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El Bairi K, Najem S, Chowdhury AR, Omar A, Abdihamid O, Teuwen LA, Benhima N, Madariaga A, Elkefi S, Diaz FC, Hussain S, Jenei K, Hammad N, Mutebi M, Rubagumya F, Trapani D, El Kadmiri N, Laouali N, Fourtassi M. Conflict of Interest Disclosure in Oncology: Preliminary Insights From the Global ONCOTRUST-1 Cross-Sectional Study. JCO Glob Oncol 2024; 10:e2400167. [PMID: 38822759 DOI: 10.1200/go.24.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/03/2024] Open
Abstract
PURPOSE Conflicts of interest (COIs) between oncologists and industry might considerably influence how the presentation of the research results is delivered, ultimately affecting clinical decisions and policy-making. Although there are many regulations on reporting COI in high-income countries (HICs), little is known about their reporting in low- and middle-income countries (LMICs). Oncology Transparency Under Scrutiny and Tracking (ONCOTRUST-1) is a pilot global survey to explore the knowledge and perceptions of oncologists regarding COI. MATERIALS AND METHODS We designed an online 27-question-based survey in the English language to explore the perceptions and knowledge of oncologists regarding COI, with an emphasis on LMICs. Descriptive statistics and the Consensus-Based Checklist for Reporting of Survey Studies guidelines were used to report the findings. RESULTS ONCOTRUST-1 surveyed 200 oncologists, 70.9% of them practicing in LMICs. Median age of the respondents was 36 (range, 26-84) years; 47.5% of them were women. Of the respondents, 40.5% reported weekly visits by pharmaceutical representatives to their institutions. Regarding oncologists' perceptions of COI that require disclosure, direct financial benefits, such as honoraria, ranked highest (58.5%), followed by gifts from pharmaceutical representatives (50%) and travel grants for attending conferences (44.5%). By contrast, personal or institutional research funding, sample drugs, consulting or advisory board, expert testimony, and food and beverage funded by pharmaceutical industry were less frequently considered as COI. Moreover, only 24% of surveyed oncologists could correctly categorize all situations representing a COI. CONCLUSION These findings underscore the importance of clear guidelines, education, and transparency in reporting COI in oncology. This hypothesis-generating pilot survey provided the rationale for ONCOTRUST-2 study, which will compare perceptions of COI among oncologists in LMICs and HICs.
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Affiliation(s)
- Khalid El Bairi
- Faculty of Medical Sciences, University Mohammed VI Polytechnic, Ben Guerir, Morocco
| | - Salma Najem
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | | | - Abeid Omar
- Department of Oncology and Nuclear Medicine, Research and Referral Hospital Kenyatta Teaching University, Nairobi, Kenya
| | - Omar Abdihamid
- Garissa Cancer Center, Garissa County Hospital, Garissa, Kenya
| | - Laure-Anne Teuwen
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Nada Benhima
- Medical Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Ainhoa Madariaga
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Safa Elkefi
- School of Nursing, Columbia Medical School, Columbia University, New York, NY
| | - Fernando Cristobal Diaz
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Sadaqat Hussain
- Oncology Department, University Hospital of Leicester, Licester, United Kingdom
| | - Kristina Jenei
- Health Policy Department, London School of Economics and Political Science, London, United Kingdom
| | - Nazik Hammad
- Division of Hematology-Oncology, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Dario Trapani
- Division of Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
- University of Milan, Milan, Italy
| | - Nadia El Kadmiri
- Molecular Engineering, Biotechnology, and Innovation Team, Geo-Bio-Environment Engineering and Innovation Laboratory, Polydisciplinary Faculty of Taroudant, Ibn Zohr University, Taroudannt, Morocco
| | - Nasser Laouali
- Faculty of Medical Sciences, University Mohammed VI Polytechnic, Ben Guerir, Morocco
| | - Maryam Fourtassi
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tetuan, Morocco
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Noor MN, Liverani M, Bryant J, Rahman-Shepherd A, Sharif S, Aftab W, Shakoor S, Khan M, Hasan R. The healthcare field as a marketplace: general practitioners, pharmaceutical companies, and profit-led prescribing in Pakistan. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:198-212. [PMID: 36322797 DOI: 10.1080/14461242.2022.2139628] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/10/2022] [Indexed: 05/18/2023]
Abstract
Incentivisation of general practitioners (GPs) by pharmaceutical companies is thought to affect prescribing practices, often not in patients' interest. Using a Bourdieusian lens, we examine the socially structured conditions that underpin exchanges between pharmaceutical companies and GPs in Pakistan. The analysis of qualitative interviews with 28 GPs and 13 pharmaceutical sales representatives (PSRs) shows that GPs, through prescribing medicines, met pharmaceutical sales targets in exchange for various incentives. We argue that these practices can be given meaning through the concept of 'field' - a social space in which GPs, PSRs, and pharmacists were hierarchically positioned, with their unique capacities, to enable healthcare provision. However, structural forces like the intense competition between pharmaceutical companies, the presence of unqualified healthcare providers in the healthcare market, and a lack of regulation by the state institutions produced a context that enabled pharmaceutical companies and GPs to use the healthcare field, also, as space to maximise profits. GPs believed the effort to maximise incomes and meet socially desired standards were two key factors that encouraged profit-led prescribing. We conclude that understanding the healthcare field is an important step toward developing governance practices that can address profit-led prescribing.
