Abstract
Many factors contribute to the inappropriate use of medicines, including not only a lack of information but also inaccurate and misleading promotional information. This review examines how the promotion of pharmaceuticals directly affects the prescribing and use of medicines. We define promotion broadly as all actions taken directly by pharmaceutical companies with the aim of enhancing product sales. We look in greater detail at promotion techniques aimed at prescribers, such as sales representatives, pharmaceutical advertisements in medical journals and use of key opinion leaders, along with the quality of information provided and the effects thereof. We also discuss promotion to the public, through direct-to-consumer advertising, and its effects. Finally, we consider initiatives to regulate promotion that come from industry, government and nongovernmental organizations.
Highlights
Medicines can cure acute illnesses, treat chronic conditions, relieve symptoms and prevent future ill health
We look in greater detail at promotion techniques aimed at prescribers, such as sales representatives, pharmaceutical advertisements in medical journals and use of key opinion leaders, along with the quality of information provided and the effects thereof
A study of the frequency of safety information provision in 1692 promotions to family physicians in four cities in Canada, the United States (US) and France found that serious adverse events were rarely mentioned, even for products with US Food and Drug Administration (FDA) “black box warnings” of risks, and the minimum of information judged a priori to be needed for patient safety was provided only 2% of the time (Mintzes et al 2013)
Summary
Medicines can cure acute illnesses, treat chronic conditions, relieve symptoms and prevent future ill health. To make an informed decision, a person needs information on the aims of the treatment, how it works, how to use it properly, the likelihood of benefit and harm, and how this medicine compares with other available treatment options or the option not to treat, as well as relative cost-effectiveness. US court cases involving multinational pharmaceutical companies have uncovered a range of promotional activities raising strong ethical and public health concerns, such as the hiring of clinical expert ‘key opinion leaders’ to promote unapproved uses (off-label), ghostwriting of scientific articles, instructions to sales staff not to mention specific evidence of harm (Waxman 2005) and efforts to discredit clinicians who raised safety concerns (Rout 2009). We conclude by reviewing initiatives from the pharmaceutical industry, government and nongovernmental organizations for improvement of the regulation of the promotion of pharmaceuticals
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