Pharmaceutical companies spend millions of dollars a year on promotion. The companies argue that they are providing information to patients and helping doctors and other medical staff. Nothing wrong with that, you may think – it’s a normal part of doing business. The problem comes when promotion stops being about providing information and becomes misleading (which might be as simple as images of healthy-looking people which do not realistically illustrate the impact of the medicine), tendentious and even illegal.

Promotion is a sensitive area because boundaries are blurred: a pen and notepad bearing a company logo may be considered a harmless promotion gift to a doctor, but as gifts get bigger – free transport and accommodation to attend conferences in holiday resorts are not uncommon – questions of obligation and bribery come into play.Other problems can arise from uncontrolled promotion: advertisements can be so attractive and their claims so enticing that they lead to ‘leakage’, where drugs approved for one purpose are used for another.

Giving samples to doctors has been shown to stimulate prescribing. Health Action International (HAI) says that doctors who report relying more on promotion “prescribe less appropriately, prescribe more often, and adopt new drugs more quickly”.

In addition, drug company sponsorship influences the choice of topics for continuing medical education, the choice of research topics and the outcome of research. It leads to secrecy, says HAI, delay in publication for commercial reasons, and conflict of interest problems for contributors to guidelines. Researchers often do not disclose funding from drug companies.

It all matters a great deal, not only because of the threats to effective prescribing and the money and time spent on promotion, which ultimately is passed on in the price of medicines, but because sales representatives (who may outnumber trained medical staff), advertisements to GPs and other promotional activities outweigh independent sources of information.

Efforts to redress the imbalance are many are varied. They include codes of conduct, laws, the establishment of marketing regulators, the creation of independent sources of information on pharmaceutical products, advertising guidelines, and limits on gifts, perks and inducements.

Given the amounts of money and professional pride at stake, dealing with promotional issues is controversial and complex. MeTA’s multi-stakeholder approach, where groups of people can build trust over time, may be more effective than confrontation in tackling the problem.

WHO Department of Essential Drugs & Medicines Policy and Health Action International Europe: Drug Promotion Database 

Health Action International: Promotion to Consumers

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