Pharmaceutical Promotion Pharmaceutical Promotion in Latin Americain Latin America

Carlos BerríosCarlos BerríosAIS LACAIS LAC

20 May 200920 May 2009WHAWHA

ContentsContents The problemThe problem

Main sources of misinformationMain sources of misinformation Poor regulationPoor regulation Physicians, main marketing agentPhysicians, main marketing agent

Addressing the problemAddressing the problem• RegulationRegulation• EducationalEducational

What we needWhat we need

3

New products to promoteNew products to promote

4

Hospital physicians´ perception of the influence of Hospital physicians´ perception of the influence of Pharmaceutical PromotionPharmaceutical Promotion

(Steinman,2001)

Professionals underestimate the Professionals underestimate the of Pharmaceutical Promotion of Pharmaceutical Promotion

A little38%

A lot 1%

None61%

How much influence do sales representatives have on your prescribing?

A little33%

A lot 51%

None16%

How much influence do sales representatives have on other physicians' prescribing?

Promotional practices downplay safety (I)

Unclear indication - what type of pain?

Does not mention risks other than gastrointestinal problems!

No bibliography references could be retrieved

No information on precautions, contraindications, price…

Nicaragua, 2003

Promotional practices downplay safety (II)

No indication mentioned

No active ingredient mentioned

Medicine approved for hormone replacement therapy but promoted for “weight control” and “ skin improvement”

No information on precautions, contraindications, price…

Costa Rica, 2007

7

Public health consequencesPublic health consequences

Therapy failureTherapy failure Harm due to adverse reactionsHarm due to adverse reactions Antimicrobial resistanceAntimicrobial resistance Increased expenditure in health: Increased expenditure in health:

• Inappropriate use of public fundsInappropriate use of public funds• Out-of-pocket payment by Out-of-pocket payment by

consumersconsumers Reduced trust in health servicesReduced trust in health services

Pharmaceutical Promotion Pharmaceutical Promotion RegulationRegulation

Results of 7 countries - HAI LAC survey: Results of 7 countries - HAI LAC survey: • DTCA not allowedDTCA not allowed• Promotion to Prescribers controlled Promotion to Prescribers controlled • Criteria for advertising establishedCriteria for advertising established• Free samples and promotional events restrictedFree samples and promotional events restricted• Control and sanctions foreseenControl and sanctions foreseen

But, in practice: Poor implementationBut, in practice: Poor implementation In Nicaragua, MoH created a Pharmaceutical In Nicaragua, MoH created a Pharmaceutical

Promotion Department: Pre-approval and Promotion Department: Pre-approval and monitoringmonitoring

Education and trainingEducation and training

PROBLEM:PROBLEM: Early contact between pharmaceutical representatives and Early contact between pharmaceutical representatives and

studentsstudents Conflict of interest of some university lecturers Conflict of interest of some university lecturers Pharmaceutical Promotion not included in Medicine and Pharmaceutical Promotion not included in Medicine and

Pharmacy schools curriculaPharmacy schools curricula

INITIATIVES: INITIATIVES: HAI Nicaragua developed teaching module HAI Nicaragua developed teaching module

• Implemented since 2005Implemented since 2005

• Adapted in 6 universities (4 Argentina, 2 Colombia): DURG – LA initiativeAdapted in 6 universities (4 Argentina, 2 Colombia): DURG – LA initiative

• Teaching in Ecuador and BrazilTeaching in Ecuador and Brazil

The Manual’s ValueThe Manual’s Value

High quality reference document to be used High quality reference document to be used in teachingin teaching

Increase awareness about the need to Increase awareness about the need to include pharmaceutical promotion teaching in include pharmaceutical promotion teaching in university curriculauniversity curricula

Strengthen current teaching experiencesStrengthen current teaching experiences Promote similar teaching in other universities Promote similar teaching in other universities

in Latin Americain Latin America