PHARMACEUTICAL INDUSTRY AND PHYSICIANS-IN-TRAINING IS THERE A

							PHARMACEUTICAL INDUSTRY AND
PHYSICIANS-IN-TRAINING: IS THERE
    A CAUSE FOR CONCERN?


                  Dr. Sara Husain



Health Systems Division, Department of Community Health
      Sciences Aga Khan University, Karachi, Pakistan
Physicians, patients and the pharmaceutical industry form a triad;
with physicians as intermediaries between manufacturers and
consumers

Increasing industrial investment in the field of medicine includes
   •   Medical education and continuing medical education seminars
   •   Clinical research and publications
   •   Patient care, education material and free medical samples
   •   Organization of and attendance at symposia, conferences and retreats
   •   Drug detailing

With $8,000 - $13,000 spent annually per physician in US alone,
there is growing public and professional concern regarding
interactions with the pharmaceutical industry
                         Objective
The paper discusses influences of the pharmaceutical industry on
the profession, particularly physicians-in-training and makes
suggestions to mitigate their impact in the context of Pakistan


                       Methodology
A literature review of articles identified using PubMed and
Medline was performed. Key words used included: physicians,
pharmaceutical industry, Pakistan and ethical issues
Industry influences on the medical profession

Studies reveal extensive influence of the pharmaceutical industry
   on
   • Research: favourable findings more likely to be reported,
     while negative trial findings are suppressed
   • Prescribing behavior:attendance at drug information
     seminars is linked to increased requests to include
     advertised drugs in hospital formularies and increased rates
     of prescriptions
   • Information provision: often, incomplete information
     presented during drug detailing
   • Hospital practice: misuse of free drug samples by
     physicians and staff
                    A Pakistani context
Reports of extensive influence of the pharmaceutical industry exist,
though little effort has been made by professional bodies within
Pakistan to address this issue
   • Physicians are known to accept gifts from token pens to free vacations
     abroad
   • Irrational prescribing habits and prescriptions for costly drugs continue
     unchecked
   • Only 35% of general practitioners consider it unethical to accept gifts
     from pharmaceutical companies
   • Paternalistic style of health care provision makes the public unable to
     identify potential conflicts of interest detrimental to patient care
   • Poor consumer protection by the government
   • Poor adherence to ethical codes of pharmaceutical promotion and poor
     implementation of Drug Act 1976 and the National Drug Policy 1999
A case for expanding the medical curriculum
Despite evidence, the medical profession has perceptions of
invulnerability to industrial overtures

Unregulated access to drug reps with unchallenged acceptance of
gifts and information engenders greater reliance on
pharmaceutical companies as sources of information and blunts
perceptions of ethical boundaries among physicians-in-training

Undergraduate and postgraduate medical programs providing
controlled exposure to the industry, along with stimulating
critical analysis of such interactions have been successful and are
welcomed by physicians-in-training
                         Conclusion
Existing evidence indicates a need to equip physicians-in-training
to handle interactions with the industry. Blunting of critical
analysis of industrial interactions over time highlights the need to
introduce early and ongoing trainings in ethical concepts, moral
reasoning and development of skills necessary to address these
issues.


Registering and regulating authorities in Pakistan have must
ensure inclusion of the existing Code of Ethics in undergraduate
and postgraduate curricula and should regulate industry
collaboration with teaching institutes; developments that are
necessary to raise the standard of clinical practice and improve
patient welfare.