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Affiliation(s)
- Muhammad Naveed Noor
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Marco Liverani
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanne Bryant
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Afifah Rahman-Shepherd
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sabeen Sharif
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Mishal Khan
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Rumina Hasan
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Khan M, Rahman-Shepherd A, Noor MN, Sharif S, Hamid M, Aftab W, Isani AK, Khan RI, Hasan R, Shakoor S, Siddiqi S. Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001890. [PMID: 37384598 DOI: 10.1371/journal.pgph.0001890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/12/2023] [Indexed: 07/01/2023]
Abstract
Focus on profit-generating enterprise in healthcare can create conflicts of interest that adversely impact prescribing and pricing of medicines. Although a global challenge, addressing the impacts on quality of care is particularly difficult in countries where the pharmaceutical industry and physician lobby is strong relative to regulatory institutions. Our study characterises the range of incentives exchanged between the pharmaceutical industry and physicians, and investigates the differences between incentivisation practices and policies in Pakistan. In this mixed methods study, we first thematically analysed semi-structured interviews with 28 purposively selected for-profit primary-care physicians and 13 medical sales representatives from pharmaceutical companies working across Pakistan's largest city, Karachi. We then conducted a content analysis of policies on ethical practice issued by two regulatory bodies responsible in Pakistan, and the World Health Organization. This enabled a systematic comparison of incentivisation practices with what is considered 'prohibitive' or 'permissive' in policy. Our findings demonstrate that incentivisation of physicians to meet pharmaceutical sales targets is the norm, and that both parties play in the symbiotic physician-pharma incentivisation dynamics. Further, we were able to categorise the types of incentive exchanged into one of five categories: financial, material, professional or educational, social or recreational, and familial. Our comparison of incentivisation practices with policies revealed three reasons for such widespread incentivisation linked to sales targets: first, some clear policies were being ignored by physicians; second, there are ambiguous or contradictory policies with respect to specific incentive types; and third, numerous incentive types are unaddressed by existing policies, such as pharmaceutical companies paying for private clinic renovations. There is a need for policies to be clarified and updated, and to build buy-in for policy enforcement from pharmaceutical companies and physicians, such that transgressions on target-driven prescribing are seen to be unethical.
