Transcript drugs WHO - Institute of Communication and Health

Section of Hygiene, Epidemiology and Public Health – University of Brescia (Italy)
Institute of Communication and Care – University of Lugano (Switzerland) Research
Centre on “Quality and Technology Assessment, Governance and Communication
Strategies in Health Systems” – University of Brescia (Italy)
“The Internhe@lth Project:
the Public Health implications
of the spread of Internet”
Grazia Orizio
Lugano, 9 March 2010
Trust and Sources of Health Information
The impact of internet and its implications for health
care providers


Arch Intern Med, 2005
Authors Affiliations: United States
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
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
CDC
Geroge Mason University (VA)
Universty of North Carolina
Harvard University (MASS)
6369 interviews
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AIMS
“To provide nationally representative
estimate for:
health-related use of the internet,
 level of trust in health information sources,
 and preferences for cancer information.”

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4
RESULTS
 Internet:
 63.0%
internet users
 e-health
 63.7%
searched for health
information
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7
TRUST IN INFIRMATION
SOURCES
Regressione logistica per valutare l’associazione con le
variabili sociodemografiche
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9
CANCER:
intention to
vs
effective behavior
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Internet Users in the European Union
AIMS
The internhe@lth Project
to investigate
the public health implications
of the spread internet
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BACKGROUND
INFORMATION
DEMAND
CITIZENS / PATIENTS
HEALTH SERVICES
DEMAND
DOCTORS
PROFESSIONAL
UPDATING
ADVERTISMENT
HEALTH
ORGANIZATION
MARKETING
DOCTORS
Drugs
CITIZENS
Diagnostic
Test
Internet
usage and
perception
Medical
consultations
Portals for
Doctors
Clinical
Management
WEB
Social
Networking
Health
Education
Health
Marketing
HEALTH
ORGANIZATIONS
The Internhe@lth:
Study Design
Pilot study
2007
33 OPs
2009
Drugs analysis
Online pharmacies (OPs) monitorage for 2 years
1° step
2° step
2007
118 OPs
2008 Economical
analisys (100 OPs)
20082009
2008
Questionnaries analysis 57 OPs
2008
31 sites
Diagnostic tests websites analysis (2008-2009)
Hospitals websites analysis
(2008-2009)
Local Health Authorities
websites analysis (2009)
ONLINE PHARMACIES
Pilot study: 33 OPs
First Survey: 118 OPs
1.
2.
1.
2.
3.
Analisis of OPs
Economic analysis
Online questionnaires analysis
Second survey: 175 FO
3.
1.
Analysis of the persuasion strategies
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BACKGROUND

e-health
›
›
Information / knowledge
Access to:
›
›
›
›
›

medical devices
diagnostic tests (i.e., genetic tests)
treatment -> drugs
WHO: context of counterfeit medicines, defined
as “a global public health crisis”
FDA: “serious public health risk”
Direct to Consumer Advertising
›
›
YES: Patient empowerment
NO: It generates demand of medical services
AIMS
To investigate offering and advertising of
Prescription Only Drugs on the internet

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
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Trasversal study to obtain an image of online
pharmacies characteristics
Selling strategies analysis
How is consumer’s trust built in the ”protected
market” of drugs ?
Which kind of guaranties are present to
prevent the risks of self-medication?
METHODS
WEBSITES SELECTION


www.google.it
Inclusion criteria:

Direct selling sites

By 3 clicks from google
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Almost English language
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Each site considered only once
INTERNET SITES CODING

Content analysis
›
Formal categories
›
Address declaration
›
Domain registration
›
Delivery declared location
›
Language
›
Communication channels
›
Content categories

