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Letter to the Editor International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2014, 22, pp. 234–235
Comment on Fincham editorial Drug promotion: the need to teach future healthcare practitioners Received April 4, 2013 Accepted August 5, 2013 doi: 10.1111/ijpp.12072
The recent editorial by Fincham[1] revives my intention to write a few paragraphs on the drug-promotion practices of pharmaceutical manufacturers. The pharmaceutical industry and the healthcare profession are unified and possess mutually supportive rapport with each other.[2] The moral values and the financial aspects of this bond are matters of extensive exploration. Pharmaceutical promotion is a persistent chain reaction that evolves progressively and is intertwined with the process of prescribing. Off-label use is simply an ancillary branch of drug promotion. The major stakeholders in this connection are the physicians, pharmacists, patients and a few supplementary prescribers, such as nurses, who are commonly influenced by pharmaceutical manufacturers. Community and hospital pharmacists, being the health information specialists, generally walk on the tightrope of therapeutics by either following the doctor’s prescription or sometimes succumbing to the patient’s demands for a prescription or non-prescription medicine that is not indicated for that particular illness. Commonly prevalent uses include promethazine as a sleeping aide in infants, taken by their mothers, aspirin for treating infertility and antibiotics for viral illness. It is observed that promethazine syrup dispensed at community pharmacies is consumed by mothers to induce sleep in infants. Likewise, even in the absence of consistent and substantial evidence, low-dose aspirin is recommended by doctors to counteract infertility. Similarly, the use of antibiotics in viral infections, practised by both patients and prescribers themselves, is no less than a scourge to handle. To domesticate the mindset of future healthcare practitioners to particular manufacturers, the companies themselves are enticing their future clients by providing utilitarian gifts to institutions in the form of computers, books, etc. My concern is that the major point of future research should be the relationship between the pharmaceutical industry and medical and pharmacy students, which has so far been investigated in only a few developed countries.[3] The research evidence clearly indicates the influence of pharmaceutical companies over future healthcare professionals[4–6] Previously documented research also highlights the persuasive power that pharmaceutical companies have over the prescribing © 2013 Royal Pharmaceutical Society
practices of these future practitioners.[7,8] A comprehensive, international, cross-sectional, exploratory study by the World Health Organization (WHO) and Health Action International (HAI) in 2005 reported that medical and pharmacy academics had already initiated the need for education and awareness about drug promotion.[9] At that time many of the countries surveyed were reported to be already incorporating the topic into therapeutics, pharmacology and professional ethics curricula, but lack of an amalgamation of curricular contents and insufficient time devoted to the topic were identified as barriers to their successful implementation.[10] Interestingly, research conducted in Malaysia on first-year pharmacy students reported ‘new drug-promotion techniques’ as the most interesting topic in a newly introduced public health pharmacy curriculum.[11] Likewise, research conducted in Kuwait has shown that pharmacy and preclinical students have a positive attitude towards industry gifts because they were exposed to these such practices early in their academic training. Moreover, they do not foresee the ethical implications of these gifts.[6] To be precise, future planning should be directed towards creating and increasing awareness about drug-promotional practices by implementing blended learning techniques like flipped-classroom or backward-classroom teaching in modules covering pharmacy practice, such as pharmaceutical marketing. In this type of modality the students will view lectures online that had been previously uploaded onto an e-learning system by the module co-ordinator (pharmacy practice faculty). At the end of the lecture the students will work through the drug-promotional scenarios and off-labeluse scenarios. The students will be asked to perform a role play on the scenario after a week. For instance, a scenario could be in the form of a prescription analysis in which they have to spot the off-label use of drug and to act accordingly by contacting and persuading the doctor to substitute the drug for some other alternative that is approved and indicated for the condition. As such scenarios are uploaded at the end of a lecture, students will gather the necessary information about the drug, its interactions and approved indications over the course of the following week. At the next lesson the students International Journal of Pharmacy Practice 2014, 22, pp. 234–235
235
will be divided into groups for presentations and discussions with the module co-ordinator on drug-promotional practices, the implications of gifts and the ramifications of offlabel drug use. In this blended-learning modality future practitioners have chances to raise queries and enhance their critical reasoning abilities in a collaborative real-time discussion with their peers and faculty. To summarize, it is imperative that we teach future healthcare practitioners, from the beginning of their
References 1. Fincham JE. Unethical pharmaceutical manufacturer conduct worldwide and its negative impact upon pharmacy practice. Int J Pharm Pract 2013; 21: 71–72. 2. Wyber R et al. Relationships between medical students and drug companies in New Zealand. N Z Med J 2011; 124: 1–7. 3. Hutchinson M. Pharmaceutical companies and medical students: a student’s view. Med J Aust 2004; 180: 414. 4. Barnes CJ, Holcenberg JS. Student reactions to pharmaceutical promotion practices. Northwest Med 1971; 70: 262–266.
