1
|
Gupta R, Ramachandran R, Ross JS. Tackling the excesses of pharmaceutical marketing and promotion. BMJ 2024; 385:e076797. [PMID: 38772671 DOI: 10.1136/bmj-2023-076797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Ravi Gupta
- Divison of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Reshma Ramachandran
- Collaboration for Regulatory Rigor, Integrity, and Transparency (CRRIT), Yale School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine and National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
| | - Joseph S Ross
- Collaboration for Regulatory Rigor, Integrity, and Transparency (CRRIT), Yale School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine and National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT, USA
| |
Collapse
|
2
|
Lexchin J. Complaints about Violations of Voluntary and Pharmaceutical Industry-Run Medicine Promotion Codes in Canada. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2023; 53:518-527. [PMID: 36938584 PMCID: PMC10631264 DOI: 10.1177/27551938231165158] [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: 11/03/2022] [Revised: 01/12/2023] [Accepted: 02/09/2023] [Indexed: 03/21/2023]
Abstract
Although regulation of pharmaceutical promotion in Canada is covered under the Food & Drugs Act and Regulations, in practice it is regulated by two codes, one a code administered by the Pharmaceutical Advertising Advisory Board and a second one controlled by Innovative Medicines Canada, the lobby organization for the large majority of the Canadian and foreign-owned pharmaceutical companies operating in Canada. This study examines complaints about code violations between 2012 and 2021 and puts those complaints and their outcomes into the context of the stringency of the codes, their governance, monitoring, penalties for violations, and compliance by companies. It combines the findings from this analysis with international experience with industry-run codes and concludes that overall, the Canadian codes are ineffective in controlling promotion. Finally, it offers recommendations for how regulation can be improved and how doctors' reliance on information from pharmaceutical companies can be reduced.
Collapse
Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
3
|
Mulinari S, Ozieranski P. Unethical pharmaceutical marketing: a common problem requiring collective responsibility. BMJ 2023; 382:e076173. [PMID: 37726130 DOI: 10.1136/bmj-2023-076173] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Shai Mulinari
- Department of Sociology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| |
Collapse
|
4
|
Astărăstoae V, Rogozea LM. Against Authority: The Bioethics of Ivermectin Use for COVID-19 Infection. Am J Ther 2023:00045391-990000000-00143. [PMID: 37068020 DOI: 10.1097/mjt.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic has brought new ethical challenges to both health care professionals and the general public. Among the ethical problems amplified during this period were the making of medical decisions to quickly introduce some drugs into therapeutic practice with unproven or insufficiently proven effects (such as ivermectin), the validity of drug testing, and the allocation of limited resources. FIELDS OF UNCERTAINTY The COVID-19 pandemic brought to the attention of the entire scientific world a new problem, which exceeded the guidelines and rules known until then. Out of the desire to quickly solve this medical problem, a series of measures were taken, however not sufficiently validated in scientific terms; the recommendations regarding the use of drugs known for their properties to treat a greater number of conditions, such as ivermectin, was tried. DATA SOURCES A narrative review of the specialized literature was carried out using keywords such as COVID-19, ivermectin, ethics, and off-label medication from Scopus and Google Scholar but also of official documents developed at the international level (World Health Organization). ETHICS AND THERAPEUTIC ADVANCES The off-label use of ivermectin alone or in combination with other medications during COVID pandemic raised problems related to the demonstration of its effectiveness, but also to ethics, starting from the expectations that both the medical staff and the population had of it. Ivermectin therapy was also evaluated by analyzing the behavior of ivermectin based on ethical principles (nonmaleficence, beneficence, and respect for one's autonomy) or on justice. Even in times of pandemic, exceptionalism must not triumph, and finding an effective treatment must be done through studies that respect ethical standard. CONCLUSIONS The failures or rather lack of success in decision making during the pandemic showed that alongside scientific knowledge and the development of health policies, it is necessary to constantly evaluate the measures and decisions from an ethical point of view, and the prevention of slippages and abuses is not only necessary but even mandatory.
