GPs’ perceptions of their relationship with the pharmaceutical industry: a qualitative study

BackgroundThe pharmaceutical industry invests heavily in promoting medications to physicians. This promotion may influence physicians’ prescribing behaviour and lead to inappropriately increased prescribing rates.AimTo understand GPs’ experience of interacting with the pharmaceutical industry, and explore their views and perceptions of the impact of this interaction in general practice in Ireland.Design & settingA qualitative design was used, and GPs practicing in Ireland were eligible.MethodA combination of purposive and snowball sampling techniques was applied and semi-structured interviews were conducted. Thematic analysis was used to develop themes from the data.ResultsTwenty-one GPs and one GP trainee participated. Five themes were developed: GP and pharmaceutical industry interface, the industry’s methods of influence, the uncomfortable relationship between GPs and industry, GPs’ perceptions of being unconsciously influenced, and GPs’ lack of knowledge of relevant regulations. Participants interacted with pharmaceutical representatives in their surgery and through continuing professional development (CPD). Reported methods of influence included biassed information and the offer of gifts. Most participants felt their prescribing was unconsciously influenced. A minority felt that they were only influenced in a way that improved their prescribing.ConclusionThe study shows that there can be a lack of clarity among GPs about relevant regulations and about the potential impact of interactions with the pharmaceutical industry on prescribing. Education of trainees and GPs has the potential to address this. Restrictions on interactions with the pharmaceutical industry may also play a role, although alternative CPD funding sources would need to be established.

Health professional’s exposure, attitude, and acceptance of drug promotion by industry representatives: A cross-sectional study in Ethiopia

Interactions between pharmaceutical companies and health care providers have long been an area of interest from ethical as well as scientific grounds. The information provided by those companies must be scientifically accurate and fair. The current study aimed to investigate the exposure, attitude, and training background of medical doctors and pharmacy professionals regarding drug promotional activities, and assess their acceptance of promotional gifts provided by pharmaceutical sales representatives. A cross-sectional study was conducted on medical doctors and pharmacy professionals working at Bahir Dar and Gondar cities, Amhara regional state, Ethiopia. Data were collected using a self-administered structured questionnaire and Statistical Package for Social Science (SPSS) version 26 was used for analysis. A Chi-square test was computed to investigate the presence of an association between the dependent and independent variables. A p-value of less than 0.05 was considered to declare significance at a 95% Confidence Interval (CI). A total of 105 health professionals, 81 pharmacy professionals, and 24 medical doctors have participated in the study. Above two-thirds of the respondents (69.5%) agreed that most talks sponsored by drug companies were helpful and educational. On the other hand, 39% of the respondents agreed and 47.6% disagreed that receiving gifts from pharmaceutical representatives will increase the chance that they will eventually sell or recommend the drug company’s products. The majority of the study participants (81%) preferred drug samples and stationery as appropriate gifts by pharmaceutical sales representatives. Significant gaps were found regarding the training of health professionals about the ethics of drug marketing and how to deal with pharmaceutical representatives. Policies aiming at restricting health care provider’s contacts with pharmaceutical companies during residency training along with incorporating gift restriction policies could bring significant improvements.

Anthropologies of Cancer

Cancer is a relatively new subject for the discipline of anthropology, but scholarship on the topic has already yielded a distinct and important body of literature. In biomedical terms, cancer can be thought of as the wide range of conditions characterized by the uncontrolled (and ultimately pathological) proliferation of cells. It is a disease that is responsible for the deaths of millions of people worldwide each year. As such, it is the focus of a vast number of discourses and practices in multiple areas, ranging from scientific research and media discussion to health insurance and government regulation, to name just a few. Anthropologists concerned with cancer typically use the methodology that is a hallmark of the discipline, long-term ethnographic fieldwork, in order to investigate these discourses and practices. This involves conducting participant observation among doctors, patients, nurses, family members, scientists, politicians, policymakers, and pharmaceutical representatives. Cancer is examined as a lived experience, revealing the numerous ways that local, regional, national, and transnational histories and politics shape the embodied realities of disease. Anthropologists also investigate the regimes of risk and statistical analysis to which bodies are subjected and the technologies around cancer, such as methods of screening or vaccination that aim to prevent it and the different ways in which these and other interventions and technologies fit into—or push uneasily against—the local words in which they are implemented. Anthropologists aims to look beyond the problem as simply one of biology and medicine, instead investigating cancer as pervasive within multiple dimensions of social, cultural, political, and economic life. Anthropological studies displace the prominent biomedical notion that cancers are the same in diverse locations and reveal the incoherence and intractability of cancer as an object. In paying close attention to this object in varied settings, anthropologists offer a critical account of discourses and practices that destabilize and decenter some of the assumptions on which global oncology is based.

