Abstract
Background: The interaction between physicians and medical representatives (MRs) through gift offering is a common cause for conflicts of interest for physicians that negatively influence prescribing behaviors of physicians throughout the world. This study aimed to evaluate the interaction between MRs and Iraqi specialist physicians through the acceptance of MRs gifts and the effect of such acceptance on physician’s prescribing patterns. Methods: A survey in a questionnaire format for specialist physicians was done during March-October 2013 in Iraq, Baghdad. The questionnaire involves four major parts regarding the approximate number of patients and medical representatives, gift acceptance, medical conferences, and prescribing pattern. Results: In Iraq specialist physicians were visited by 1 - 3 MRs/day. 50% of the Iraqi physicians like to get the educational information by attending conferences outside Iraq. Regarding Gift acceptance, 41% of participated physicians showed a general acceptance to promotional gifts, and 91% of physicians accept low cost gifts but only 41% of them accept high cost recreational gifts. Free samples were used by 59% of Iraqi physicians to treat some people. 77% of physicians prefer prescribing new medications, while more than 95% of participated physicians stated that they stop prescribing these new drugs either due to their ineffectiveness or due to their side effects. On the other hand physicians significantly change their prescribing behavior through shifting not only among generic drugs, but also from brand to generic drugs in their prescriptions. Gift acceptance is directly correlated with such shift and change in prescribing behavior. Conclusion: Iraqi physicians accept various types of gifts from pharmaceutical companies; this can influence physician prescribing pattern and result in early adoption to prescribe newly medications depending on promotional information even in absence of clinical evidence about the drug effectiveness or side effects, which may result in undesirable outcomes to the patient.
Highlights
A large budget of pharmaceutical companies is usually spent on drug promotion [1]
While for high cost gifts 59% of participated physicians didn’t accept such gifts (Figure 1), there is a significant agreement among physicians (73%) that high cost gift at every visit of medical representatives (MRs) to the clinic is not justifiable (Figure 2)
This study showed that 41% of physicians accept high cost gifts, while in USA a lower percent (25.4%) of physicians consider the acceptance of high cost gift is appropriate and ethical [25], despite the higher percent of unethical acceptance for high cost gifts among Iraqi physicians than American physicians, but this difference may be resulted from the higher percent of surgeons who participated in the current study, at which surgeons are one of the most common specialist physicians who accept gifts [25]
Summary
A large budget of pharmaceutical companies is usually spent on drug promotion [1]. Physician targeted promotion through medical sale representatives (MRs) is one of the most common tactics that was adopted by pharmaceutical companies for promoting their products [2]-[4]. MRs use a variety of promotional tactics during their interaction with physicians like free drug samples, inviting physicians to educational conferences, giving brochures and sometimes gifts offering [5]. This study aimed to evaluate the interaction between MRs and specialist physicians through the acceptance of MRs gifts and the effect of such acceptance on physician’s prescribing patterns. This study aimed to evaluate the interaction between MRs and Iraqi specialist physicians through the acceptance of MRs gifts and the effect of such acceptance on physician’s prescribing patterns. Conclusion: Iraqi physicians accept various types of gifts from pharmaceutical companies; this can influence physician prescribing pattern and result in early adoption to prescribe newly medications depending on promotional information even in absence of clinical evidence about the drug effectiveness or side effects, which may result in undesirable outcomes to the patient
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