Collapse
Affiliation(s)
- Vasile Astărăstoae
- Faculty of Medicine, Grigore T Popa University of Medicine & Pharmacy, Iasi, Romania; and
| | - Liliana M Rogozea
- Basic, Preventive and Clinical Sciences Department, Transilvania University, Brasov, Romania
| |
Collapse
|
5
|
Ozieranski P, Saito H, Rickard E, Mulinari S, Ozaki A. International comparison of pharmaceutical industry payment disclosures in the UK and Japan: implications for self-regulation, public regulation, and transparency. Global Health 2023; 19:14. [PMID: 36869318 PMCID: PMC9985252 DOI: 10.1186/s12992-022-00902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/20/2022] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Self-regulation of payment disclosure by pharmaceutical industry trade groups is a major global approach to increasing transparency of financial relationships between drug companies and healthcare professionals and organisations. Nevertheless, little is known about the relative strengths and weaknesses of self-regulation across countries, especially beyond Europe. To address this gap in research and stimulate international policy learning, we compare the UK and Japan, the likely strongest cases of self-regulation of payment disclosure in Europe and Asia, across three dimensions of transparency: disclosure rules, practices, and data. RESULTS The UK and Japanese self-regulation of payment disclosure had shared as well unique strengths and weaknesses. The UK and Japanese pharmaceutical industry trade groups declared transparency as the primary goal of payment disclosure, without, however, explaining the link between the two. The rules of payment disclosure in each country provided more insight into some payments but not others. Both trade groups did not reveal the recipients of certain payments by default, and the UK trade group also made the disclosure of some payments conditional on recipient consent. Drug company disclosure practices were more transparent in the UK, allowing for greater availability and accessibility of payment data and insight into underreporting or misreporting of payments by companies. Nevertheless, the share of payments made to named recipients was three times higher in Japan than in the UK, indicating higher transparency of disclosure data. CONCLUSIONS The UK and Japan performed differently across the three dimensions of transparency, suggesting that any comprehensive analysis of self-regulation of payment disclosure must triangulate analysis of disclosure rules, practices, and data. We found limited evidence to support key claims regarding the strengths of self-regulation, while often finding it inferior to public regulation of payment disclosure. We suggest how the self-regulation of payment disclosure in each country can be enhanced and, in the long run, replaced by public regulation to strengthen the industry's accountability to the public.
Collapse
Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| |
Collapse
|
6
|
Ozieranski P, Martinon L, Jachiet PA, Mulinari S. Tip of the Iceberg? Country- and Company-Level Analysis of Drug Company Payments for Research and Development in Europe. Int J Health Policy Manag 2022; 11:2842-2859. [PMID: 35297231 PMCID: PMC10105170 DOI: 10.34172/ijhpm.2022.6575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Creating new therapies often involves drug companies paying healthcare professionals and institutions for research and development (R&D) activities, including clinical trials. However, industry sponsorship can create conflicts of interest (COIs). We analysed approaches to drug company R&D payment disclosure in European countries and the distribution of R&D payments at the country and company level. METHODS Using documentary sources and a stakeholder survey we identified country- regulatory approaches to R&D payment disclosure. We reviewed company-level descriptions of disclosure practices in the United Kingdom, a country with a major role in Europe's R&D. We obtained country-level R&D payment data from industry trade groups and public authorities and company-level data from eurosfordocs.eu, a publicly available payments database. We conducted content analysis and descriptive statistical analysis. RESULTS In 32 of 37 studied countries, all R&D payments were reported without named recipients, following a self-regulatory approach developed by the industry. The methodological descriptions from 125 companies operating in the United Kingdom suggest that within the self-regulatory approach companies had much leeway in deciding what activities and payments were considered as R&D. In five countries, legislation mandated the disclosure of R&D payment recipients, but only in two were payments practically identifiable and analysable. In 17 countries with available data, R&D constituted 19%-82% of all payments reported, with self-regulation associated with higher shares. Available company-level data from three countries with self-regulation suggests that R&D payments were concentrated by big funders, and some companies reported all, or nearly all, payments as R&D. CONCLUSION The lack of full disclosure of R&D payments in countries with industry self-regulation leaves considerable sums of money unaccounted for and potentially many COIs undetected. Disclosure mandated by legislation exists in few countries and rarely enhances transparency practically. We recommend a unified European approach to R&D payment disclosure, including clear definitions and a centralised database.
