Pharmaceutical Company Representatives Research Articles

Beliefs and practices of physicians in Lebanon regarding promotional gifts and interactions with pharmaceutical companies.

Pharmaceutical companies invest greatly in promotional gifts to influence prescription of medications by physicians, yet there is limited published information evaluating its impact on healthcare. This study aimed to assess the beliefs and practices of physicians in Lebanon regarding promotional gifts and their interactions with representatives of pharmaceutical companies. This cross-sectional study was conducted between December 2019 and January 2020 through an email-based questionnaire sent to 5936 physicians of different specialties registered in the Lebanese Order of Physicians. Assessment was done using a validated tool and data analysis was conducted using SPSS version 26.0. Of the 268 respondents, 188 (70.4%) reported that physicians in Lebanon accepted gifts from representatives of pharmaceutical companies. Most of the physicians (31.7%) interacted with company representatives more than once a week. Medication samples (251 respondents) and stationary items (222 respondents) were the most common gifts accepted by physicians who admitted accepting gifts. Overall, 225 (84.9%) respondents believed that prescriptions by physicians in Lebanon were influenced by the gifts. Only 74 (40.0%) of those who accepted gifts from pharmaceutical companies believed that it was unethical, and around half did not know if the Lebanese Code of Medical Ethics allowed them to accept gifts from pharmaceutical companies. Although physicians in Lebanon were aware of the effect that gifts from pharmaceutical companies could have on their prescription behaviours, many of them still accepted the gifts. This study provides evidence to policymakers for decision-making regarding ethical guidance on interactions between physicians and pharmaceutical companies in Lebanon.

Therapeutic drug monitoring to personalize dosing of imatinib, sunitinib, and pazopanib: A mixed methods study on barriers and facilitators.

Personalized dosing based on measurement of individual drug levels and adjusting the dose accordingly can improve efficacy and decrease unnecessary toxicity of oncological treatment. For imatinib, sunitinib, and pazopanib, this therapeutic drug monitoring (TDM)-guided dosing is, however, not routinely used, despite accumulating evidence favoring individualized dosing. Therefore, we aimed to identify and quantify (potential) barriers and facilitators in TDM-guided dosing for imatinib, sunitinib, and pazopanib. We performed a mixed methods study among all stakeholders involved: patients, healthcare professionals (HCPs), pharmaceutical companies, and health insurance companies. During the first qualitative part of this study, we performed semi-structured individual interviews and one focus group interview to identify all (potential) barriers and facilitators, and during the second quantitative part of this study, we used a web-based survey to quantify these findings. The interviews addressed the six domains of the implementation of change model of Grol and Wensing: (1) the innovation itself; (2) the HCP; (3) the patient; (4) social context; (5) organizational context; and (6) finances, law, and governance. In the qualitative study, we interviewed 20 patients, 18 HCPs and 10 representatives of pharmaceutical and health insurance companies and identified 72 barriers and 90 facilitators. In the quantitative study, the survey was responded by 66 HCPs and 58 patients. Important barriers were on the domain of the HCP, such as a lack of experience with TDM (36.4%), on the domain of the patient, such as lack of awareness of TDM (39.7%), and the processing time for measurement and interpretation of the TDM result (40.9%) (organizational domain). Important facilitators were education of HCPs (95.5%), education of patients (87.9%) and facilitating an overview of when and where TDM measurements are being performed (86.4%). We identified and quantified important barriers and facilitators for the implementation of TDM-guided dosing for imatinib, sunitinib, and pazopanib. Based on our results, the implementation strategy should mainly focus on educating both HCPs and patients and on the organizational aspect of TDM.