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Affiliation(s)
- Mishal Khan
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Afifah Rahman-Shepherd
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Muhammad Naveed Noor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sabeen Sharif
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Meherunissa Hamid
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wafa Aftab
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Saito S, Mukohara K, Shimomura K, Murotani K. Changes in Japanese physicians' relationships with the pharmaceutical industry between 2008 and 2021: A national survey. PLoS One 2023; 18:e0286339. [PMID: 37262046 DOI: 10.1371/journal.pone.0286339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/12/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND A national survey we conducted in 2008 showed that many Japanese physicians interacted with and received gifts from pharmaceutical representatives (PRs) and had a positive attitude toward relationships with PRs. The revised promotion code of the Japan Pharmaceutical Manufacturers Association in 2019 prohibited the provision of non-educational promotional aids including sticky notes, mouse pads, and calendars. During the COVID-19 pandemic in 2020, face-to-face meetings were socially restricted. This study assessed the extent of current Japanese physicians' involvement in pharmaceutical promotional activities and their attitudes toward relationships with PRs and to ascertain any changes between 2008 and 2021. We also examined the factors that predicted positive attitudes toward gifts from PRs. METHODS From January to March 2021, we conducted a national mail survey of Japanese physicians in seven specialties: internal medicine, surgery, orthopedics, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. RESULTS There were 1636 participants and the response rate was 63.2%. Most physicians met face-to-face with PRs (78.8%), whereas only a minority received meals outside the workplace (4.5%). PRs were thought to have an important role in continuing medical education (66.1%) and to provide accurate information about new drugs (74.2%). Opinions were divided on the appropriateness of gifts from PRs. Most thought that stationery and meals provided by the industry did not affect prescribing behavior (89.7% and 75.8%, respectively). Factors that predicted a positive attitude toward gifts from PRs were male, orthopedic specialty vs. internal medicine, more interactions with PRs, a positive attitude toward informational value, and no rules banning meetings with PRs. CONCLUSION Involvement in pharmaceutical promotional activities is still common among practicing physicians in Japan, although the extent of the involvement had declined. Rules banning meetings with PRs appear to continue being effective at limiting a physician's involvement with promotional activities and their critical attitudes toward gifts from PRs.
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Affiliation(s)
- Sayaka Saito
- Department of General Medicine, National Hospital Organization Kasumigaura Medical Center, Tsuchiura, Ibaraki, Japan
| | - Kei Mukohara
- Department of General and Family Medicine, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Kazuhiro Shimomura
- Department of Biostatistics, Graduate School of Medicine, Kurume University, Kurume, Fukuoka, Japan
- Department of Pharmacy, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Kurume, Fukuoka, Japan
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Rubagumya F, Mutebi M, Manirakiza A, Abdihamid O, Mushonga M, Vanderpuye V, Hammad N, Booth CM. Pharmaceutical industry relationships with oncologists in sub-Saharan Africa. Lancet Oncol 2023; 24:e96-e101. [PMID: 36725154 DOI: 10.1016/s1470-2045(22)00639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 02/03/2023]
Abstract
Health-care systems in sub-Saharan Africa are considered to be new markets for pharmaceutical companies. This perception is particularly relevant within oncology, as the pharmaceutical industry has changed strategic priorities in the past 10 years to focus on cancer. Since the 1930s, pharmaceutical companies have used advertisements, sample drugs, gifts, paid speaking engagements, advisory boards, and trips to conferences to influence clinical practice and policy. A large amount of literature describes the commonness of these practices and their effects on the behaviour of doctors. However, these data come almost exclusively from high-income countries. Industry-doctor relationships are increasingly common in sub-Saharan Africa and other low-income and middle-income countries. Although there are undoubtedly risks of industry engagement in low-income and middle-income countries, many programmes with educational, research, and clinical value would not occur in these countries without industry support. Thus, what is known about these relationships in high-income countries will not necessarily apply in low-income and middle-income countries. There is a need for widespread discussion about industry-oncologist interactions across the African continent and context-specific data to understand the potential risks and benefits of these relationships.
