Medicines Transparency Alliance05/09/2015 Medicine Promotion Robert Louie P. So, MD Program Manager DOH - National Center for Pharmaceutical Access and Management

Medicines Transparency Alliance Session on Promotion Wednesday June 30, 2010 lasting an hour and a half 2 presenters, Carole Piriou of HAI gave the keynote while Uganda, through Mr. Nazeem Muhamed, shared with us their country experience This was followed by a 6-person open fora/panel discussion Chaired by Harvard Professor Michael Reich. Along with the 2 presenters earlier, representatives from Jordan, the Philippines, WHO, and ABPI (Association of the British Pharmaceutical Industry) completed the panel 05/09/2015

Medicines Transparency Alliance05/09/2015 Prescribers who rely on promotion as their main source of information tend to prescribe less appropriately, prescribe more often and adopt new medicines faster WHO/HAI 2005 Manufacturing 30% Profits After Taxes) 20% Taxes/Interest 6% R&D 13% Marketing/Admin. 31%

Medicines Transparency Alliance Keynote Key points of the keynote dwelt on Medicines promotion, how it forges asymmetric information to both providers and patients, and how this adversely affects rational drug use. It was stressed that this irrationality is a GLOBAL problem, experienced even in developed countries, that wastes resources, causes resistance to medications, and is among the leading causes of death and debility After which the keynote gave glimpses of the aspects of promotion, existing standards on ethical promotion, challenges, sustainable change interventions to limit the undesired impacts of promoting medicines, and some recommendations to move forward A novel intervention shared in its pilot stages is the HAI/MeTA methodology to assess impact of promotion control. This is envisioned to give evidences that help policy makers improve national policies on promotions. Such was piloted in Uganda 05/09/2015

Medicines Transparency Alliance The UGANDA experience UGANDA was one of the countries where the HAI/WHO/MeTA methodology was piloted The presentation began with a situational analyses, issues and challenges faced, lessons learnt from the pilot tool tested, and recommendations Noteworthy of the presentation were the following: that ethical standards were not consistent across different, even neighboring, countries, that sales representative are the most common and most effective means of promoting medicines, that the public remained unaware that medicines’ promotion is regulated, and issues on enforcement stymie any progress in correcting the problem and that in the HAI/WHO/MeTA methodology used the Civil Societies played no or minimal roles in regulating and monitoring promotions 05/09/2015

Medicines Transparency Alliance PANEL: Questions After stressing that the issue of medicines promotion is a good example of public and private interests coming into direct conflict, as well as the fact that what we are against is UNETHICAL promotions but we allow legitimate promotions, discussions were focused on answering the following key questions: – What is acceptable promotions? – Who is responsible to make decisions on this? – How to implement standards to change what is promoted in the country? 05/09/2015

Medicines Transparency Alliance PANEL: Thoughts The regulation of information getting to health care professionals at the early stages of their training The transparency of declaring and making public perks received from sales representatives to deter or limit unethical practices That information is available (ex. Through the internet) but which methods are transferrable to countries and what processes? That there is “no free lunch” and that there are costs to providing good information to all And that media and its avenues have a very strong influence on patient behavior just as incentives have on professional behavior 05/09/2015

Medicines Transparency Alliance Open Forum In certain countries, infractions are published In some instances, medical representatives are the only source of information. Some companies limit the information given to providers such that the true health risks are sometimes underemphasized On issues on standards and codes, a MeTA code where expectations from ethical promotions was suggested Important realities – Companies behave ethically in countries where the codes exist but then do not follow the same code when they do business elsewhere – The call by companies to comply to ethical marketing standards is not given the same enthusiasm as their call to contain counterfeit medicines even when both subject people to higher health risks. – It is important to give information to patients and providers but it is not for industry to take care of this. – But sources of information is not limited to manufacturers since the whole supply chain gives information (such as dispensers and pharmacists) but manufacturers are critical – Regulatory Enforcement is weak

Medicines Transparency Alliance Open Forum Quotable questions/quotes/solutions When does information become advertising? What is the most effective role of MeTA to support pharmacists? Doctor’s entertainment from the pockets of the patients There is no free lunch. Regulators should regulate information going to doctors Banning medical representatives as sources of information and limit such to medical journals Role of MeTA Training of dispensers Provide platform for exchanges in information MeTA code and methodology 05/09/2015

Medicines Transparency Alliance Summary We want truth in advertising. But who decides? What does it apply to? (traditional/herbal medications) Promotion identifies conflicts in objectives – Give information. Change behavior in favor of public health – Make money. Change behavior for profits Revisit the Role of incentives and make it transparent Need for standards and to reconcile if it is acceptable to have differing standards among different areas Addressing implementation and enforcement issues. Combination and balance of regulatory tools. – Self regulation is important – Government faces limitations due to resource issues – NGO and individual patient 05/09/2015

Medicines Transparency Alliance We have products to sell: Rational Drug Precribing, Dispensing, and Use Right information at the right time to the right people People/Patient empowerment and informed choices 05/09/2015 Our Profits: better health outcomes

Medicines Transparency Alliance Promoting Medicines, promoting MeTA 05/09/2015 We find strength in MeTA MeTA helps in giving voices There is strength in unity There is strength in information

Medicines Transparency Alliance Thank you Robert Louie P. So, MD International MeTA Secretariat: MeTA: 05/09/2015