1. Drug Promotion and Critical Appraisal of Drug AdvertisementDr. Gyanendra Raj Joshi PharmD, RPh 1

2. Drug Promotion/Advertisement Journal advertisements Mailings Company representative visits Gifts ( medical samples , cash , personal gifts , cultural courtesy gifts ,promotional aids, reminder items , medical utility items ) Sponsorships ( travel , meals , accommodation, registration fees) Direct-to-consumer advertising2 3. Traits of a medical representative Must be adequately trained Must not give misleading information Must not offer inducement to gain interview Must not cause inconvenience Provision of hospitality3 4. Guidelines for MRs Appointment system for meeting clinicians Leaving samples of medicines Sponsorship of educational meetings Frequency of meetings4 5. Meeting with Medical representative Whats in it for me? Be selective By appointment with time limits Be in control Prepare standard questions Beware of bold statements 5 6. Information from representatives Can be misleading Promotes non-rational prescribing Decreases generic prescribing Increases awareness of new drugs but without theevidence Increases prescribing costs6 7. Oral presentations At least one inaccurate fact in 81% of presentations On average, at least 11% of statements made in an oralpresentation maybe inaccurate All inaccuracies are likely to favour promotion of thedrug7 8. Critical Appraisal Supporting Evidence Words and phrases Appeal to Authority Colours, pictures and emotion Graphs8 9. Written literature Protocols as evidence of clinical benefits Publication in non-peer reviewed / obscure journals Graphs with misleading axes! Surrogate endpoints Claims of superior potency Data from in-vitro studies, healthy volunteers Claims from emerging or scientific opinions Price comparisons Statistics9 10. What printed material should contain: Name of the product Active ingredient Name and address of manufaturer Date of production Abbreviated prescribing information10 11. Abbreviated prescribing information Approved indications Dose Method of use Contraindications Side effects Precautions 11 12. S TTolerabilityEEffectivenessP12SafetyPrice 13. Commonly misused shortcuts for choosing therapies Newer is better Experts know best If there is a mechanism for how a drug works, then it works If my peers are prescribing the drug then so should I. If the patient improves after the drug is prescribed, then thetherapy must have worked. If the manufacturer gives gifts, I should support them in return 13 14. Free samples and promotional materials14 15. Countering misleading drug promotion15 16. Healthy skepticism16 17. 17 18. Drug companies know how to manipulate our main motivations Burnt out Dodo Caring Bunny Conservative Sheep Entrepreneurial Wolf Branthwaite A, Downing T. Marketing to doctors the human factor. Scrip Magazine 1995 March;32-5 18 19. Your ability to cope with potentially misleading promotion depends on your understanding of: Medicine Pharmacology, Epidemiology, Public Health, Evidence Based Medicine, Drug Evaluation, Pharmacovigilance Social sciences Psychology, Economics, Sociology, Anthropology, Management, History, Politics, Communication Studies, Humanities Logic, Rhetoric,Linguistics, Literature, Art Marketing Product Management, Advertising Account Planning, Public Relations Statistics 19 20. 20 21. Is it ethically acceptable fordoctors to receive gifts from drug companies?21 22. Will you accept visits fromdrug company representatives?22 23. Will you accept gifts fromdrug companies?23 24. How often is information fromdrug companies reliable?24 25. Will you be vulnerable tobeing misled by drug companies?25 26. 26