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Affiliation(s)
- Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda; Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | | | - Omar Abdihamid
- Garissa Cancer Center, Garissa County Referral Hospital, Garissa, Kenya
| | | | - Verna Vanderpuye
- Department of Oncology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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Fadare JO, Bankole I, Babatola A, Simeon Olatunya O, Aina F, Godman B. Adherence to WHO Criteria on Drug Promotion Literature: An Exploratory Study From a Tertiary Healthcare Facility in South-West Nigeria. Hosp Pharm 2023; 58:62-69. [PMID: 36644744 PMCID: PMC9837328 DOI: 10.1177/00185787221123217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: In many low and middle-income countries (LMIC), drug promotional literature (DPL) remains one of the main sources of drug information for physicians. Studies conducted in many LMICs showed poor compliance to the WHO guidelines for ethical drug promotion especially in the area of information about excipients, adverse drug reactions, drug-drug interactions and contra-indications. These inadequacies in the information provided may mislead the prescriber with potential adverse consequences among patients using the medicines. Nigeria has a big pharmaceutical sector which is poorly regulated and we hypothesize that such unethical drug promotional practices may exist. This study therefore set out to assess compliance to the WHO ethical drug promotion (using DPL) at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, South-West Nigeria. Methodology: This was a descriptive cross-sectional study conducted in several specialist clinics of EKSUTH, Ado-Ekiti. Printed DPLs (brochures and leaflets) were collected from these clinics, collated using a pre-designed data collection form and analyzed using the WHO ethical criteria for medicinal drug promotion. Results:Two hundred seventy-five DPLs were screened A total of out of which 234 DPLs were selected after screening to after removal of duplications. Only 5 (2.1%) DPLs met all the WHO criteria. DPLs promoting antibiotics, cardiovascular drugs, and vitamins/nutritional supplements were in the majority (22.2%, 17.1%, and 11.5% respectively. Most of the DPLs had the generic (223; 95.3%) and brand (234; 100%) names, active ingredients (209; 89.3%), excipients (149; 63.7%), and indications (232; 99.1%). Information about adverse drug reactions (76; 32.5%), contra-indications (73; 31.2%), and drug interactions (46; 19.7%) was less represented. Only 59 (25.2%) DPLs had references. Fixed-dose combination drugs made up 34.6% of drugs being promoted. Conclusion:The DPLs assessed in this study had low adherence to WHO ethical drug promotion criteria especially those related to adverse drug reaction, drug interactions, and contra-indications.
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Affiliation(s)
- Joseph O. Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
| | - Iyanu Bankole
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Adefunke Babatola
- Department of Paediatrics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
- Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oladele Simeon Olatunya
- Department of Paediatrics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
- Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Felix Aina
- Department of Family Medicine, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Zarei E, Ghaffari A, Nikoobar A, Bastami S, Hamdghaddari H. Interaction between physicians and the pharmaceutical industry: A scoping review for developing a policy brief. Front Public Health 2023; 10:1072708. [PMID: 36711334 PMCID: PMC9879663 DOI: 10.3389/fpubh.2022.1072708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Background Payments to physicians by the pharmaceutical industry are common, but recent evidence shows that these payments influence physician prescribing behavior in the form of increased prescription of brand-name drugs, expensive and low-cost drugs, increased prescription of payer company drugs, etc. Considering that these payments increase drug costs for patients and health systems, there is a public interest in controlling them. Therefore, this study aimed to identify and propose policy options for managing physician-pharmaceutical industry interactions in the context of Iran's health system. Methods In the first phase, a systematic search was conducted to identify relevant policies and interventions in Web of Science, PubMed, and ProQuest databases from 2000 to 2022. Then, the opinions of the research team and an expert group (physicians, health policy and transparency experts, and industry representatives) were used to categorize the interventions and propose policy options along with their advantages, disadvantages, and implementation considerations. Results In the search, 579 articles were retrieved, and 44 articles were found suitable for the final analysis. Twenty-nine interventions and strategies were identified, and based on these; Five policy options were identified: prohibition, restriction, physician self-regulation, voluntary industry disclosure, and mandatory industry disclosure. Conclusion The proposed policies in our study include advantages, challenges, and implementation considerations based on up-to-date evidence that can help policymakers use them to manage COI in physician-pharmaceutical industry interactions in Iran's health system. A combination of measures seems to help manage COI: firstly, using self-regulating physicians and industry to institutionalize transparency, and in the next step, implementing mandatory industry disclosure policies and establishing restrictions on some financial interactions.