Knowledge attitude and practices of drug promotional literature: a clinician’s perspective

Background: Promotion of drugs by pharmaceutical industries is fully regulated by drug regulators. Doctors are focus of intense marketing by representatives of pharmaceutical companies (MR). It is reported that very few physicians are equipped with the necessary skills and knowledge to critically assess the information delivered in drug promotional literature (DPL). Hence this study was carried out with the objective to determine knowledge, attitude and practices of doctors about the DPL Methods: This was a questionnaire-based study population included clinicians working in a government set up and others doing private practice. Questionnaire was circulated online on social media platforms via Google forms. Results: The 32.11% participants were aware of regulations and guidelines of DPL in India 80.7% participants searched for cost of medicine on DPL, 54.12% respondents perceive that the product claims made on DPL are balanced and supported by good evidence, 56.88% participants opined that their integrity is compromised by accepting gift from MR, 43.1% participants are exposed to drug advertisement through social media and 51.06% of them opined that their prescribing habits are influenced through this. Writing brand names while prescribing is significantly more in private practitioners as compared to doctors employed in government set up. Conclusions: DPL serves to update the knowledge of the busy clinicians of the latest developments in the medical field. Quality check of drug promotion on social media is the need of the hour as this is influential. Private practitioners need to be addressed regarding enforced laws for rational prescribing.

Challenges and Solutions in Implementing eSource Technology for Real-World Studies in China: Qualitative Study Among Different Stakeholders.

eSources consist of data that were initially documented in an electronic structure. Typically, an eSource encompasses the direct acquisition, compilation, and retention of electronic information (such as electronic health records [EHRs] or wearable devices), which serves to streamline clinical research. eSources have the potential to enhance the accuracy of data, promote patient safety, and minimize expenses associated with clinical trials. An opinion study published in September 2020 by TransCelerate outlined a road map for the future application of eSource technology and identified 5 key areas of challenges. The background of this study concerns the use of eSource technology in clinical research. The aim of this study was to present challenges and possible solutions for the implementation of eSource technology in real-world studies by summarizing team experiences and lessons learned from an eSource record (ESR) project. After initially developing a simple prototype of the ESR software that can be demonstrated systematically, the researchers conducted in-depth interviews and interacted with different stakeholders to obtain guidance and suggestions. The researchers selected 5 different roles for interviewees: regulatory authorities, pharmaceutical company representatives, hospital information department employees, medical system providers, and clinicians. After screening all consultants, the researchers concluded that there were 25 representative consultants. The hospital information department needs to implement many demands from various stakeholders, which makes the existing EHR system unable to meet all the demands of eSources. The emergence of an ESR is intended to divert the burden of the hospital information department from the enormous functional requirements of the outdated EHR system. The entire research process emphasizes multidisciplinary and multibackground expert opinions and considers the complexity of the knowledge backgrounds of personnel involved in the chain of clinical source data collection, processing, quality control, and application in real-world scenarios. To increase the readability of the results, the researchers classified the main results in accordance with the paragraph titles in "Use of Electronic Health Record Data in Clinical Investigations," a guide released by the US Food and Drug Administration. This study introduces the requirement dependencies of different stakeholders and the challenges and recommendations for designing ESR software when implementing eSource technology in China. Experiences based on ESR projects will provide new insights into the disciplines that advance the eSource research field. Future studies should engage patients directly to understand their experiences, concerns, and preferences regarding the implementation of eSource technology. Moreover, involving additional stakeholders, including community health care providers and social workers, will provide valuable insights into the challenges and potential solutions across various health care settings.

Practices and challenges related to antibiotic use in paediatric treatment in hospitals and health centres in Niger and Uganda: a mixed methods study