Selling Aspects

Selling Arguments

Medicines available

Disclaimers
PRESCRIPTION REQUIREMENTS
39; 22%
57; 42%
79; 58%
136;
78%
No-prescription
With prescritption
Not asking for any
information
Online questionnaire
PHYSICAL ADDRESS
66 OP (38%) displayed their physiscal address
100%
80%
60%
40%
34
20%
P=0.000
32
0%
With prescription
Physical address
No-prescription
Virtual interface
PHYSICAL ADDRESS / DOMAIN
Address
Domain
Canada
United States
Address=Domain
Central America
56 %Address=Domain
Europe
Oceania
Asia
Australia
Indian Ocean
DECLARED DELIVERY LOCATION
6%
64;
37%
NO
58%
111;
(69)
Declared
96 %
India
13%
YES
42%
(49)
63%
3%
42%
14%
22%
Not declared
Asia
Variable
Canada
USA
Europe
Other
AVAILABLE DRUGS
160
140
120
100
80
60
40
20
0
No-Prescription OPs
Prescription OPs
SIDE EFFECTS DECLARED
(Sildenafil, fluoxetine, tramadol and amitryptiline)
34%
66%
36%
64%
Sildenafil
Fluoxetina
30%
34%
66%
70%
Tramadolo
NO SIDE EFFECTS DECLARED
Amitriptilina
SIDE EFFECTS DECLARED
(Sildenafil, fluoxetine, tramadol and amitryptiline)
Number of declared side effects
80
Fluoxetine*
Amitriptyline*
Tramadol
Sildenafil*
60
40
20
0
No prescription OPs
Prescription OPs
*p<0.05
QUALITY MARKERS
100%
80%
60%
40%
20%
22
1
0%
With prescription
Quality marker
P=0.000
No-prescription
No quality marker
SELLING ARGUMENTS
We safeguard your private data
*
Delivery time information
*
*
Free shipping
*
Possibility of checking order online
*
Good drug quality
*
*
*
The more you buy the less you pay
Affiliation or advertising policy
Low prices versus "brick and mortar" pharmacies
Prescription OPs (n = 39)
Presence of testimonials
No prescription OPs (n = 136)
Buying drugs online is legal
*
*
Your drugs arrive in a discreet package
Advice to buy another drug together with the selected one
*
*
You don't need to go to the doctor
0
* Higher number in using the selling argument among
the two types of OPs, with a statistically significant
difference
10
20
30
40
50
Percent
60
70
80
90
100
SELLING ARGUMENTS
1. Better from us:
•Economical reasons
•Privacy issues
•No prescription
2. Don’t worry:
•Service quality
•Drug quality
•It is legal
Want to give a try?
Examples
(www.mycanadapharmacy.info)
Sales and induced demand
Free offer of not required drugs
Confiscation policy
Examples
testimonials
42 OPs (36%)
(www.rx-giant.com)
Questionnaries analysis
(57 websites) – ANAMNESIS ISSUES
Pre-filled in
70% (40)
Questionnaries analysis
(57 websites) – DOCTOR INVOLVMENT
53%
19%
63%
21%
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Numero dei siti web
CONCLUSIONS
• Access to health services
• Drugs like the other commodities
• Advertisement in an argumentative fashion
• Selling arguments play on aspects far away from
the intrinsic characteristics of the drug
• Empowered of empoored?
• Gap between the information got and the
information should be received to make informed
health decisions
• Effects on patient-doctor communication?
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Legal implications
• Which rules should apply?
• Drugs quality issues
CONCLUSIONS
• Which strategies to face the issue?
• There is no shared international regulation so far
• A law enforcement appproach is costly and few
effective
• Health education seems to be the winning plan
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CONCLUSIONS
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The prescription has a value on the market. A
consumer who wants to buy a drug without
prescription has to pay a higher price.
The unit cost of the active principle decreases with
quantity; this may be due to decreasing marginal
cost, but it may also suggest a strong demand
inducement effect
Active principles that do not originate from the
US/Europe/Canada, because the drug is shipped
from elsewhere, cost less. The shipping origin
may be related to the quality of the drug sold.
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