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Affiliation(s)
- Ehsan Zarei
- Department of Health Service Management, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ghaffari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Nikoobar
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shayan Bastami
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Hamdghaddari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Ali KE, Naser AY, Al-Rousan R, Alwafi H, AbuAlhommos AK, Alsairafi ZK, Salawati EM, Samannodi M, Dairi MS. The attitude and acceptability towards medical promotional tools and their influence on physicians' prescribing practices in Jordan and Iraq: a cross-sectional study. BMC Health Serv Res 2022; 22:105. [PMID: 35078461 PMCID: PMC8790844 DOI: 10.1186/s12913-022-07525-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pharmaceutical companies spend more than one-third of their sales revenue on marketing and promotion directed toward healthcare professionals. There has been a focus on the relationship between healthcare professionals and the pharmaceutical industry in recent years. This study aims to explore the attitude toward and acceptability of medical promotional tools and their influence on physicians’ prescribing practices in Jordan and Iraq. Methods A cross-sectional survey study was conducted to explore the influence of visits by medical representatives (MRs) and medical promotions on physicians’ prescribing practices between June and October 2020 in Jordan and Iraq. Previously validated questionnaires were used. Results A total of 801 physicians completed the questionnaires. Face-to-face visits, followed by the dispensing of medical samples, were the two most common promotional methods used by MRs. 48% of participating physicians reported that they would accept the promotional marketing tools offered to them. MRs focused on the key selling points of their product during medical promotions, and 39.6% of the physicians reported that MRs had a negative attitude toward their competitors’ products. 69.9% of the physicians reported that they would change their practice after participating in conferences or meetings. Conclusion Medical promotional tools have a clear influence on physicians’ prescribing practices in Jordan and Iraq. Therefore, medical promotion should be controlled and guided by clear and country-specific ethical guidelines. This will ensure safe medical promotion to physicians and optimise the healthcare practices provided to patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07525-1.
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Affiliation(s)
- Karrar Ehsan Ali
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.,Inpatient pharmacy department, General Hospital in Al Diwaniyah, Al Qadisiyah, Al Diwaniyah, Iraq
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Rabaa Al-Rousan
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura university, Mecca, Saudi Arabia
| | - Amal Khaleel AbuAlhommos
- Pharmacy Practice Department, Clinical Pharmacy College, King Faisal University, Alhasa, Al Hofuf, Saudi Arabia
| | | | - Emad M Salawati
- Family medicine Department, Faculty of medicine, King Abdulaziz university, Jeddah, Saudi Arabia
| | | | - Mohammad S Dairi
- Faculty of Medicine, Umm Al-Qura university, Mecca, Saudi Arabia
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Sulis G, Sayood S, Gandra S. Antimicrobial resistance in low- and middle-income countries: current status and future directions. Expert Rev Anti Infect Ther 2021; 20:147-160. [PMID: 34225545 DOI: 10.1080/14787210.2021.1951705] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Rising rates of antimicrobial resistance (AMR) globally continue to pose agrave threat to human health. Low- and middle-income countries (LMICs) are disproportionately affected, partly due to the high burden of communicable diseases.Areas covered: We reviewed current trends in AMR in LMICs and examined the forces driving AMR in those regions. The state of interventions being undertaken to curb AMR across the developing world are discussed, and the impact of the current COVID-19 pandemic on those efforts is explored.Expert opinion: The dynamics that drive AMR in LMICs are inseparable from the political, economic, socio-cultural, and environmental forces that shape these nations. The COVID-19 pandemic has further exacerbated underlying factors that increase AMR. Some progress is being made in implementing surveillance measures in LMICs, but implementation of concrete measures to meaningfully impact AMR rates must address the underlying structural issues that generate and promote AMR. This, in turn, will require large infrastructural investments and significant political will.