BackgroundAntibiotic resistance is a significant public health problem and is responsible for high mortality in children and new-borns. Strengthening the rational use of antibiotics and improving the quality and access to existing antibiotics are important factors in the fight against antibiotic resistance. This study aims to provide knowledge on the use of antibiotics in children in resource-limited countries in order to identify problems and possible avenues for improvement of antibiotics use.MethodsWe conducted a retrospective study in July 2020 and collected quantitative clinical and therapeutic data on antibiotic prescriptions between January and December 2019 in 4 hospitals or health centres in both Uganda and Niger, respectively from January to December 2019. Semi-structured interviews and focus groups were conducted among healthcare personnel and carers for children under 17 years of age, respectively.ResultsA total of 1,622 children in Uganda and 660 children in Niger (mean age of 3.9 years (SD 4.43)) who received at least one antibiotic were included in the study. In hospital settings, 98.4 to 100% of children prescribed at least one antibiotic received at least one injectable antibiotic. Most hospitalized children received more than one antibiotic in both Uganda (52.1%) and Niger (71.1%). According to the WHO-AWaRe index, the proportion of prescriptions of antibiotics belonging to the Watch category was 21.8% (432/1982) in Uganda and 32.0% (371/1158) in Niger. No antibiotics from the Reserve category were prescribed. Health care provider’s prescribing practices are rarely guided by microbiological analyses. Prescribers are faced with numerous constraints, such as lack of standard national guidelines, unavailability of essential antibiotics at the level of hospital pharmacies, the limited financial means of the families, and pressure to prescribe antibiotics from caregivers as well as from drug company representatives. The quality of some antibiotics provided by the National Medical Stores to the public and private hospitals has been questioned by some health professionals. Self-medication is a widespread practice for the antibiotic treatment of children for economic and access reasons.ConclusionThe study findings indicate that an intersection of policy, institutional norms and practices including individual caregiver or health provider factors, influence antibiotic prescription, administration and dispensing practices.

The Efficacy of Human Resource Management Practices in Building Organizational Commitment of Employees: Evidence from Pharmaceutical Sector of Pakistan

This study aimed to investigate the adoption level of standardized HRM practices (compensation, performance evaluation, and promotion) by local and multinational pharmaceutical companies in Pakistan. Furthermore, the study also attempted to analyze the impact of these practices on organizational commitment of employees in the investigated firms. Using random sampling technique, data was collected from 503 sales representatives of various pharmaceutical companies operating in the country. Results of one-sample t test presented that multinational companies have a higher level of adoption of standardized HRM practices than local companies. Similarly, multiple regression analyses demonstrated that compensation, performance evaluation and promotion practices significantly influence employees' organizational commitment. These findings provide support for the contingency approach to HRM. The study's practical implications suggest that the manufacturing companies should adopt standardized HRM practices to increase organizational commitment among their employees.

The reality of embedded drug purchasing practices: Understanding the sociocultural and economic aspects of the use of medicines in Bangladesh.

Purchasing drugs with or without prescription from retail drug shops is common practice in Bangladesh. However, what actually takes place between the drug seller and customer during the transaction is under-researched. This study explores the drug purchasing practices which underlie the socio-cultural and economic aspects of a Bangladeshi city. Adopting ethnographic methods, we conducted thirty in-depth interviews (IDIs) with customers, patients, and sales assistants, and ten key informant interviews (KIIs) with drug sellers, experienced sales assistants and pharmaceutical company representatives. Thirty hours were spent observing drug sellers' and buyers' conversations and interactions for medicine. A total of 40 heterogeneous participants were purposively selected from three drug stores. Transcribed data were coded, and analyzed thematically. We found through thematic analysis that some individuals visited the drug store with fixed ideas about the name, brand, and dose of the drugs they wanted. Among the 30 IDIs participants, most individuals come without any preconceived ideas, describe their symptoms, and negotiate purchases with the expectation of quick remedies. Cultural practices of buying medicines in full or partial course of doses, with or without prescription, trust in sellers, and positive previous experiences of medications shape the drug purchasing behavior, regardless of any preconceived ideas concerning brand name, and dose. Few customers (n = 7) sought drugs by trade name, but most drug sellers often offered a generic substitute because selling non-brand drugs is more profitable. Notably, many of the clients (n = 13) bought drugs through installment payments and with loans. Community people choose and purchase the most necessary medicines in a self-medicated way from shortly trained drug sellers that can harm individuals' health and reduce the effectiveness of medication. In addition, the results of buying medicine through installments and loans suggest further research on the financial burden of consumers' purchasing behavior. Policymakers, regulators, and healthcare professionals might implicate the study findings to deliver practical information on the rational use of medicines to sellers and customers.

Barriers and enablers to healthcare system uptake of direct oral anticoagulants for stroke prevention in atrial fibrillation: a qualitative interview study with healthcare professionals and policy makers in England

ObjectiveTo better understand the factors influencing the uptake of direct oral anticoagulants (DOACs) across different health economies in National Health Service England from the perspective of health professionals and other...