Collapse
Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | | | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| |
Collapse
|
7
|
Zuckerman S, Barlavie Y, Niv Y, Arad D, Lev S. Accessing unproven interventions in the COVID-19 pandemic: discussion on the ethics of 'compassionate therapies' in times of catastrophic pandemics. JOURNAL OF MEDICAL ETHICS 2022; 48:1000-1005. [PMID: 34645620 PMCID: PMC8520601 DOI: 10.1136/medethics-2020-106783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
Since the onset of the SARS-CoV-2 pandemic, an array of off-label interventions has been used to treat patients, either provided as compassionate care or tested in clinical trials. There is a challenge in determining the justification for conducting randomised controlled trials over providing compassionate use in an emergency setting. A rapid and more accurate evaluation tool is needed to assess the effect of these treatments. Given the similarity to the Ebola Virus Disease (EVD) pandemic in Africa in 2014, we suggest using a tool designed by the WHO committee in the aftermath of the EVD pandemic: Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI). Considering the uncertainty around SARS-CoV-2, we propose using an improved MEURI including the Plan-Do-Study-Act tool. This combined tool may facilitate dynamic monitoring, analysing, re-evaluating and re-authorising emergency use of unproven treatments and repeat it in cycles. It will enable adjustment and application of outcomes to clinical practice according to changing circumstances and increase the production of valuable data to promote the best standard of care and high-quality research-even during a pandemic.
Collapse
Affiliation(s)
- Shlomit Zuckerman
- Department of Disaster Medicine & Center for Bioethics and Law, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Barlavie
- Division of Intensive Care, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Yaron Niv
- Quality and Safety Program, Ministry of Health, Jerusalem, Israel
- Department of Internal Medicine, Ariel University, Ariel, Israel
| | - Dana Arad
- Division of Patient Safety, Ministry of Health, Jerusalem, Israel
- Department of Health System Managment, Bar Ilan University, Ramat Gan, Israel
| | - Shaul Lev
- Unit of General Intensive Care, Hasharon Hospital, Petah Tikva, Israel
| |
Collapse
|
8
|
Pashley D, Ozieranski P, Mulinari S. Disclosure of Pharmaceutical Industry Funding of Patient Organisations in Nordic Countries: Can Industry Self-Regulation Deliver on its Transparency Promise? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:347-362. [PMID: 35230175 PMCID: PMC9203660 DOI: 10.1177/00207314221083871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Pharmaceutical companies regularly fund patient organizations. It is important for patient organizations’ credibility that there be transparency regarding this financial support. In Europe, the pharmaceutical industry promises to deliver transparency through self-regulation, as opposed to legally binding provisions, but self-regulation's effectiveness is contested. We compared the industry's transparency of funding in four Nordic countries that, given their general reputation for high transparency, offered a critical test of self-regulation's ability to deliver on its transparency promise. For 2017–2019, we compared: national rules regarding funding disclosure; disclosure practices as evidenced by the availability, accessibility, and format of company transparency reports; and disclosure data, including payment descriptions and sums. Transparency problems differed in kind and magnitude between countries. In Norway and Finland, unlike in Sweden and Denmark, data on funding were difficult to access and analyze and sometimes seemed incomplete or missing. We explain that a key factor allowing for country differences is the freedom given to a country's pharmaceutical industry trade associations to form self-regulatory rules, provided they do not fall below the weak, European-level minimum requirements. Transparency could be improved by aligning rules and practices with the FAIR data principles: that is, corporate disclosures should be findable, accessible, interoperable, and reusable.
