"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.