Transcript Poster presentation

The WHO/ HAI
Drug Promo Database
Andrew Herxheimer, Joel Lexchin
Why the WHO/ HAI database on
pharmaceutical promotion? (1)
to document how much drug
promotion is inappropriate
to document the health impact of
inappropriate promotion
to identify topics not so far studied
to recommend needed research
Why the WHO/ HAI database on
pharmaceutical promotion? (2)
to review tools for use in teaching
health professionals about drug
promotion;
to provide tools to monitor drug
promotion
to facilitate networking by linking
people concerned about promotion
through the website
What it is
 It aims to be a comprehensive reference
guide to research and observations on all
aspects of drug promotion from all countries
and – eventually – in all languages
 It is intended to help researchers and policy
makers by providing abstracts of a large
collection of material together with critical
comments and summary reviews
 It is conceived as a living database which
will be kept up to date
How it was built
by collecting the widest possible range of material
describing, analyzing, reporting or commenting on any
aspect of pharmaceutical promotion :

articles, letters, news in various journals*
magazine articles*
articles from drug bulletins/newsletters
unpublished reports/studies
videos
radio/TV reports with accessible transcripts
theses
guidelines from diverse professional sources
books & chapters from books
then analyzing and reviewing all this material
*BUT few from industry publications
How it is organized
 Each reference of an article or other
item has a number, and is indexed by
the key words
 This makes it possible to search the
database using the keywords as well
as other words in the titles or text; but
some kinds of searches are complex
 For certain major themes there are
reviews summarising the material
These are the four themes
1. The attitudes of professionals and of
lay people to promotion
2. The impact of drug promotion on attitudes
and knowledge
3. The impact of drug promotion on
behaviour
4. Interventions that have been tried to
counter promotional activities, and their
results
Also on the drugpromo site
 An annotated list of the ‘Top Eleven’
pieces of research that everyone
concerned with the subject will find
worth reading and thinking about – as
a stimulus and jumping off point for
further work
 e-Links to the five most important
NGO websites and to the WHO sites
concerned with drug promotion
Some stats – 07.03 to 01.04
total
53,000
5,700
2,100
per day
272
29
Hits
Visitors
Internet providers
Visitors by country
USA 2800; Malaysia 1300; UK 170; Oz 150;
Canada 110; France 100; Germany 70;
NL 60; India, Singapore, Sweden, Switz 50
Most popular pages: Home, indiv. abstracts,
‘About Drugpromo’, Reviews
The Contributors

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



Joel Lexchin
Pauline Norris
Peter Mansfield
Andrew Herxheimer
Barbara Mintzes
Charles Medawar
 Zulham Hamdan
the webmaster
 Margaret Ewen
 Richard Laing
 Hans Hogerzeil
Please use the database
 Give us feedback!
 We’d love to know how you use it
 What work that you or your colleagues
have done should be included?
 Should anything be improved in the
structure or content of the database?
 Suggest links that would be useful
Conclusions (1): Doctors’
attitudes to promotion
Attitudes vary, and don’t necessarily match their
behaviour. Their opinions differ on the value of reps.
Most doctors think information from drug companies is
biased, but many think it is useful. Most find small
gifts from drug companies acceptable, and
believe that drug reps or gifts do not influence them
personally, but do influence many colleagues. Few
patients know that doctors receive promotional gifts.
Doctors who rely on promotion tend to be older, less
conservative, see more patients, are GPs rather
than specialists, have less access to peers and have
a more positive attitude towards medicines.
Conclusions (2):
Effects on doctors’ knowledge
They often use promotional information
about new drugs, and for drugs used
outside their usual therapeutic field.
Doctors in private practice, or who
graduated long ago, are the heaviest
users of promotion as a source of drug
information.
Conclusions (3):
Effects on doctors’ behaviour
*Promotion is associated with greater drug sales,
promotion influences prescribing more than doctors
realise, & they rarely acknowledge that promotion has
influenced their prescribing. Doctors who report relying
more on promotion prescribe more often, less
appropriately, & adopt new drugs more quickly.
*Samples stimulate prescribing.
*Doctors who receive company funds tend to request
additions to hospital formularies. Company sponsorship
influences the choice of topics for continuing
education, the choice of research topics, & the
outcomes of research. It leads to secrecy, delays
publication for commercial reasons, and conflict of
interest problems. Researchers often don’t disclose
funding from drug companies.
Countering bad promotion –
what’s ineffective
• Voluntary regulation, eg by industry
• Guidelines –
for sales reps
for post-marketing surveillance
on conflict of interest in research
for package inserts & compendia
about gifts
for trainee doctors & for hospitals
Countering bad promotion –
interventions that can work
• Government regulation
• Training students – before & after
graduation
• Media exposure of abusive promotion
• Giving abundant free & reliable
therapeutic information to
professionals and the public
Research has focused on health
professionals – little has been
done on consumers or patients
Phase 2 of the project will look at
interventions for medical and pharmacy
students, and studies evaluating them
An update of the database is intended every
2 years
6. Research
 Every country needs to understand the
effects of promotion on its health system
and its people
 At present only pharma companies do
research on promotion to help them sell
expensive drugs – the results are of course
secret
 Independent public research is needed to
ensure that promotion does more good than
harm
Conclusion
 The database should is a tool for all
our efforts to educate and inform not
only health professionals, but also
politicians, civil servants, journalists,
and the public about the issues.
 All have to understand that health
policy must come before commercial
interests.