and India is no exception. This article begins with an analysis of the therapeutic value of medications on the Indian market because, by definition, if a drug has no therapeutic value or has a negative benefit-to-harm ratio, then any promotion of that drug is inappropriate. It then examines 2 Indian case studies: drug promotion in Mumbai and the misuse of the World Health Organization logo in promotion. Next it describes specific types of promotion: advertisements in medical journals, brochures, and pamphlets; the actions of sales representatives; and the content of continuing medical education courses and medical conferences. The next sections examine medical students' and trainees' exposure to promotion and their attitudes about promotion; the attitudes of doctors about their interactions with the pharmaceutical industry; and whether promotion has an influence on prescribing. The article concludes with a critique of the existing industry, professional, and government regulatory regimes in India.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Damlin A, Sharma M, Marrone G, Stålsby Lundborg C. Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India - a time series analysis over 10 years. BMC Infect Dis 2020; 20:340. [PMID: 32404055 PMCID: PMC7218632 DOI: 10.1186/s12879-020-05059-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/28/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antibiotic resistance is an emerging problem caused due to antibiotic use. In countries with high rates of infectious diseases, antibiotic resistance is a frequent cause of mortality. The aim was to analyse antibiotic prescribing practices between 2008 and 2017 in a teaching (TH) and a non-teaching (NTH) hospital, as typical hospitals of low- and middle-income countries, and to compare antibiotic prescribing for severe infectious indications for which empiric antibiotic treatment is recommended. METHODS Data from adult patients registered at two Indian private-sector hospitals with one of the following indications: epiglottitis, pneumonia, peritonitis, pyelonephritis, cellulitis, erysipelas, septic arthritis, endocarditis, meningitis or sepsis; were included and analysed. Antibiotic prescription data was analyzed using the World Health Organization's (WHO) Anatomical Therapeutic Chemical classification system and the Defined Daily Doses. Chi-square and linear regression were used to compare the data between groups. Time series analyses were conducted using linear regression. P-values < 0.05 were considered significant. RESULTS In total, 3766 patients were included, 2504 inpatients in the NTH and 1262 in the TH, of which 92 and 89% patients, respectively, were prescribed antibiotics. Sixty-one percent of total prescriptions in the TH and 40% in the NTH comprised the access category of antibiotics (i.e. the first-choice of treatment according to the WHO). The WHO's second-choice of treatment, the watch category, comprised 29 and 40% of total prescriptions in the TH and NTH, respectively. Prescribing of fixed-dose combinations (FDCs) of antibiotics was significantly higher in the NTH (18%) than in the TH (8%, P < 0.05). Prescribing of watch antibiotics and FDCs increased significantly in both hospitals between 2008 and 2017 among patients with pneumonia, cellulitis and peritonitis (P < 0.05). CONCLUSIONS Prescribing of watch antibiotics and FDCs of antibiotics increased over time at both hospitals, indicating under prescribing of access antibiotics and more prescribing of second-choice antibiotics. The results can be used to highlight the areas of improvement in similar settings. Implementing diagnostic routines and local prescribing guidelines could improve the prescribing practices.
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Affiliation(s)
- Anna Damlin
- Department of Global Public Health, Health Systems and Policy. Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Megha Sharma
- Department of Global Public Health, Health Systems and Policy. Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, 456006 Surasa, Ujjain, India
| | - Gaetano Marrone
- Department of Global Public Health, Health Systems and Policy. Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy. Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Chatterjee C, Mohapatra DP, Estay M. From courts to markets: New evidence on enforcement of pharmaceutical bans in India. Soc Sci Med 2019; 237:112480. [DOI: 10.1016/j.socscimed.2019.112480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
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