© 2013 Royal Pharmaceutical Society
education, not only about drug-promotional practices but also about the unethical aspects of these practices. Shazia Qasim Jamshed Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia
5. Sandberg WS et al. The effect of educational gifts from pharmaceutical firms on medical students’ recall of company names or products. Acad Med 1997; 72: 916–918. 6. Ball DE, Al-Manea SA. Exposure and attitudes to pharmaceutical promotion among pharmacy and medical students in Kuwait. Pharm Educ 2007; 7: 303– 313. 7. Wazan A. Physicians and the pharmaceutical industry: is a gift ever just a gift? J Am Med Assoc 2000; 283: 373– 380. 8. Rogers WA et al. The ethics of pharmaceutical industry relationships with medical students. Med J Aust 2004; 180: 411–414.
9. Arokiasamy JT, Med J. Malaysia 1997 – Malaysia’s ageing issues. Med J Malaysia 1997; 52: 197–201. 10. Mintzes B. Educational Initiatives for Medical and Pharmacy Students about Drug Promotion. WHO/PSM/PAR/ 2005.2 ed. Geneva and Amsterdam: World Health Organization and Health Action International, 2005. 11. Babar Z-U-D et al. Examination of students’ interest in a public health pharmacy course in Malaysia. Curr Pharm Teach Learn 2011; 3: 199–207.
International Journal of Pharmacy Practice 2014, 22, pp. 234–235
Letter to the Editor International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2014, 22, pp. 234–235
Comment on Fincham editorial Drug promotion: the need to teach future healthcare practitioners Received April 4, 2013 Accepted August 5, 2013 doi: 10.1111/ijpp.12072
The recent editorial by Fincham[1] revives my intention to write a few paragraphs on the drug-promotion practices of pharmaceutical manufacturers. The pharmaceutical industry and the healthcare profession are unified and possess mutually supportive rapport with each other.[2] The moral values and the financial aspects of this bond are matters of extensive exploration. Pharmaceutical promotion is a persistent chain reaction that evolves progressively and is intertwined with the process of prescribing. Off-label use is simply an ancillary branch of drug promotion. The major stakeholders in this connection are the physicians, pharmacists, patients and a few supplementary prescribers, such as nurses, who are commonly influenced by pharmaceutical manufacturers. Community and hospital pharmacists, being the health information specialists, generally walk on the tightrope of therapeutics by either following the doctor’s prescription or sometimes succumbing to the patient’s demands for a prescription or non-prescription medicine that is not indicated for that particular illness. Commonly prevalent uses include promethazine as a sleeping aide in infants, taken by their mothers, aspirin for treating infertility and antibiotics for viral illness. It is observed that promethazine syrup dispensed at community pharmacies is consumed by mothers to induce sleep in infants. Likewise, even in the absence of consistent and substantial evidence, low-dose aspirin is recommended by doctors to counteract infertility. Similarly, the use of antibiotics in viral infections, practised by both patients and prescribers themselves, is no less than a scourge to handle. To domesticate the mindset of future healthcare practitioners to particular manufacturers, the companies themselves are enticing their future clients by providing utilitarian gifts to institutions in the form of computers, books, etc. My concern is that the major point of future research should be the relationship between the pharmaceutical industry and medical and pharmacy students, which has so far been investigated in only a few developed countries.[3] The research evidence clearly indicates the influence of pharmaceutical companies over future healthcare professionals[4–6] Previously documented research also highlights the persuasive power that pharmaceutical companies have over the prescribing © 2013 Royal Pharmaceutical Society
