Transcript Title of presentation - Medicines Transparency

Medicine Promotion
Robert Louie P. So, MD
Program Manager
DOH - National Center for Pharmaceutical
Access and Management
20/07/2015
Medicines Transparency Alliance
Session on Promotion

Wednesday June 30, 2010 lasting an hour and a half

2 presenters, Carole Piriou of HAI gave the keynote while
Uganda, through Mr. Nazeem Muhamed, shared with us their
country experience

This was followed by a 6-person open fora/panel discussion
Chaired by Harvard Professor Michael Reich. Along with the
2 presenters earlier, representatives from Jordan, the Philippines,
WHO, and ABPI (Association of the British Pharmaceutical
Industry) completed the panel
20/07/2015
Medicines Transparency Alliance
Prescribers who rely on promotion as
their main source of information tend to
prescribe less appropriately, prescribe
more often and adopt new medicines
faster WHO/HAI 2005
Manufacturing
30%
Marketing/Admin.
31%
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Medicines Transparency Alliance
Profits After
Taxes) 20%
Taxes/Interest
6%
R&D
13%
Keynote

Key points of the keynote dwelt on Medicines promotion, how it
forges asymmetric information to both providers and patients, and
how this adversely affects rational drug use. It was stressed that this
irrationality is a GLOBAL problem, experienced even in developed
countries, that wastes resources, causes resistance to medications,
and is among the leading causes of death and debility

After which the keynote gave glimpses of the aspects of promotion,
existing standards on ethical promotion, challenges, sustainable
change interventions to limit the undesired impacts of promoting
medicines, and some recommendations to move forward

A novel intervention shared in its pilot stages is the HAI/MeTA
methodology to assess impact of promotion control. This is
envisioned to give evidences that help policy makers improve
national policies on promotions. Such was piloted in Uganda
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Medicines Transparency Alliance
The UGANDA experience

UGANDA was one of the countries where the HAI/WHO/MeTA
methodology was piloted

The presentation began with a situational analyses, issues and
challenges faced, lessons learnt from the pilot tool tested, and
recommendations

Noteworthy of the presentation were the following: that ethical
standards were not consistent across different, even neighboring,
countries, that sales representative are the most common and most
effective means of promoting medicines, that the public remained
unaware that medicines’ promotion is regulated, and issues on
enforcement stymie any progress in correcting the problem and that
in the HAI/WHO/MeTA methodology used the Civil Societies played
no or minimal roles in regulating and monitoring promotions
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Medicines Transparency Alliance
PANEL: Questions

After stressing that the issue of medicines promotion is a good
example of public and private interests coming into direct conflict,
as well as the fact that what we are against is UNETHICAL
promotions but we allow legitimate promotions, discussions were
focused on answering the following key questions:
–
What is acceptable promotions?
–
Who is responsible to make decisions on this?
–
How to implement standards to change what is promoted in
the country?
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Medicines Transparency Alliance
PANEL: Thoughts

The regulation of information getting to health care professionals
at the early stages of their training

The transparency of declaring and making public perks received
from sales representatives to deter or limit unethical practices

That information is available (ex. Through the internet) but which
methods are transferrable to countries and what processes?


That there is “no free lunch” and that there are costs to providing
good information to all
And that media and its avenues have a very strong influence on
patient behavior just as incentives have on professional behavior
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Medicines Transparency Alliance
Open Forum

In certain countries, infractions are published

In some instances, medical representatives are the only source of
information. Some companies limit the information given to providers
such that the true health risks are sometimes underemphasized

On issues on standards and codes, a MeTA code where expectations
from ethical promotions was suggested

Important realities
–
–
–
–
–
Companies behave ethically in countries where the codes exist but then do not follow
the same code when they do business elsewhere
The call by companies to comply to ethical marketing standards is not given the same
enthusiasm as their call to contain counterfeit medicines even when both subject
people to higher health risks.
It is important to give information to patients and providers but it is not for industry to
take care of this.
But sources of information is not limited to manufacturers since the whole supply chain
gives information (such as dispensers and pharmacists) but manufacturers are critical
Regulatory Enforcement is weak
Medicines Transparency Alliance
Open Forum
Quotable questions/quotes/solutions

When does information become advertising?

What is the most effective role of MeTA to support pharmacists?

Doctor’s entertainment from the pockets of the patients

There is no free lunch. Regulators should regulate information going
to doctors

Banning medical representatives as sources of information and limit
such to medical journals
Role of MeTA

Training of dispensers

Provide platform for exchanges in information

MeTA code and methodology
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Medicines Transparency Alliance
Summary

We want truth in advertising. But who decides? What does it
apply to? (traditional/herbal medications)

Promotion identifies conflicts in objectives
–
–
Give information. Change behavior in favor of public health
Make money. Change behavior for profits

Revisit the Role of incentives and make it transparent

Need for standards and to reconcile if it is acceptable to have
differing standards among different areas

Addressing implementation and enforcement issues. Combination
and balance of regulatory tools.
–
–
–
Self regulation is important
Government faces limitations due to resource issues
NGO and individual patient
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We have products to sell:

Rational Drug Precribing,
Dispensing, and Use

Right information at the right
time to the right people

People/Patient empowerment
and informed choices
Our Profits: better health outcomes
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Medicines Transparency Alliance
Promoting Medicines,
promoting MeTA
MeTA helps in giving voices
There is strength in unity
There is strength in information
We find strength in MeTA
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Medicines Transparency Alliance
Thank you
Robert Louie P. So, MD
Email: [email protected], [email protected]
International MeTA Secretariat: [email protected]
MeTA: www.MedicinesTransparency.org
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Medicines Transparency Alliance