Collapse
Affiliation(s)
- Dylan Pashley
- Department of Sociology, Faculty of Social Sciences, 5193Lund University, Lund, Sweden
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, 1555University of Bath, Bath, UK
| | - Shai Mulinari
- Department of Sociology, Faculty of Social Sciences, 5193Lund University, Lund, Sweden
| |
Collapse
|
9
|
Shen S, Yang J, Chen Y, Xie J, Huang Y, Lin W, Liao Y. Off-label indications of aspirin in gynaecology and obstetrics outpatients at two Chinese tertiary care hospitals: a retrospective cross-sectional study. BMJ Open 2022; 12:e050702. [PMID: 35190417 PMCID: PMC8860038 DOI: 10.1136/bmjopen-2021-050702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of off-label aspirin indications and the level of scientific support for off-label indications of aspirin in gynaecology and obstetrics outpatients. DESIGN A retrospective cross-sectional study. SETTING Two tertiary hospitals (a general hospital and a women and children's specialised hospital) in Xiamen, a city located on the southeastern coast of China. PARTICIPANTS A total of 4257 prescriptions were included for 2091 female patients aged >18 who visited the gynaecology and obstetrics outpatient clinics and received aspirin treatment. OUTCOME MEASURES The primary measure of this study was the proportion of off-label indications and of off-label indications supported by strong scientific evidence. Evidence from clinical guidelines and Micromedex is shown using descriptive statements. On-label indications of drugs in the same class as aspirin were also referred to for off-label aspirin use without strong evidence support. RESULTS All indications of aspirin on outpatient prescriptions were determined as off-label use in this study. The most frequent off-label indication was recurrent miscarriage (2244 prescriptions, 52.71%). Totally, 30.94% of the prescriptions were supported by strong evidence for indications, including recurrent miscarriage with antiphospholipid syndrome and prophylaxis for pre-eclampsia. No drugs in the same class as aspirin had on-label indications for off-label aspirin use without strong evidence support. CONCLUSIONS This study demonstrated that all indications of aspirin used in gynaecology and obstetrics outpatients at the two tertiary hospitals were off-label and not always supported by strong evidence, implicating that physicians should be cautious when issuing off-label prescriptions. More original clinical research on off-label aspirin use is needed to provide reference for routine clinical practice.
Collapse
Affiliation(s)
- Sijie Shen
- Department of Pharmacy, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jianhui Yang
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yao Chen
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jingxian Xie
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yanni Huang
- Department of Gynaecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Wubin Lin
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yufang Liao
- Department of Pharmacy, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| |
Collapse
|
10
|
Sofat R, Cremers S, Ferner RE. Drug and therapeutics committees as guardians of safe and rational medicines use. Br J Clin Pharmacol 2019; 86:10-12. [PMID: 31625180 PMCID: PMC6983503 DOI: 10.1111/bcp.14088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Reecha Sofat
- Institute of Health Informatics, University College London, London, UK.,Centre for Clinical Pharmacology, University College London, London, UK
| | - Serge Cremers
- Departments of Pathology and Cell Biology and Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - R E Ferner
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| |
Collapse
|
11
|
Jones L, Drobe B, González-Méijome JM, Gray L, Kratzer T, Newman S, Nichols JJ, Ohlendorf A, Ramdass S, Santodomingo-Rubido J, Schmid KL, Tan D, Tan KO, Vera-Diaz FA, Wong YL, Gifford KL, Resnikoff S. IMI - Industry Guidelines and Ethical Considerations for Myopia Control Report. Invest Ophthalmol Vis Sci 2019; 60:M161-M183. [PMID: 30817831 DOI: 10.1167/iovs.18-25963] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To discuss guidelines and ethical considerations associated with the development and prescription of treatments intended for myopia control (MC). Methods Critical review of published papers and guidance documents was undertaken, with a view to carefully considering the ethical standards associated with the investigation, development, registration, marketing, prescription, and use of MC treatments. Results The roles and responsibilities of regulatory bodies, manufacturers, academics, eye care practitioners, and patients in the use of MC treatments are explored. Particular attention is given to the ethical considerations for deciding whether to implement a MC strategy and how to implement this within a clinical trial or practice setting. Finally, the responsibilities in marketing, support, and education required to transfer required knowledge and skills to eye care practitioners and academics are discussed. Conclusions Undertaking MC treatment in minors creates an ethical challenge for a wide variety of stakeholders. Regulatory bodies, manufacturers, academics, and clinicians all share an ethical responsibility to ensure that the products used for MC are safe and efficacious and that patients understand the benefits and potential risks of such products. This International Myopia Institute report highlights these ethical challenges and provides stakeholders with recommendations and guidelines in the development, financial support, prescribing, and advertising of such treatments.