Community physicians’ attitudes towards meetings with representatives of pharmaceutical companies: a pilot study

BackgroundMarketing by pharmaceutical companies has become an increasingly controversial issue for the medical community and the public. This controversy stems from the potential influence that pharmaceutical companies can wield through marketing on the medical community. This study assesses community physicians’ attitudes towards pharmaceutical companies and their representatives to get a better understanding of how their activities affect daily work in community clinics.MethodsA cross-sectional anonymous questionnaire-based study of 170 community physicians in southern Israel was conducted via convenience sampling. The questionnaire was designed to assess physicians’ attitudes about the nature of their relationships with representatives of pharmaceutical companies and possible associations with physicians’ demographic and professional profiles. The questionnaire was distributed, at weekly staff meetings in the study clinics, to a convenience sample of physicians, who agreed to participate in the study.ResultsMost physicians did not have an extreme attitude on interactions with representatives of pharmaceutical companies. Interestingly, while they thought that pharmaceutical companies play an important role in medical progress, they did express concern regarding the risk of misleading information. While they believed that interactions between physicians and representatives of pharmaceutical companies had a negative effect on the clinic workflow, they were not in favor of prohibiting such interactions. Physicians who graduated from medical schools in Israel held a less sympathetic position towards these interactions.ConclusionThe anticipated heterogeneous attitudes of community-based physicians on interactions with representatives of pharmaceutical companies reflect an inherent complex relationship, with aspects that are specific to the Israeli medical field. Interestingly, physicians trained in other countries than Israel also have divergent attitudes, further affecting the socio-cultural impact on practitioner’s attitudes towards this intricate and often politicized topic. Open professional dialogue and targeted educational programs on the physician–pharmaceutical relationship, with more explicit regulation, could potentially ease the discomfort experienced by physicians, especially in the Israeli context and result in a clearer framework of interaction that would leverage the potential advantages while accounting for ethical and regulatory pitfalls.

Identifying outcome measures for atrial fibrillation value-based contracting using the Delphi method.

Value-based contracts that tie payments for pharmaceuticals to predefined outcomes aim to promote value through shared risk and aligned incentives between manufacturers and payers. We conducted a Delphi study among diverse stakeholders (patients, providers, payers, pharmacy benefits managers, pharmaceutical company representatives) to identify top meaningful outcomes for inclusion in value-based contracts for atrial fibrillation medications. The final panel (n=55) rated the importance of each outcome on a 5-point Likert scale and selected their top 3 most meaningful outcomes. Non-patient participants rated the feasibility of collecting each outcome on a 5-point Likert scale. Consensus was defined as ≥75% agreement (Likert scores ≥4/5 or selection of an outcome as most meaningful). Differences between stakeholder groups were examined using Fisher's Exact Test. Consensus was achieved for importance of 10 outcomes (Likert scale), where "preventing stroke or mini-stroke" reached 100% agreement (55/55). Eighty-one percent (44/54) of participants selected "preventing stroke or mini-stroke" as the most meaningful outcome (rank order question). The measures rated as most feasibly collected were "reducing hospitalizations" (97%, 36/37) followed by "preventing stroke or mini-stroke" and "reducing emergency department visits" (both 92%, 34/37). There were statistically significant differences between patients and non-patients [0% (0/17) vs 22% (8/37), P=0.047] and patients and providers [0% (0/17) vs 39% (7/18), P=0.008] in selection of "improving health-related quality of life" as a most meaningful outcome. These findings will inform the design of atrial fibrillation value-based pharmaceutical contracts and provide additional insight into preferences for outcomes which could be used to improve the quality of atrial fibrillation care.

