Thursday, November 1, 2007

Consumers International Report: A Must-Read

In my recent post on bribery I mentioned the new report from Consumers International:

This 44 page report focuses on how drug marketing to physicians in the developing world seriously distorts health priorities. CI concludes that industry self-regulation is a flop, and calls for strict legal bans on "gifts" from drug companies to doctors in developing countries, with severe sanctions for violators.

ADDED 11/4/07: Here are a few more details from this important report. CI notes that most developing countries have effectively abandoned regulation of pharamceutical marketing to the industry. In turn, industry has blatantly violated many of its own claimed ethical codes. Advertisements to physicians in developing countries often leave out even the limited information that is required for the same drug in the developed world, and give blatantly misleading impressions about a drug. CI estimates that up to 50% of medicines in developing countries are irrationally prescribed. In these countries, people may pay a much larger percentage of their extremely limited health care dollars for medicines, so when an expensive drug does not work or is dangerous, the damage is doubled--both the direct effects of the drug, and the waste of money that could have been so much better spent on something else. While the amount of business done in the developing world by the major international drug companies is a small percentage of their total, this small sum is increasing much faster proportionally than most other sectors of the company's business, making it very tempting to keep on doing what drives the most profits. "Gifts" to physicians are often thinly disguised payoffs for the quantity of prescriptions written. Cars and televisions are not uncommon gifts received by high-prescribing doctors. (Popular gifts noted in a Pakistani survey included air conditioners, cars, cash, home appliances, and domestic cattle--the last a nice homey touch, don't you think?) Other popular gifts are air tickets, hotel and meal expenses to attend CME conferences, which are simply outside the affordability range of many practitioners in these nations without company funding.

CI notes that there are already laws and regulations against many of these practices; they need to be enforced. They call for a total ban on gifts; transparency in all industry marketing practices; and more government efforts at making CME and unbiased drug information available to their doctors.

A sad anecdote from Kenya--medical students have been spotted wearing white coats with drug company logos on them. When U.S. educators see residents going around with a lot of drug company pens and other gimmicks sticking out of all their pockets, they often try to shame them by asking, "Would you sell the company advertising space on your white coat?" In Kenya the answer seems to be "yes." CI reports that the same rationalizations that are in common usage among U.S. physicians to excuse taking company largesse are in evidence all around the world--only perhaps more understandable in nations where physicians are paid a relative pittance compared to their American income.

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