Collapse
Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Björn Drobe
- Essilor Research and Development, Vision Sciences AMERA, Center of Innovation and Technology AMERA, Singapore, Singapore
| | - José Manuel González-Méijome
- Clinical & Experimental Optometry Research Lab, Center of Physics (Optometry), School of Science, University of Minho, Braga, Portugal
| | - Lyle Gray
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Timo Kratzer
- Carl Zeiss Vision International GmbH, Aalen, Germany
| | | | - Jason J Nichols
- University of Alabama at Birmingham, School of Optometry, Birmingham, Alabama, United States
| | - Arne Ohlendorf
- Carl Zeiss Vision International GmbH, Aalen, Germany.,Institute for Ophthalmic Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stephanie Ramdass
- Vision Research Institute, Michigan College of Optometry, Ferris State University, Big Rapids, Michigan, United States
| | | | - Katrina L Schmid
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Donald Tan
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kah-Ooi Tan
- Brien Holden Vision Institute, and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | | | - Yee-Ling Wong
- Essilor Research and Development, Vision Sciences AMERA, Center of Innovation and Technology AMERA, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kate L Gifford
- Private Practice and School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute, and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
12
|
Abstract
Drug company payment disclosures have limited transparency, but Piotr Ozieranski and colleagues find that they are increasing in value and are targeted at select patient organisations
Collapse
Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| |
Collapse
|
13
|
Song SY, Lee JH, Kim SC, Choi JW, Bae J, Kim E. Complaints addressed by regulatory authorities in drug advertising targeted at consumers: Cases across three, different countries. Res Social Adm Pharm 2018; 15:1274-1279. [PMID: 30552049 DOI: 10.1016/j.sapharm.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Misleading advertisements can affect behavior of both consumers and prescribers and may lead to inappropriate use of medications. OBJECTIVE To analyze the complaints upheld by regulatory authorities in the United Kingdom, Canada, and Australia regarding pharmaceutical advertising directed at consumers. METHODS Complaints addressed between January 2014 and June 2017 were retrieved from the websites of regulatory authorities. Complaints addressed by self-regulatory bodies were not included due to the poor availability of data. RESULTS Sixty complaints, 374 complaints, and 223 complaints from the United Kingdom, Canada, and Australia, respectively, were analyzed. In the United Kingdom, the most frequent type of violation was advertising of prescription drugs (70.5%); most of these violations involved botulinum toxin. In Canada, advertising on online media was more likely to be associated with prescription drugs than that on traditional media (P < 0.001). In Australia, advertising of prescription drugs accounted for less than 10% of complaints, but all were associated with online media. CONCLUSIONS In countries where direct-to-consumer advertising of prescription drugs is prohibited, regulatory authorities may need to devise further strategies to safeguard the public as this is an unresolved issue and is predicted to become more problematic with the increased use of online media.