Understanding the barriers to, and facilitators of, ovarian toxicity assessment in breast cancer clinical trials

BackgroundDetailed toxicity data are routinely collected in breast cancer (BC) clinical trials. However, ovarian toxicity is infrequently assessed, despite the adverse impacts on fertility and long-term health from treatment-induced ovarian insufficiency. ObjectivesTo determine the barriers to and facilitators of ovarian toxicity assessment in BC trials of anti-cancer drugs. MethodsSemi-structured interviews were conducted with purposively selected stakeholders from multiple countries involved in BC clinical trials (clinicians, consumers, pharmaceutical company representatives, members of drug-regulatory agencies). Participants were asked to describe the perceived benefits and barriers to evaluating ovarian toxicity. Interviews were transcribed verbatim, coded in NVivo software and analysed using inductive thematic analysis. ResultsSaturation of the main themes was reached and the final sample size included 25 participants from 14 countries (9 clinicians, 7 consumers, 5 members of regulatory agencies, 4 pharmaceutical company representatives); half were female. The main reported barrier to ovarian toxicity assessment was that the issue was rarely considered. Reasons included that these data are less important than survival data and are not required for regulatory approval. Overall, most participants believed evaluating the impact of BC treatments on ovarian function is valuable. Suggested strategies to increase ovarian toxicity assessment were to include it in clinical trial design guidelines and stakeholder advocacy. ConclusionLack of consideration about measuring ovarian toxicity in BC clinical trials that include premenopausal women suggest that guidelines and stronger advocacy from stakeholders, including regulators, would facilitate its more frequent inclusion in future trials, allowing women to make better informed treatment decisions.

A Comprehensive Scenario on Application of Aqua Drugs and Chemicals for the Fish Health Management in Fish Hatcheries and Farms of South-Eastern Part, Bangladesh

Aims: The study was carried out to understand the current status of used drugs and chemicals in fish hatcheries and farms in Feni district, Bangladesh.
 Methodology: Data were collected by pre-defined questionnaire interview, personal contact with farm and hatchery owners, and representatives of pharmaceutical companies by market survey.
 Results: Twelve different groups of chemicals were being used for disease treatment and fish health management. Traditionally used chemicals were Lime, Salt, Potash (KMnO4) and Melathion. Although Malachite green hazardous to human health, it was widely used in hatcheries. Geotox, JV Zeolite, Amoxy fish, Megavit Aqua, Square aqua premix, Orgavit, Pure Oxy, Vitamin gel, O2-Marine etc. were widely used new chemicals. Renamycin was the most widely (36% farmer) used antibiotic followed by Oxysentin 20%, Orgamycin15% and Otetra vet power 50.
 Conclusion: Nearly all farmers did not apply chemicals and drugs at proper doses because they thought the higher the doses applied the more and rapid will be the action. It was found that manufacturers and retailers of the products often neglected to provide farmers with necessary information regarding active ingredients and relevant instructions for safe and efficient use of aqua-drugs and chemicals. Recommended use of chemicals apparently brings good result but indiscriminate use of chemicals can be extremely detrimental to fish and our environment as well as to us and therefore, all of us should be aware of the proper use of chemicals.

Marketing and Distribution System Foster Misuse of Antibiotics in the Community: Insights from Drugs Wholesalers in India.

Antibiotic misuse is one of the major drivers of antimicrobial resistance (AMR). In India, evidence of antibiotic misuse comes largely from retailers as well as formal and informal healthcare providers (IHCPs). This paper presents the practices and perspectives of drug wholesalers, a critical link between manufacturers and last-mile dispensers. Four experienced wholesalers and an ex-State Drug Controller (ex-SDC) were interviewed in depth, using semi-structured guides in the National Capital Region of Delhi, India, between November 2020 and January 2021. Four main findings were that wholesalers (i) have limited knowledge about wholesale licensing and practice regulations, as well as a limited understanding of AMR; (ii) directly supply and sell antibiotics to IHCPs; (iii) facilitate medical representatives (MRs) of pharmaceutical companies and manufacturers in their strategies to promote antibiotics use in the community; and (iv) blame other stakeholders for unlawful sale and overuse of antibiotics. Some of the potential solutions aimed at wholesalers include having a minimum education qualification for licensing and mandatory Good Distribution Practices certification programs. Decoupling incentives by pharmaceutical companies from sales targets to improve ethical sales practices for MRs and optimize antibiotic use by IHCPs could alleviate wholesalers’ indirect actions in promoting antibiotic misuse.

