1. External Influences on Prescribing Practice Karen Ford

2. Learning Outcomes At the end of the session students will have Examined the factors which might be considered to be external influences on prescribing practice. An increased awareness of those factors should enable students to prescribe in a more objective and evidence based way.

3. What are the factors likely to affect our prescribing decisions? Think of what might influence you when you start prescribing and then when you have been prescribing for five years. Make a note of those things you think about

4. Factors Influencing Prescribing Prescriber PoliciesResearchMarketing Product licence PeersMediaRelativesPatientEducation

5. Some influences are positive ones Policies, guidelines Research evidence Cost and clinical effectiveness

6. Other influences are not so positive? Or are they? The prescribers personal selection list (known as P drugs) Custom and practice Influence of opinion leaders, colleagues and peers

7. Pharmaceutical Industry promotions Companies promote their products to prescribers by: Direct mailing Adverts in journals Stands at events Seminars and educational meetings

8. Advertising Promotional material is usually attractive and easy to digest. Tends to emphasis positive aspects of the product Tailored to appeal to specific groups of prescribers

9. Advertising is, of course, not the only promotional tool used Thinking point: What else is used to promote products?

10. Look at your handout of MHRA advertising complaints 1.No Scientific evidence to support claims of this herbal medicine- ambiguous advertising 2.Promoting a POM to the public- what are the ethical issues here? 3.This complaint was not upheld do you think this was correct?

11. Sponsorship and gifts How many “gifts” have you received in the last year? Did receipt of these gifts influence you in any way?

12. Are we influenced ? Current cost of NHS drug spending 10 billion pounds per year 30 million per day 8,000 sales reps promote to 60,000 Drs = 1 rep per 7.5 Drs It is very difficult to find out how much drug companies spend on promotions but think about drug rep salaries alone

13. Sponsorship and gifts Standards of expected behaviour are identified within: NMC Code of Professional conduct Standards of business conduct for NHS staff (HSG (93) 5) The ABPI Code of Practice for the pharmaceutical industry 2006 (see link on Blackboard)

14. NMC Code Of Professional Conduct 7 : AS A REGISTERED NURSE MIDWIFE OR HEALTH VISITOR YOU MUST: Be Trustworthy –You must ensure that your registration status is not used in the promotion of commercial products or services, declare any financial or other interests in relevant organisations providing such goods or services and ensure that your professional judgement is not influenced by any commercial considerations.

15. Gifts and sponsorship Prescribers should maintain an independent stance to avoid accusations of inappropriate partiality to particular products being made.

16. How do you conduct a meeting with a rep? Take control of the discussion at the outset Look for more information than is given in the advert Make sure you get all the relevant info- drug trial info, cost and clinical effectiveness Copy of product characteristics

17. What to ask for Copies of published articles Consider those from peer reviewed journals first Check what specialists in the field know about products

18. Gifts Should be worth no more than £5 Relevant to practice The standard of any hospitality should be the same as you would routinely pay for yourself Only prescribers and not their family members should receive hospitality

19. REMEMBER There is no such thing as a free lunch! www.nofreelunch-uk.org

20. So back to our learning outcomes What are the most powerful influences? How can we remain objective? What good habits can we form in order to keep us on the straight and narrow?

21. Further Reading ABPI Code of Practice for the Pharmaceutical Industry 2006 Available online @ www.abpi.org.ukwww.abpi.org.uk Advertising of Medicines MHRA 2009 Available on line@ www.mhra.org.uk House of Commons Health Committee Fourth Report of Session 2004–05 -The Influence of the Pharmaceutical Industry Available on line@ http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhea lth/42/42.pdf http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhea lth/42/42.pdf Pharmacy Journal Gifts & Inducements The Pharmaceutical Journal Vol 278 No 7457 p752 23 June 20073 June 2007

22. This work was produced as part of the TIGER project and funded by JISC and the HEA in 2011. For further information see: http://www.northampton.ac.uk/tiger. http://www.northampton.ac.uk/tiger This work by TIGER Project is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. Based on a work at tiger.library.dmu.ac.uk.tiger.library.dmu.ac.uk The TIGER project has sought to ensure content of the materials comply with a CC BY NC SA licence. Some material links to third party sites and may use a different licence, please check before using. The TIGER project nor any of its partners endorse these sites and cannot be held responsible for their content. Any logos or trademarks in the resource are exclusive property of their owners and their appearance is not an endorsement by the TIGER project.