External Influences on
At the end of the session students will have
• Examined the factors which might be considered to be
external influences on prescribing practice.
• An increased awareness of those factors should enable
students to prescribe in a more objective and evidence
What are the factors likely to affect
our prescribing decisions?
• Think of what might influence you when you start
prescribing and then when you have been prescribing for
• Make a note of those things you think about
Factors Influencing Prescribing
Some influences are positive ones
• Policies, guidelines
• Research evidence
• Cost and clinical effectiveness
Other influences are not so
positive? Or are they?
• The prescribers personal selection list (known
as P drugs)
• Custom and practice
• Influence of opinion leaders, colleagues and
Companies promote their products to
• Direct mailing
• Adverts in journals
• Stands at events
• Seminars and educational meetings
• Promotional material is usually attractive
and easy to digest.
• Tends to emphasis positive aspects of the
• Tailored to appeal to specific groups of
Advertising is, of course, not the
only promotional tool used
What else is used to promote products?
Look at your handout of MHRA
1. No Scientific evidence to support claims
of this herbal medicine- ambiguous
2. Promoting a POM to the public- what are
the ethical issues here?
3. This complaint was not upheld do you
think this was correct?
Sponsorship and gifts
• How many “gifts” have you received in the last
• Did receipt of these gifts influence you in any
Are we influenced ?
• Current cost of NHS drug spending 10 billion pounds per
• 30 million per day
• 8,000 sales reps promote to 60,000 Drs =
1 rep per 7.5 Drs
• It is very difficult to find out how much drug companies
spend on promotions but think about drug rep salaries
Sponsorship and gifts
• Standards of expected behaviour are
• NMC Code of Professional conduct
• Standards of business conduct for NHS
staff (HSG (93) 5)
• The ABPI Code of Practice for the
pharmaceutical industry 2006 (see link on
NMC Code Of Professional
• 7 : AS A REGISTERED NURSE MIDWIFE OR
HEALTH VISITOR YOU MUST:
• Be Trustworthy
– You must ensure that your registration status is not
used in the promotion of commercial products or
services, declare any financial or other interests in
relevant organisations providing such goods or
services and ensure that your professional judgement
is not influenced by any commercial considerations.
Gifts and sponsorship
• Prescribers should maintain an
independent stance to avoid accusations
of inappropriate partiality to particular
products being made.
How do you conduct a meeting with
• Take control of the discussion at the
• Look for more information than is given in
• Make sure you get all the relevant info-
drug trial info, cost and clinical
• Copy of product characteristics
What to ask for
• Copies of published articles
• Consider those from peer reviewed
• Check what specialists in the field know
• Should be worth no more than £5
• Relevant to practice
• The standard of any hospitality should be the same as
you would routinely pay for yourself
• Only prescribers and not their family members should
There is no such thing
as a free lunch!
So back to our learning outcomes
• What are the most powerful influences?
• How can we remain objective?
• What good habits can we form in order to
keep us on the straight and narrow?
• ABPI Code of Practice for the Pharmaceutical Industry 2006
Available online @ www.abpi.org.uk
• Advertising of Medicines MHRA 2009 Available on line@
• House of Commons Health Committee Fourth Report of Session
2004–05 -The Influence of the Pharmaceutical Industry Available on
• Pharmacy Journal Gifts & Inducements The Pharmaceutical
Vol 278 No 7457 p752
23 June 2007
This work was produced as part of the TIGER project and funded by JISC and
the HEA in 2011. For further information see:
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