practices of these future practitioners.[7,8] A comprehensive, international, cross-sectional, exploratory study by the World Health Organization (WHO) and Health Action International (HAI) in 2005 reported that medical and pharmacy academics had already initiated the need for education and awareness about drug promotion.[9] At that time many of the countries surveyed were reported to be already incorporating the topic into therapeutics, pharmacology and professional ethics curricula, but lack of an amalgamation of curricular contents and insufficient time devoted to the topic were identified as barriers to their successful implementation.[10] Interestingly, research conducted in Malaysia on first-year pharmacy students reported ‘new drug-promotion techniques’ as the most interesting topic in a newly introduced public health pharmacy curriculum.[11] Likewise, research conducted in Kuwait has shown that pharmacy and preclinical students have a positive attitude towards industry gifts because they were exposed to these such practices early in their academic training. Moreover, they do not foresee the ethical implications of these gifts.[6] To be precise, future planning should be directed towards creating and increasing awareness about drug-promotional practices by implementing blended learning techniques like flipped-classroom or backward-classroom teaching in modules covering pharmacy practice, such as pharmaceutical marketing. In this type of modality the students will view lectures online that had been previously uploaded onto an e-learning system by the module co-ordinator (pharmacy practice faculty). At the end of the lecture the students will work through the drug-promotional scenarios and off-labeluse scenarios. The students will be asked to perform a role play on the scenario after a week. For instance, a scenario could be in the form of a prescription analysis in which they have to spot the off-label use of drug and to act accordingly by contacting and persuading the doctor to substitute the drug for some other alternative that is approved and indicated for the condition. As such scenarios are uploaded at the end of a lecture, students will gather the necessary information about the drug, its interactions and approved indications over the course of the following week. At the next lesson the students International Journal of Pharmacy Practice 2014, 22, pp. 234–235
235
will be divided into groups for presentations and discussions with the module co-ordinator on drug-promotional practices, the implications of gifts and the ramifications of offlabel drug use. In this blended-learning modality future practitioners have chances to raise queries and enhance their critical reasoning abilities in a collaborative real-time discussion with their peers and faculty. To summarize, it is imperative that we teach future healthcare practitioners, from the beginning of their
References 1. Fincham JE. Unethical pharmaceutical manufacturer conduct worldwide and its negative impact upon pharmacy practice. Int J Pharm Pract 2013; 21: 71–72. 2. Wyber R et al. Relationships between medical students and drug companies in New Zealand. N Z Med J 2011; 124: 1–7. 3. Hutchinson M. Pharmaceutical companies and medical students: a student’s view. Med J Aust 2004; 180: 414. 4. Barnes CJ, Holcenberg JS. Student reactions to pharmaceutical promotion practices. Northwest Med 1971; 70: 262–266.
© 2013 Royal Pharmaceutical Society
education, not only about drug-promotional practices but also about the unethical aspects of these practices. Shazia Qasim Jamshed Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia
5. Sandberg WS et al. The effect of educational gifts from pharmaceutical firms on medical students’ recall of company names or products. Acad Med 1997; 72: 916–918. 6. Ball DE, Al-Manea SA. Exposure and attitudes to pharmaceutical promotion among pharmacy and medical students in Kuwait. Pharm Educ 2007; 7: 303– 313. 7. Wazan A. Physicians and the pharmaceutical industry: is a gift ever just a gift? J Am Med Assoc 2000; 283: 373– 380. 8. Rogers WA et al. The ethics of pharmaceutical industry relationships with medical students. Med J Aust 2004; 180: 411–414.
9. Arokiasamy JT, Med J. Malaysia 1997 – Malaysia’s ageing issues. Med J Malaysia 1997; 52: 197–201. 10. Mintzes B. Educational Initiatives for Medical and Pharmacy Students about Drug Promotion. WHO/PSM/PAR/ 2005.2 ed. Geneva and Amsterdam: World Health Organization and Health Action International, 2005. 11. Babar Z-U-D et al. Examination of students’ interest in a public health pharmacy course in Malaysia. Curr Pharm Teach Learn 2011; 3: 199–207.
International Journal of Pharmacy Practice 2014, 22, pp. 234–235
