Extent of physician–pharmaceutical industry interactions in low- and middle-income countries: a systematic review

Fadlallah, Racha; Alkhaled, Lina; Brax, Hneine; Nasser, Mayse; Rajabbik, Mhd Hashem; Nass, Hala; Kahale, Lara A; Akl, Elie A.

doi:10.1093/eurpub/ckx204

Cited by 21 publications

(22 citation statements)

References 28 publications

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“…But what about the widespread practice of inducements, some of little monetary value, such as pens, by pharmaceutical sales representatives? 12 There is considerable evidence that this is associated with increased prescribing of the brands concerned. 13 Then there are informal payments, made to secure faster or higher quality treatment.…”

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confidence: 99%

We Need to Talk About Corruption in Health Systems

Hutchinson

Balabanova

McKee

2018

Int J Health Policy Manag

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The health sector consistently appears prominently in surveys of perceived corruption, with considerable evidence that this has serious adverse consequences for patients. Yet this issue is far from prominent in the international health policy discourse. We identify five reasons why the health policy community has been reluctant to talk about it. These are the problem of defining corruption, the fact that some corrupt practices are actually ways of making dysfunctional systems work, the serious challenges to researching corruption, concerns that a focus on corruption is a form of victim blaming that ignores larger issues, and a lack of evidence about what works to tackle it. We propose three things that can be done to address this situation. First, seek consensus on the scale and nature of corruption. Second, decide on priorities, taking account the importance of the particular problem and the feasibility of doing something about it. Third, take a holistic view, drawing on a wide range of disciplines.

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confidence: 99%

We Need to Talk About Corruption in Health Systems

Hutchinson

Balabanova

McKee

2018

Int J Health Policy Manag

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“…Formularies are seen as important for delineating and directing appropriate prescribing enhanced by trust in their development (Rucker and Schiff, 1990;Pillans et al, 1992;Eriksen et al, 2018). This is especially important when the principal means of physician education is via pharmaceutical companies (Spurling et al, 2010;Civaner, 2012;Jacob, 2018;Fadare et al, 2018a;Fadlallah et al, 2018).…”

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confidence: 99%

Formulary Management Activities and Practice Implications Among Public Sector Hospital Pharmaceutical and Therapeutics Committees in a South African Province

et al. 2020

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Introduction: The World Health Organization identified Pharmaceutical and Therapeutics Committees (PTCs) at district and hospital levels as one of the pivotal models to promote rational use of medicines (RUM). This is endorsed by the Government in South Africa. Formulary development and management is one of the main functions of PTCs. This study aimed to describe the formulary management activities among PTCs in public hospitals in Gauteng Province, South Africa, following initiatives to promote RUM in South Africa. Methods: Qualitative, nonparticipatory, observational study, observing 26 PTC meetings. Data were coded and categorized using NVivo9 ® qualitative data analysis software. Themes and sub-themes were developed. The themes and sub-themes on formulary management are the principal focus of this paper. Results: More than half of the observed PTCs reviewed their formulary lists. There was variation in the review process among institutions providing different levels of care. Various aspects were considered for formulary management especially requests for medicines to be added. These included cost considerations (mainly focusing on acquisition costs), evidence-based evaluation of clinical trials, patient safety, clinical experience and changes in the National Essential Medicines List (NEML). The tertiary PTCs mostly dealt with applications for new non-EML medicines, while PTCs in the other hospitals mainly requested removal or addition of EML medicines to the list. Conclusion: This is the first study from Gauteng Province, South Africa, reporting on how decisions are actually taken to include or exclude medicines onto formularies within public sector hospitals providing different levels of care. Various approaches are adopted at different levels of care when adding to-or removing medicines from the formulary lists. Future programs should strengthen PTCs in specialized aspects of formulary management. A more structured approach to formulary review at the local PTC level

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“…This increase in the number of visits and the closer relationship raise concerns regarding violations of professional codes of ethics. Recently, many studies and reports have been published confirming industry influence on the objectivities and behaviors of physicians Research article (8)(9)(10)(11)(12)(13)(14)(15)(16). Many physicians frequently do not recognize that their decisions have been affected by commercial gifts and services and may in fact deny or minimize such influence.…”

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confidence: 99%

Attitudes and behaviours of physicians towards the relationship with the pharmaceutical industry in Saudi Arabia

Bahammam

Asiri

Al-Jahdali

et al. 2020

East Mediterr Health J

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Background: The relationship and interactions between physicians and the pharmaceutical industry can affect patient care. A physician's practice can be influenced by this relationship. It is believed that these interactions are common among doctors in Saudi Arabia. Aims: This study was undertaken to assess the frequency of such relationships and physicians' attitudes and behaviours toward them. Methods: This was a cross-sectional questionnaire survey completed by practicing physicians at four Saudi government and private tertiary care centres in Riyadh, Saudi Arabia. The questionnaire addressed the frequency of meetings with representatives of pharmaceutical companies (PRs) and of receiving gifts and considered the physicians' attitudes and behaviours towards PRs. Results: A total of 300 completed questionnaires were obtained. Among the physicians surveyed, 223 (74.3%) met PRs one to three times per month. Up to 191 (64%) of physicians admitted receiving gifts. More than two thirds of physicians-192 (63%) have been invited to activities sponsored by pharmaceutical companies. Among the physicians, 239 (80%) agreed that PRs use promotional techniques in their approach and 251 (84%) of them stressed the need for expert physicians to attend presentations by PRs to correct the facts. Conclusion: The frequent meetings between physicians and PRs and the use of promotional techniques by PRs are concerning. Future studies should assess the impact of this involvement on medical practice and drugs prescription in Saudi Arabia.

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Extent of physician–pharmaceutical industry interactions in low- and middle-income countries: a systematic review

Abstract: A relatively high percentage of physicians in LMICs interact with pharmaceutical companies. Findings have implications for policy and practice, given the current extent of interaction is likely affecting the prescribing habits and professional behaviour of physicians.

Cited by 21 publications

References 28 publications

We Need to Talk About Corruption in Health Systems

We Need to Talk About Corruption in Health Systems

Formulary Management Activities and Practice Implications Among Public Sector Hospital Pharmaceutical and Therapeutics Committees in a South African Province

Attitudes and behaviours of physicians towards the relationship with the pharmaceutical industry in Saudi Arabia

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