Marketing training strategies that pharmaceutical sales managers use to reduce unethical behavior.

BACKGROUND:Some pharmaceutical company sales representatives are using bribes to encourage increasing medication prescriptions. In 2012, GlaxoSmithKline paid $3 billion on a felony charge related to bribing doctors to prescribe the company's medications. Using Hunt and Vitell's general theory of marketing ethics, the purpose of this qualitative multiple case study was to explore strategies some sales managers in the pharmaceutical industry used to improve marketing training to reduce unethical sales representative behavior.MATERIALS AND METHODS:Data were collected from company reports and documents provided by sales managers and semistructured interviews with five sales managers of different pharmaceutical companies in the northeast region of the United States. Data were analyzed using thematic analysis and Yin's 5-step process of compiling, disassembling, reassembling, interpreting, and concluding thematic data analysis.RESULTS:Three themes emerged from data analysis: developing ethical standards, developing organizational policy, and implementing training and development programs. A key recommendation is that pharmaceutical sales managers identify ethical standards to inculcate in their business practices to achieve ethical marketing training that can result in sales representatives’ ethical behavior. The implications for positive social change include the potential for sales managers to develop strategies to reduce unethical behavior in the pharmaceutical industry.CONCLUSION:Reducing unethical behavior may lead to more trust between patients and physicians, improving patient satisfaction and promoting prosperity for the community through enhancing the quality of health care.

Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh

BackgroundThe National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence.MethodsWe conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, and model drug shop operators; and a group discussion with stakeholders representing key actors in informal market systems namely: representatives from the government, private sector, not-for-profit sector and membership organizations.ResultsBarriers to policy compliance among drug shop operators included limited knowledge of government drug policies, or the government-led Bangladesh Pharmacy Model Initiative (BPMI), a national guideline piloted to regulate drug sales. Drug shop operators had no clear knowledge of different antibiotic generations, how and for what diseases antibiotics work contributing to inappropriate antibiotic dispensing. Nonetheless, drug shop operators wanted the right to prescribe antibiotics based on having completed related training. Drug shop customers cited poor healthcare facilities and inadequate numbers of attending physician as a barrier to obtaining prescriptions and they described difficulties differentiating between qualified and unqualified providers.ConclusionAwareness of the National Drug Policy and the BPMI was limited among urban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.

A Survey of Knowledge and Practices in Generic Prescribing Among Doctors in Kurunegala District, Sri Lanka

Generic prescribing is promoted by most governments and insurers as a measure of reducing health care cost. Doctors are key players health care provision and powerful deciders in drug market. The practice of doctors in prescribing is critical in determining both clinical and economic efficiency and effectiveness of a health system. The study was questionnaire based and conducted in Kurunegala district in Sri Lanka with the participation of government doctors. It was revealed that most doctors were engaged in generic prescribing and they had a satisfactory knowledge regarding the concept. Practice of generic prescribing among doctors was not significantly associated with their work experience, gender, engagement in private practice or post graduate qualifications. It was depicted that the promotional visits by representatives of pharmaceutical companies mainly focused at doctors who did part time private practice. Yet it was claimed that most doctors did not consider brand name when purchasing drugs for their practices.

Content analysis of persuasive techniques used by pharmaceutical company representatives during promotional visits to doctors

Content analysis of persuasive techniques used by pharmaceutical company representatives during promotional visits to doctors

Le débat sur l'extension de l'obligation vaccinale en France: analyse discursive et argumentative d'une parole "éclatée"

French vaccination policy has recently been the subject of much debate on the advisability and risks of extending the vaccination obligation. The legal provision introducing 11 compulsory vaccines on January 1, 2018 called for the mobilization of different groups of actors (institutional representatives, doctors, researchers, parents’ associations, representatives of pharmaceutical companies, citizens, etc.) often speaking in different arenas. Indeed, if political debates and parliamentary committees are invested by institutional actors and experts, discussion forums and social networks constitute the privileged place of expression of non-institutional actors or lay-experts, who use this space for discussion above all to express their scepticism or their reluctance over vaccines. The objective of this contribution is to analyse on the one hand the forms and mechanisms put in place in the construction of the debate on this social issue and, on the other hand, to highlight the linguistic and argumentative specificities of the discourse of pro-vaccinalists and of the anti-vaccinalists, categories which bring together different actors.

