Major outcomes from the reviews

Drug promotion strongly influences prescribing behaviour, but doctors underestimate this influence. Company funding of doctors, of educational events, and of research are important elements in this influence.

Of various interventions to control or counter the influences of promotion, the only ones that have been found effective are government regulation, training of students (both before and after graduation), media exposure of abusive promotion, and free and abundant provision of reliable non-commercial therapeutic information to professionals and the public.

Research and policy questions to be addressed include the development of effective methods of educating doctors about drug promotion, the impact of guidelines on promotional gifts, and the development of effective guidelines for managing conflicts of interest in research. The effects of different regulatory frameworks also urgently need to be compared. Governments and other organisations that introduce policies to regulate promotional activities need good evidence of the advantages and drawbacks of different systems.

Some promising research designs, such as that pioneered by Avorn et al. to determine how far prescribers’ beliefs are influenced by promotional information, should be applied in different contexts. It could be used to examine a treatment for which there is strong scientific support, but little advertising, such as Oral Rehydration Solution (ORS). If such a study also found that doctors claimed to be influenced more by scientific rather than commercial information, but tended not to prescribe ORS (because there is little or no commercial information about its benefits), Avorn et al.’s conclusions would be much strengthened. Such a study, using a modest telephone survey, would be relatively cheap.

Finally, qualitative studies are essential to provide an understanding of prescribers’ and patients’ behaviour and their attitudes to commercial and non-commercial information.

 

See Index | Date Entered : Tuesday, June 10, 2003