Indian Journal of Medical Ethics

LETTER


Educating healthcare professionals about pharmaceutical promotion

Published online first on September 6, 2024. DOI:10.20529/IJME.2024.058

Keywords: Fiduciary relationship, pharmaceutical promotion, physicians


I read with great interest the editorial on the pharmaceutical company–healthcare relationship published in the April-June issue of this journal [1]. Clinical practice guidelines are increasingly used by physicians to guide treatment decisions, and the pharmaceutical industry focuses on influencing the authors of these guidelines. Almost one in four guideline writers with no disclosed ties may have potentially relevant undisclosed ties to pharmaceutical companies [2]. Doctors are in a fiduciary relationship with patients and expected to act in their best interests. The relationship with the industry influences doctors in several ways; they may obtain information about medicines, but this information has been provided with an intention of influencing prescribing and increasing sales of the medicine [3].

Educating students

My colleagues and I have been involved in teaching the rational use of medicines along with understanding and responding to pharmaceutical promotions to medical students for over two decades [4]. Health Action International, in association with the World Health Organization, published a book on Understanding and responding to pharmaceutical promotion, which is one of the free resources available to educate students about such promotions [5]. Disparate methods are used to teach medical students to interact “properly” with the industry, making comparison of the effectiveness of different teaching methods difficult [6]. Identification and analysis of context-dependent educational interventions is needed. Published studies from developing nations may be few. Incorporating understanding and responding to pharmaceutical promotion in the medical curriculum is required. It is also important to study the impact of this initiative.

Clinicians’ interactions with the industry

Medical representatives are a key part of the pharmaceutical sales force. They build personal relationships with doctors and may provide incomplete medical information to influence prescribing and offer a variety of incentives to prescribers [7]. Clinicians may have a positive attitude toward promotion, regarding it as a means to obtain information about drugs and other benefits [8]. They also expect their continuing medical education (CME) needs to be sponsored by pharmaceutical companies. Developing countries do not yet require CMEs to be provided independent of the industry. A recent article argues that the fiduciary nature of the physician’s relationship with patients requires CMEs to be provided by medical professional societies [9].

Academic detailing

Medical students should learn to understand and respond to pharmaceutical promotion during pharmacology sessions and their clinical training. Several exercises can be conducted using free resources. Clinicians should be role-models of appropriate behaviour with the industry. This education should be reinforced during postgraduation, and unbiased information must be provided through academic detailing, a structured educational programme in which a trained healthcare professionals visits healthcare professionals in their practice to provide tailored evidence-based information [10]. In developing nations like India, major challenges to implementing academic detailing include inadequate funding, lack of human resources, lack of health information, and the influence of pharmaceutical promotion. Educating doctors and other professionals about pharmaceutical promotion is vital for them to fulfil their primary fiduciary duty to their patients.

Pathiyil Ravi Shankar (ravi.dr.shankar@gmail.com), IMU Centre for Education, IMU University, Kuala Lumpur, MALAYSIA.

References

  1. Kurpad SS. The pharmaceutical company–healthcare relationship: much ado about something. Indian J Med Ethics. 2024 Apr-Jun; 9 (2); 89-93. https://doi.org/10.20529/IJME.2024.023
  2. Moynihan R, Lai A, Jarvis H, Duggan G, Goodrick S, Beller E, Bero L. Undisclosed financial ties between guideline writers and pharmaceutical companies: a cross-sectional study across 10 disease categories. BMJ open. 2019 Feb 1; 9(2): e025864. https://doi.org/ 10.1136/bmjopen-2018-025864
  3. Almasri M, Bukhari YR, Alzuair BS, Almadi MK, Abdulrahman AK. Ethical considerations in doctors & pharmaceutical industries relationship: a narrative review. Int J Med Dev Countries. 2020 Jan 26; 4(1): 244-52. https://doi.org/10.24911/IJMDC.51-1572794591
  4. Shankar PR, Singh KK, Piryani RM. Student feedback about the Skeptic Doctor, a module on pharmaceutical promotion. J Educ Eval Health Prof. 2011; 8: 11. Available from: https://doi.org/10.3352/jeehp.2011.8.11
  5. World Health Organization, Health Action International. Understanding and responding to pharmaceutical promotion: A practical guide. [cited 2024 Sep 1]. Available from: https://www3.paho.org/hq/dmdocuments/2011/drug-promotion-manual-CAP-3-090610.pdf
  6. Farah S, Bilszta JL. Teaching medical students how to interact with the pharmaceutical industry: A scoping review. GMS J Med Educ. 2022; 39(5): 57. https://doi.org/10.3205/zma001578
  7. Goyal R, Pareek P. A review article on prescription behavior of doctors, influenced by the medical representative in Rajasthan, India. IOSR Journal of Business and Management. 2013 Jan; 8(1): 56-60.
  8. Kabir SM, Maulan S, Manaf NH, Nasir ZW. Attitude of physicians and patients towards pharmaceutical promotion in healthcare: A qualitative study from ethical context. International Journal of Innovative Research and Publications. 2021 [cited 2024 May 19]; 1(1): 1-1. Available from: https://www.ijirp.com/wp-content/uploads/2021/03/Attitude-of-Physicians-and-Patients-towards-Pharmaceutical-Promotion-in-Healthcare.pdf
  9. Kearney P, Simoons M, Ryden L, Kirchhof P, Pries A, O’Morain C, Bax JJ. The medical profession, industry, and continuing medical education: finding the balance that’s right for patients. Am J Med. 2019 Aug 1; 132(8): 921-5. Available from: https://doi.org/10.1016/j.amjmed.2019.02.026
  10. Khanal S. Academic detailing in low-and Middle-Income countries: Principles, Use, impact, and Lessons learned. In Social and Administrative Aspects of Pharmacy in Low-and Middle-Income Countries. Academic Press. 2018 Jan 1. (pp. 73-92).