Ethics of Giving Gifts to Physicians from the Perspective of Pharmaceutical

Ethics of Giving Gifts to Physicians from the Perspective of Pharmaceutical Representatives (PR) and Differences Between Indigenous (IC) and Multinational (MC) Pharmaceutical Companies in South India Stephanie Albin University of Chicago Pritzker School of Medicine GHEC Conference Background: Pharmaceutical Industry in India Study Objectives • Describe the culture of gift-giving by pharmaceutical companies to physicians. • Explore the differences in attitudes and beliefs of Medical Representatives (MRs) and Sales Managers employed by MultiNational Companies (MNC) and Indian Local Pharmaceutical Companies (LPC). Qualitative Survey • Survey Design – 30 Minute Survey – Structured and Administered by Research Assistant – Goal: Assess the role of MRs in patient care activities, clinical research, and details of gift giving practices. • Recruitment – Methodology: Using a key informant, we recruited a convenience sample of 11 subjects (snowball methodology). Quantitative Survey • Survey Design – 87 Item Multiple Choice Survey – Domains: Ethics and Marketing Practices (Likert Scales) • Recruitment – Methodology: We recruited a convenience sample of 169 from large hospitals in Hyderabad, India. Subject Background Information Pharmaceutical Company Type MNC employees LPC employees Unknown Company Type Total 63, (37.3%) 99, (58.6%) 7 (4.1%) N = 169 Employment Information # of Medical Representatives 67 subjects (39.6%) # of Sales Managers # of unknown position Years at current company Average Salary # of MRs in company 60 subjects (35.5%) 42 subjects (24.9%) 84.3% less than 5 years 10,911.16 Rp/month (~$235/month) 45.5% have more than 300 MRs # of doctors covered 200 (median) Current State of Pharma Marketing Question Policy Company has written policy on gift-giving Agree Disagree 26.8% 51.8% 51.2% 31.5% Pharmaceutical profession should have gift-giving policy Attitudes towards doctors Doctors ask for unethical gifts No gift, no prescription Doctors are more honest 57.4% 63.2% 27.6% 68.2% 31.3% 25.7% 36.9% 13.9% Gifts to physicians are too expensive Comparative Analysis: MNC, LPC Employee Attitudes Question Pens, Notepads Textbooks Stethoscope Private Lunch (p<0.10) O/R 0.667 0.314 1.276 0.53 0.47 0.677 0.904 0.52 0.418 95% CI 0.281 0.056 0.583 0.267 0.239 0.318 0.439 0.212 0.129 1.58 1.773 2.792 1.049 0.923 1.442 1.861 1.278 1.354 Sporting Event Tickets (p<0.05) National Conference International Conference 10,000 Rp 100,000 Rp Survey Trends: Ethics of Gift Giving Gifts Received By Each Specialty * Difference statistically significant when compared with MBBS: Fisher’s Exact 2 sided Test < .05. * * * * * * Survey Trends: Gift-Giving Practices Conclusions – Quote from an LPC Medical Representative: “I feel there is nothing like ethical and non-ethical these days. It all depends on how you perceive it. See, if you feel that the doctor is asking for something which is justified, if you feel that whatever you give and the prescriptions will be justified, then I think that everything is fair, because right now there is a lot of competition in all the companies.” Limitations • Convenience Sample • Cultural/Language Limitations • Distrust Acknowledgements • • • • • • • John Schneider, MD, MPH Vineet Arora, MD, MSA Anand Akundy, PhD Vijay Rhagavan, MD Falguni Sen, PhD Jonathan Dick, MS2 UCP3: Univ. of Chicago Program for Pharmaceutical Policy