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Affiliation(s)
- Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Sena Sayood
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis
| | - Sumanth Gandra
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis
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10
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Roberts‐Thomson IC. Ethics, gastroenterologists, and pharmaceutical and equipment companies. JGH Open 2020; 4:1025-1026. [PMID: 33319032 PMCID: PMC7731820 DOI: 10.1002/jgh3.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/06/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Ian C Roberts‐Thomson
- Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
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11
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Matlala M, Gous AGS, Meyer JC, Godman B. Formulary Management Activities and Practice Implications Among Public Sector Hospital Pharmaceutical and Therapeutics Committees in a South African Province. Front Pharmacol 2020; 11:1267. [PMID: 32973508 PMCID: PMC7466677 DOI: 10.3389/fphar.2020.01267] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/31/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction The World Health Organization identified Pharmaceutical and Therapeutics Committees (PTCs) at district and hospital levels as one of the pivotal models to promote rational use of medicines (RUM). This is endorsed by the Government in South Africa. Formulary development and management is one of the main functions of PTCs. This study aimed to describe the formulary management activities among PTCs in public hospitals in Gauteng Province, South Africa, following initiatives to promote RUM in South Africa. Methods Qualitative, nonparticipatory, observational study, observing 26 PTC meetings. Data were coded and categorized using NVivo9® qualitative data analysis software. Themes and sub-themes were developed. The themes and sub-themes on formulary management are the principal focus of this paper. Results More than half of the observed PTCs reviewed their formulary lists. There was variation in the review process among institutions providing different levels of care. Various aspects were considered for formulary management especially requests for medicines to be added. These included cost considerations (mainly focusing on acquisition costs), evidence-based evaluation of clinical trials, patient safety, clinical experience and changes in the National Essential Medicines List (NEML). The tertiary PTCs mostly dealt with applications for new non-EML medicines, while PTCs in the other hospitals mainly requested removal or addition of EML medicines to the list. Conclusion This is the first study from Gauteng Province, South Africa, reporting on how decisions are actually taken to include or exclude medicines onto formularies within public sector hospitals providing different levels of care. Various approaches are adopted at different levels of care when adding to- or removing medicines from the formulary lists. Future programs should strengthen PTCs in specialized aspects of formulary management. A more structured approach to formulary review at the local PTC level should be encouraged in line with the national approach when reviewing possible additions to the NEML.
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Affiliation(s)
- Moliehi Matlala
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa
| | - Andries G S Gous
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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12
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Ebrahimi A, Zand S, Bagheri Amiri F, Shahi F, Jafarian A, Kaviani A. Conflict of Interest: Are Iranian Breast Cancer Specialists Prone to it? Asian Pac J Cancer Prev 2020; 21:1653-1658. [PMID: 32592360 PMCID: PMC7568883 DOI: 10.31557/apjcp.2020.21.6.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Giving gifts is a common way to promote and encourage the use of products of trading companies and increase the patient referrals to diagnostic centers. The present study aimed to assess the practice of physicians of different (sub) specialties/educational levels engaged in breast cancer management in some conflict of interest (COI) situations in their relation with pharmaceutical companies and paraclinical centers. Methods: A self-administered online questionnaire including questions on demographic and professional information as well as the attitude of physicians toward COI by answering the questions in three different practical scenarios was developed. Respondents were asked to answer each question by selecting one of the five options: strongly agree, agree, undecided/neutral, disagree, and strongly disagree in their own practices as well as the same questions asking the same subject for what they think of the other physicians. Descriptive statistical analysis was used to report qualitative and quantitative variables. Result: The response rate was 66.24%. In general, physicians considered their performance better than that of other physicians in the situations asked. More than 90% stated that they would participate in the sponsorship congress for introducing new drugs. One fifth of the physicians stated that they would accept the 30% financial proposition for the referral of every single patient to other clinics. More than half of the physicians stated that they had considered the risks resulted from the COI for referring patients to private radiobiological centers. Conclusion: This study indicated that physicians in the field of breast cancer were at the risk of COI. Even within the medical field, there is not sufficient trust in the proper functioning of doctors in dealing with COI situations.
