Perceptions of and barriers to ethical promotion of pharmaceuticals in Pakistan: perspectives of medical representatives and doctors

Abstract

Background In Pakistan, drug promotion practices, ethical or unethical, have rarely been in the spotlight. We aimed to assess the perception and barriers of medical representatives (MRs) and doctors (MDs) regarding ethical promotion of pharmaceuticals in Pakistan. Methods A cross sectional survey was conducted in seven major cities of Pakistan for 6-months period. Self-administered questionnaire was used for data collection. Logistic regression and five-point Likert scale scoring was used to estimate the perceptions and barriers. Results Compared to national companies (NCs), the medical representatives (MRs) of multinational companies (MNCs) strongly believed that their companies follow World Health Organization (WHO) (OR; 5.31, p = 0.0005), International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) (OR; 6.45, p = 0.0005) and national codes of ethics (OR; 5.84, p = 0.0005). MNCs trained their MRs (OR; 6.68, p = 0.0005), provide accurate and valid scientific data (OR; 4.01, p = 0.007) with adequate system of accountability and controls on product samples (OR; 1.96, p = 0.047), while, NCs sponsor social or entertainment activities, seminars and conferences, and all sort of facilitation in form of gifts of their choice and clinic renovation for medical doctors (MDs). MDs perceptions were similar to MRs mentioned above, yet strongly agreed that companies offer cash payments or equivalents to MDs. The MRs of NCs/MNCs and MDs agreed/strongly agreed that no external accountability, profiteering, pressure on sale targets, job insecurity, condoning unethical promotion by high-ups’ and business promotion by junior MDs were the predominant barriers. Conclusion In conclusion, MRs of MNCs and MDs believed that MNCs follow certain codes of ethics in the promotion of pharmaceuticals, while NCs tend to be more profit oriented and even condone unethical promotion. All stakeholders, MRs, MDs and companies, might pose certain barriers, intentionally or unintentionally, in ethical promotion.

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“…Gul et al [34] shed promotional challenges for social media marketing from doctors and medical representatives. The study drew a thin line between good and bad practices between multinational and national companies for following ethics and profit gaining.…”

Potential Strategies to Improve Antimicrobial Utilisation in Hospitals in Bangladesh Building on Experiences Across Developing Countries

“…In addition, there can be multiple prescribing of antibiotics to patients in hospitals in Bangladesh, which can often be inappropriate 8 . Alongside this, hospital physicians in LMICs often gain their knowledge about antimicrobials from pharmaceutical companies, and are influenced by them [33][34][35][36][37] , with physicians in Bangladesh no exception 38,39 . There can also be limited knowledge regarding ASPs among physicians in LMICs versus higher-income countries [40][41][42] , building on variable knowledge generally regarding antibiotics among healthcare workers and students in LMICs including Bangladesh [43][44][45][46] .…”

How conflicts of interest hinder effective regulation of healthcare: an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan

“… 51 The value of the pharmaceutical industry in Pakistan has doubled over the past decade, with more than 700 pharmaceutical companies operating, of which the vast majority are domestic. 52 Pharmaceutical sales per annum are over US$2 billion. 52 Although a national drug policy exists to regulate this sector, unethical drug promotion has become an acceptable norm.…”

“… 52 Pharmaceutical sales per annum are over US$2 billion. 52 Although a national drug policy exists to regulate this sector, unethical drug promotion has become an acceptable norm. 52 In 2017, the Ministry of National Health Services developed a national AMR action plan and established a national coordination group and multisectoral secretariat.…”

“… 52 Although a national drug policy exists to regulate this sector, unethical drug promotion has become an acceptable norm. 52 In 2017, the Ministry of National Health Services developed a national AMR action plan and established a national coordination group and multisectoral secretariat. 53 The same year, as part of a WHO evaluation process, Pakistan scored the lowest in policy and capacity to combat AMR, signalling a weak regulatory environment for the monitoring and control of antibiotic use in both human and animal sectors.…”