Le débat sur l'extension de l'obligation vaccinale en France: analyse discursive et argumentative d'une parole "éclatée"

French vaccination policy has recently been the subject of much debate on the advisability and risks of extending the vaccination obligation. The legal provision introducing 11 compulsory vaccines on January 1, 2018 called for the mobilization of different groups of actors (institutional representatives, doctors, researchers, parents’ associations, representatives of pharmaceutical companies, citizens, etc.) often speaking in different arenas. Indeed, if political debates and parliamentary committees are invested by institutional actors and experts, discussion forums and social networks constitute the privileged place of expression of non-institutional actors or lay-experts, who use this space for discussion above all to express their scepticism or their reluctance over vaccines. The objective of this contribution is to analyse on the one hand the forms and mechanisms put in place in the construction of the debate on this social issue and, on the other hand, to highlight the linguistic and argumentative specificities of the discourse of pro-vaccinalists and of the anti-vaccinalists, categories which bring together different actors.

The Epidemic of Substandard and Falsified Medications in Iraq: Evaluating the Effectiveness of National Pharmacovigilance Alerts to Community Pharmacies.

BackgroundAssessing Iraqi experience with the impact of substandard and falsified (S/F) medicines can help other countries deal comprehensively with the underlying causes of this multifactorial problem. The tools used in this study to assess strategies to prevent the use of S/F medications can be used in other developing countries. This study investigated the problem of S/F medications at three levels: the Ministry of Health (MOH), pharmaceutical company representatives, and community pharmacists.ObjectivesStudy objectives were to evaluate the effectiveness of alerts about S/F medications issued by the national Iraqi Pharmacovigilance Center (IqPhvc) to community pharmacies and to explore the reasons and potential solutions for this problem from the perspective of both pharmaceutical companies and pharmacists.MethodsThis was an exploratory mixed-method study. The qualitative phase comprised seven 1-h semi-structured interviews and one focus group conducted via Zoom. Thematic analysis was used to analyse the qualitative data. The findings of the qualitative phase were then used to develop the survey items. The quantitative phase included an electronic survey distributed among pharmacists via two professional Facebook groups between 23 April and 19 May 2020. The Kruskal–Wallis test was used to measure differences in pharmacists’ knowledge of and ability to detect S/F medications according to their years of experience in the private sector.ResultsOver the last 5 years (2016–2020), the IqPhvc received 183 reports about S/F medications from representatives of 25 international companies. Only 29 (15.8%) of the reports were about falsified medications; the majority were about substandard (parallel) medicines. We interviewed 12 pharmacists (11 male, 1 female) representing ten large international pharmaceutical companies. We also received surveys from 590 pharmacists, of whom 475 (80.9%) were women. Although 72% of the participants had not received any training in the identification of S/F medications, 59.4% of them easily identified S/F medications. Likewise, approximately three-quarters of the participating pharmacists recognized genuine registered medications through three means: medication price sticker, cost, and packaging features. Although 61% of the pharmacists followed-up alerts about S/F medications, only 25.6% were willing to report S/F medications.ConclusionsMost reports to the IqPhvc were about substandard medications. Participants of the two study phases agreed on several reasons for the problem of S/F medications, including their low prices, the unavailability of registered medications, the lengthy medicine registration process, and inadequate awareness of S/F medications among healthcare providers and the public. They also agreed that national alerts and price stickers are helpful in the identification of S/F medications. Community pharmacists can increase their efforts to report S/F medicines, but they need training, awareness, and tools. The study highlighted the need for a track-and-trace system to detect S/F medicines in the supply chain. In brief, the problem of S/F medication is multifaceted. Reducing it will require effective collaboration among different entities, including health officials, border agencies, healthcare providers, and registered pharmaceutical companies.