Collapse
Affiliation(s)
- Seung Yeon Song
- Department of Health, Social and Clinical Pharmacy, Chung-Ang University College of Pharmacy, Seoul, South Korea
| | - Ji Hyei Lee
- The Graduate School of Pharmaceutical Industry Management, Chung-Ang University, Seoul, South Korea
| | - Seong Chul Kim
- The Graduate School of Pharmaceutical Industry Management, Chung-Ang University, Seoul, South Korea
| | - Jin-Woo Choi
- The Graduate School of Pharmaceutical Industry Management, Chung-Ang University, Seoul, South Korea
| | - Jongwoo Bae
- The Graduate School of Pharmaceutical Industry Management, Chung-Ang University, Seoul, South Korea
| | - EunYoung Kim
- Department of Health, Social and Clinical Pharmacy, Chung-Ang University College of Pharmacy, Seoul, South Korea; The Graduate School of Pharmaceutical Industry Management, Chung-Ang University, Seoul, South Korea.
| |
Collapse
|
14
|
Mulinari S, Ozieranski P. Disclosure of payments by pharmaceutical companies to healthcare professionals in the UK: analysis of the Association of the British Pharmaceutical Industry's Disclosure UK database, 2015 and 2016 cohorts. BMJ Open 2018; 8:e023094. [PMID: 30344175 PMCID: PMC6196800 DOI: 10.1136/bmjopen-2018-023094] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To analyse the section of Disclosure UK that pertains to healthcare professionals (HCPs) in order to provide insight into the database's structure and content and suggest ways to improve its transparency. DESIGN AND PARTICIPANTS Cohort study of drug companies and HCPs in the 2015 and 2016 versions of Disclosure UK. RESULTS Companies report transfers of value (ToVs) to named HCPs or, where an HCP declines to consent, in aggregate. Only a limited number of variables describe the recipient HCP and the ToV, precluding refined analyses. In 2015, 107 companies reported 54 910 ToVs worth ₤50 967 728. In 2016, 109 companies reported ToVs but spending decreased by 7.3%. The spending was concentrated: the top 10 spenders reported about 50% of the total value, with consultancy-related payments comprising over 70%, and the rest being costs for events. In 2015, 55.5% (30 478) of ToVs worth ₤24 428 619 (47.9%) were disclosed at the individual HCP level, increasing to 64.5% (32 407) and ₤28 145 091 (59.2%) in 2016. Despite increased individual-level disclosure in 2016, the median number of ToVs reported by each company at the individual level was only 57.7%, with 25% of companies reporting less than 38.6%. We found little agreement (62%-48% in 2015 and 46%-30% in 2016) between HCP consent rates that we calculated based on information in the database and those provided by companies. CONCLUSIONS Key deficiencies in Disclosure UK include: insufficient information on payments and recipients, a relatively low HCP consent rate for individual-level disclosure, differences in consent rates across companies and payment types, and reporting ambiguities or inconsistencies. We employ these findings to develop recommendations for improving transparency, including an easily interpretable consent rate statistic that allows for comparison across years, firms and countries. If deficiencies remain unresolved, the UK should consider introducing legislation requiring mandatory disclosure to allow for adequate tracking of industry payments.
Collapse
Affiliation(s)
- Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| |
Collapse
|
15
|
Vilhelmsson A, Mulinari S. Pharmaceutical lobbying and pandemic stockpiling of Tamiflu: a qualitative study of arguments and tactics. J Public Health (Oxf) 2018; 40:646-651. [PMID: 28977398 PMCID: PMC6166586 DOI: 10.1093/pubmed/fdx101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/07/2017] [Accepted: 07/21/2017] [Indexed: 11/13/2022] Open
Abstract
Background Little is known about how pharmaceutical companies lobby authorities or experts regarding procurement or the use of vaccines and antivirals. This paper investigates how members of Denmark's pandemic planning committee experienced lobbying efforts by Roche, manufacturer of Tamiflu, the antiviral that was stockpiled before the 2009 A(H1N1) pandemic. Methods Analysis of interviews with six of seven members of the Danish core pandemic committee, supplemented with documentary analysis. We sought to identify (1) arguments and (2) tactics used in lobbying, and to characterize interviewees' views on the impact of (3) lobbying and (4) scientific evidence on the decision to stockpile Tamiflu. Results Roche lobbied directly (in its own name) and through a seemingly independent third party. Roche used two arguments: (1) the procurement agreement had to be signed quickly because the drug would be delivered on a first-come, first-served basis and (2) Denmark was especially vulnerable to an influenza crisis because it had smaller Tamiflu stocks than other countries. Most interviewees suspected that lobbying had an impact on Tamiflu procurement. Conclusions Our study highlights risks posed by pharmaceutical lobbying. Arguments and tactics deployed by Roche are likely to be repeated whenever many countries are negotiating drug procurements in a monopolistic market.