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Affiliation(s)
- Amirpasha Ebrahimi
- Department of Surgery, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sanaz Zand
- Department of Research, Kaviani Breast Diseases Institute(KBDI), Tehran, Iran
| | - Fahimeh Bagheri Amiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Shahi
- Department of Internal Medicine, Cancer Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Jafarian
- Department of Surgery, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ahmad Kaviani
- Department of Surgery, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Breast Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Surgical Oncology, University de Montreal, Montreal, Canada
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Fernández-Álvarez I, Zapata-Cachafeiro M, Vázquez-Lago J, López-Vázquez P, Piñeiro-Lamas M, García Rodríguez R, Figueiras A. Pharmaceutical companies information and antibiotic prescription patterns: A follow-up study in Spanish primary care. PLoS One 2019; 14:e0221326. [PMID: 31437201 PMCID: PMC6706057 DOI: 10.1371/journal.pone.0221326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 08/06/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess the impact of sources of drug information on antibiotic prescribing patterns (quantity and quality) among primary care physicians. Methods We conducted a cohort study on primary care physicians who were actively engaged in medical practice in 2010 in a region in north-west Spain (Galicia), fulfilling inclusion criteria (n = 2100). As the independent variable, we took the perceived utility of 6 sources of information on antibiotics, as measured by the validated KAAR-11 questionnaire. As dependent variables, we used: (1) a quality indicator (appropriate quality, defined as any case where 6 of the 12 indicators proposed by the European Surveillance of Antimicrobial Consumption Network [ESAC-Net] were better than the mean values for Spain); and, (2) a quantity indicator (high prescribing), defined as any case where defined daily doses (DDD) per 1 000 inhabitants per day of antibacterials for systemic use were higher than the mean values for Spain. The adjusted odds ratio for a change in the interquartile range (IqOR) for each sources of information on antibiotics was calculated using Generalized Linear Mixed Models. Results The questionnaire response rate was 68%. Greater perceived utility of pharmaceutical sales representatives increases the risk of having high prescribing (1/IqOR = 2.50 [95%CI: 1.63–3.66]) and reduces the probability of having appropriate quality (1/IqOR = 2.28 [95%CI: 1.77–3.01]). Greater perceived utility of clinical guidelines increases the probability of having appropriate quality (1/IqOR = 1.25 [95%CI: 1.02–1.54]) and reduces the probability of high prescribing (1/IqOR = 1.25 [95%CI: 1.02–1.54]). Conclusions Sources of information on antibiotics are an important determinant of the quantity and quality of antibiotic prescribing in primary care. Commercial sources of information influence prescribing negatively, and clinical guidelines are associated with better indicators.
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Affiliation(s)
- Iria Fernández-Álvarez
- Preventive Medicine Service, Santiago de Compostela University Teaching Hospital, Santiago de Compostela, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
| | - Juan Vázquez-Lago
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Paula López-Vázquez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | | | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- * E-mail:
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Akl EA, Khamis AM. The intersections of industry with the health research enterprise. Health Res Policy Syst 2019; 17:53. [PMID: 31142343 PMCID: PMC6542139 DOI: 10.1186/s12961-019-0457-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/30/2019] [Indexed: 01/05/2023] Open
Abstract
There is increased awareness of the negative impact of large multinational corporations - the 'industry' - on public health. These corporations have established different types of relationships with a number of actors in the field of health research. This Commentary explores the different types of relationships between the industry and the actors of health research, how they intersect with the different research steps, and how these relationships allow the industry to exert influence. The types of relationships discussed consist of funding of research, direct relationships with the actors of research (namely advocacy groups, funding agencies, experts, professional organisations, regulatory agencies and health practitioners), and the influencing research standards. The potentially influenced research steps either precede the research (i.e. the prioritisation of research question), relate to it directly (i.e. its planning, conduct, reporting, dissemination and evaluation), or build on it (i.e. regulatory approval, integration into guidelines and adoption into practice). In conclusion, the industry has successfully fostered relationships with almost every actor of the health research enterprise and is using these relationships to influence the different steps of health research. The degree of influence the industry is having on health research calls for more work on managing the relationships discussed herein.
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Affiliation(s)
- Elie A. Akl
- Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020 Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario Canada
| | - Assem M. Khamis
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
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Hutchinson E, Balabanova D, McKee M. We Need to Talk About Corruption in Health Systems. Int J Health Policy Manag 2019; 8:191-194. [PMID: 31050963 PMCID: PMC6499907 DOI: 10.15171/ijhpm.2018.123] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/09/2018] [Indexed: 11/09/2022] Open
Abstract
The health sector consistently appears prominently in surveys of perceived corruption, with considerable evidence that this has serious adverse consequences for patients. Yet this issue is far from prominent in the international health policy discourse. We identify five reasons why the health policy community has been reluctant to talk about it. These are the problem of defining corruption, the fact that some corrupt practices are actually ways of making dysfunctional systems work, the serious challenges to researching corruption, concerns that a focus on corruption is a form of victim blaming that ignores larger issues, and a lack of evidence about what works to tackle it. We propose three things that can be done to address this situation. First, seek consensus on the scale and nature of corruption. Second, decide on priorities, taking account the importance of the particular problem and the feasibility of doing something about it. Third, take a holistic view, drawing on a wide range of disciplines.
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Affiliation(s)
- Eleanor Hutchinson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- Department of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
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