GPs and Pharma Reps: Why Are We So Ambivalent? Crossing perspectives from sociology, psychology and general practice toward a qualitative study in France

Background: Receiving a gift from pharma reps or meeting them is correlated with an amount of bigger, more expensive and sometimes less rational prescriptions. French General Practitioners (GPs) tend to express an unfavorable opinion towards the pharmaceutical industry; they however adopt rather favorable behavior with pharmaceutical representatives. Yet no study has sought to understand the reasons for this discrepancy. The aim of this study was exploratory: why do some general practitioners receive pharmaceutical representatives when they express an unfavorable opinion regarding the pharmaceutical industry?Method: Qualitative descriptive study by semi-structured face to face interviews with French GPs of the south-east of France. A general inductive analysis was carried out. Data were analysed by researchers from different disciplines (psychology, sociology and general practice).Results: Ten GPs were interviewed for an average time of 50 minutes. The analysis yield to three forces competing to keep meeting pharmaceutical representatives despite unfavorable opinions towards it: practical reasons such as a substitute for continuous training; social and cultural reasons such as propriety toward representatives; psychological mechanisms such as cognitive dissonance and hidden curriculum. Cognitive dissonance is a well-supported social-psychology theory explaining how it is possible to maintain a behavior despite an unfavorable opinion. Since meeting pharma reps is implemented during traineeship, it could be considered as a part of the hidden curriculum. The strengths of this work are the confrontation of medicine, social psychology and sociology with the original approach of the interpretative phenomenological approach.Discussion: The GPs/representative relationship is complex, involving psychological mechanisms which are unknown to the medical profession. GPs use reps as a convenient continuous education tool furthermore in a private practice setting in which GPs feel they lack time. Lifting the veil of individual ambivalence raises questions which are more social and political than individual.

Pharmaceutical promotions and trustworthiness on new drug prescribing among physicians in public general hospitals

Objective: The interaction between physicians and the pharmaceutical industry influences physicians’ attitudes and prescribing behaviors. In this regard, physicians’ attitudes towards pharmaceutical promotions and their trustworthiness towards pharmaceutical representatives’ information on new drugs were explored in this study.Methods: The present study was an analysis of a cross-sectional survey of 183 physicians with different job and education hierarchies and from various clinical settings in Erbil-Iraqi Kurdistan in July 2018. The physicians were invited from the public sector, comprising a general, emergency, and pediatric hospital. The information was collected through an anonymous, self-administered questionnaire. The questionnaire included exposure to marketing activities, motivations to contact pharmaceutical representatives, attitudes towards promotional activities, and trustworthiness of the pharmaceutical representatives’ information on new drugs.Results: Majority of the physicians reported that the information provided by pharmaceutical representatives assisted them in staying up to date or learning about new products (76.5%), but 55.7% of them trusted their medical information. In addition, most of them reported that pharmaceutical representatives prioritized the promotion of their products over patients’ benefits (70.5%). They reported that receiving promotional material and participating in promotional activities have an effect on doctors’ behaviors to prescribe a new drug, including promotional materials (55.2%); medical samples (67.8%); funding of registration costs to conferences (60.1%); participation in industry-funded researches (69.9%); and continuing medical education (69.4%). Receiving promotional materials and participation in promotional activities were considered to be ethical.Conclusions: The present study showed that most of the physicians reported the role of promotional materials and activities on physicians’ behaviors to prescribe new drugs.

Premedical Student Exposure to Pharmaceutical Marketing: Too Much, Too Soon?

Background and Objectives: Direct pharmaceutical marketing to physicians by pharmaceutical representatives is effective in changing behavior of health care providers, resulting in less evidence-based prescribing. Although much has been written about pharmaceutical marketing exposures among medical students, less is known about direct marketing exposures before students matriculate. This study examined the types of pharmaceutical representative direct marketing exposures for premedical students and where they occurred. Methods: From June to August of 2017, researchers surveyed students who accepted admission to US public medical schools. These prematriculated students completed our survey just prior to matriculation. The survey inquired about whether the students were exposed to pharmaceutical marketing directly from pharmaceutical salespeople, the types of marketing they observed or received, and where these interactions occurred. Results: Survey participants included 911 prematriculated students from 14 of the 188 medical schools invited to participate. Seventy-one percent (646) of the participants received or observed someone receiving pharmaceutical marketing gifts, small meals or snacks, articles, or samples. The two most common contexts for direct pharmaceutical marketing exposures were during shadowing experiences (54%, 346) and during employment (50%, 323). Conclusions: The findings suggest that it may be common for medical students to have interacted directly with pharmaceutical salespeople or observed other health professionals in these interactions before they matriculate in medical school. Because many of these interactions occur during clinical experiences required by institutions for admission, medical schools and premedical associations should consider delivering conflict-of-interest education early in medical school education or before students matriculate.