The WHO/ HAI Drug Promo Database Andrew Herxheimer, Joel Lexchin

Why the WHO/ HAI database on pharmaceutical promotion? (1) to document how much drug promotion is inappropriate to document the health impact of inappropriate promotion to identify topics not so far studied to recommend needed research

Why the WHO/ HAI database on pharmaceutical promotion? (2)  to review tools for use in teaching health professionals about drug promotion; to provide tools to monitor drug promotion to facilitate networking by linking people concerned about promotion through the website

What it is  It aims to be a comprehensive reference guide to research and observations on all aspects of drug promotion from all countries and – eventually – in all languages  It is intended to help researchers and policy makers by providing abstracts of a large collection of material together with critical comments and summary reviews  It is conceived as a living database which will be kept up to date

How it was built  by collecting the widest possible range of material describing, analyzing, reporting or commenting on any aspect of pharmaceutical promotion :  articles, letters, news in various journals* magazine articles* articles from drug bulletins/newsletters unpublished reports/studies videos radio/TV reports with accessible transcripts theses guidelines from diverse professional sources books & chapters from books then analyzing and reviewing all this material * BUT few from industry publications

How it is organized  Each reference of an article or other item has a number, and is indexed by the key words  This makes it possible to search the database using the keywords as well as other words in the titles or text; but some kinds of searches are complex  For certain major themes there are reviews summarising the material

These are the four themes 1.The attitudes of professionals and of lay people to promotion 2.The impact of drug promotion on attitudes and knowledge 3.The impact of drug promotion on behaviour 4.Interventions that have been tried to counter promotional activities, and their results

Also on the drugpromo site  An annotated list of the ‘Top Eleven’ pieces of research that everyone concerned with the subject will find worth reading and thinking about – as a stimulus and jumping off point for further work  e-Links to the five most important NGO websites and to the WHO sites concerned with drug promotion

Some stats – to totalper day Hits53, Visitors 5, Internet providers 2,100 Visitors by country USA 2800; Malaysia 1300; UK 170; Oz 150; Canada 110; France 100; Germany 70; NL 60; India, Singapore, Sweden, Switz 50 Most popular pages: Home, indiv. abstracts, ‘About Drugpromo’, Reviews

The Contributors  Joel Lexchin  Pauline Norris  Peter Mansfield  Andrew Herxheimer  Barbara Mintzes  Charles Medawar  Zulham Hamdan the webmaster  Margaret Ewen  Richard Laing  Hans Hogerzeil

Please use the database  Give us feedback!  We’d love to know how you use it  What work that you or your colleagues have done should be included?  Should anything be improved in the structure or content of the database?  Suggest links that would be useful

Conclusions (1): Doctors’ attitudes to promotion Attitudes vary, and don’t necessarily match their behaviour. Their opinions differ on the value of reps. Most doctors think information from drug companies is biased, but many think it is useful. Most find small gifts from drug companies acceptable, and believe that drug reps or gifts do not influence them personally, but do influence many colleagues. Few patients know that doctors receive promotional gifts. Doctors who rely on promotion tend to be older, less conservative, see more patients, are GPs rather than specialists, have less access to peers and have a more positive attitude towards medicines.

Conclusions (2): Effects on doctors’ knowledge They often use promotional information about new drugs, and for drugs used outside their usual therapeutic field. Doctors in private practice, or who graduated long ago, are the heaviest users of promotion as a source of drug information.

Conclusions (3): Effects on doctors’ behaviour *Promotion is associated with greater drug sales, promotion influences prescribing more than doctors realise, & they rarely acknowledge that promotion has influenced their prescribing. Doctors who report relying more on promotion prescribe more often, less appropriately, & adopt new drugs more quickly. *Samples stimulate prescribing. *Doctors who receive company funds tend to request additions to hospital formularies. Company sponsorship influences the choice of topics for continuing education, the choice of research topics, & the outcomes of research. It leads to secrecy, delays publication for commercial reasons, and conflict of interest problems. Researchers often don’t disclose funding from drug companies.

Countering bad promotion – what’s ineffective  Voluntary regulation, eg by industry Guidelines – for sales reps for post-marketing surveillance on conflict of interest in research for package inserts & compendia about gifts for trainee doctors & for hospitals

Countering bad promotion – interventions that can work  Government regulation Training students – before & after graduation Media exposure of abusive promotion Giving abundant free & reliable therapeutic information to professionals and the public

Research has focused on health professionals – little has been done on consumers or patients  Phase 2 of the project will look at interventions for medical and pharmacy students, and studies evaluating them An update of the database is intended every 2 years

6. Research  Every country needs to understand the effects of promotion on its health system and its people  At present only pharma companies do research on promotion to help them sell expensive drugs – the results are of course secret  Independent public research is needed to ensure that promotion does more good than harm

Conclusion  The database should is a tool for all our efforts to educate and inform not only health professionals, but also politicians, civil servants, journalists, and the public about the issues.  All have to understand that health policy must come before commercial interests.