Collapse
Affiliation(s)
- Andreas Vilhelmsson
- Department of Sociology, Faculty of Social Sciences, Lund University, Box 117, Lund, Sweden
- Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, CRC, House 28 Floor 12, Jan Waldenströms gata 35, Malmö, Sweden
| | - Shai Mulinari
- Department of Sociology, Faculty of Social Sciences, Lund University, Box 117, Lund, Sweden
| |
Collapse
|
16
|
Off-label treatments were not consistently better or worse than approved drug treatments in randomized trials. J Clin Epidemiol 2018; 94:35-45. [DOI: 10.1016/j.jclinepi.2017.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/13/2017] [Accepted: 11/08/2017] [Indexed: 12/26/2022]
|
17
|
Fadlallah R, Nas H, Naamani D, El-Jardali F, Hammoura I, Al-Khaled L, Brax H, Kahale L, Akl EA. Knowledge, Beliefs and Attitudes of Patients and the General Public towards the Interactions of Physicians with the Pharmaceutical and the Device Industry: A Systematic Review. PLoS One 2016; 11:e0160540. [PMID: 27556929 PMCID: PMC4996522 DOI: 10.1371/journal.pone.0160540] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To systematically review the evidence on the knowledge, beliefs, and attitudes of patients and the general public towards the interactions of physicians with the pharmaceutical and the device industry. METHODS We included quantitative and qualitative studies addressing any type of interactions between physicians and the industry. We searched MEDLINE and EMBASE in August 2015. Two reviewers independently completed data selection, data extraction and assessment of methodological features. We summarized the findings narratively stratified by type of interaction, outcome and country. RESULTS Of the 11,902 identified citations, 20 studies met the eligibility criteria. Many studies failed to meet safeguards for protecting from bias. In studies focusing on physicians and the pharmaceutical industry, the percentages of participants reporting awareness was higher for office-use gifts relative to personal gifts. Also, participants were more accepting of educational and office-use gifts compared to personal gifts. The findings were heterogeneous for the perceived effects of physician-industry interactions on prescribing behavior, quality and cost of care. Generally, participants supported physicians' disclosure of interactions through easy-to-read printed documents and verbally. In studies focusing on surgeons and device manufacturers, the majority of patients felt their care would improve or not be affected if surgeons interacted with the device industry. Also, they felt surgeons would make the best choices for their health, regardless of financial relationship with the industry. Participants generally supported regulation of surgeon-industry interactions, preferably through professional rather than governmental bodies. CONCLUSION The awareness of participants was low for physicians' receipt of personal gifts. Participants also reported greater acceptability and fewer perceived influence for office-use gifts compared to personal gifts. Overall, there appears to be lower awareness, less concern and more acceptance of surgeon-device industry interactions relative to physician-pharmaceutical industry interactions. We discuss the implications of the findings at the patient, provider, organizational, and systems level.
Collapse
Affiliation(s)
- Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Hala Nas
- Faculty of Medicine, University of Damascus, Damascus, Syria
| | - Dana Naamani
- Department of Biology, Faculty of Art and Science, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Ihsan Hammoura
- Department of Biology, Faculty of Art and Science, American University of Beirut, Beirut, Lebanon
| | - Lina Al-Khaled
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Faculty of Medicine, Université Saint Joseph, Beirut, Lebanon
| | - Lara Kahale
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Elie A. Akl
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
18
|
Unhealthy marketing of pharmaceutical products: An international public health concern. J Public Health Policy 2016; 37:149-59. [PMID: 26911654 DOI: 10.1057/jphp.2016.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care.
Collapse
|