Interaction between pharmaceutical companies and physicians who prescribe antiretroviral drugs for treating AIDS

Abstract

CONTEXT AND OBJECTIVE: Given that Brazil has a universal public policy for supplying medications to treat HIV and AIDS, the aim here was to describe the forms of relationship between physicians and the pharmaceutical companies that produce antiretrovirals (ARVs). DESIGN AND SETTING: Cross-sectional epidemiological study conducted in the state of São Paulo. METHODS: Secondary database linkage was used, with structured interviews conducted by telephone among a sample group of 300 physicians representing 2,361 professionals who care for patients with HIV and AIDS. RESULTS: Around two thirds (64%) of the physicians prescribing ARVs for HIV and AIDS treatment in the state of São Paulo who were interviewed declared that they had some form of relationship with pharmaceutical companies, of which the most frequent were receipt of publications (54%), visits by sales promoters (51%) and receipt of small-value objects (47%). CONCLUSIONS: Two forms of relationship between the pharmaceutical industry and physicians who deal with HIV and AIDS can be highlighted: facilitation of professionals' access to continuing education; and antiretroviral drug brand name promotion. RESUMO CONTEXTO E OBJETIVO:Diante da existência no Brasil de uma política pública universal de fornecimento de medicamentos para tratamento do HIV e aids, o objetivo é descrever formas de relacionamento entre os médicos e as empresas farmacêuticas produtoras de antirretrovirais (ARVs). TIPO DE ESTUDO E LOCAL: Estudo epidemiológico de tipo transversal realizado no estado de São Paulo. MÉTODOS: Foi realizado cruzamento entre bancos de dados secundários e entrevistas estruturadas, por meio telefônico, em amostra de 300 médicos representativa de 2.361 profissionais que assistem pacientes com HIV e aids. RESULTADOS: Cerca de dois terços (64%) dos médicos entrevistados que prescrevem ARVs para tratamento de HIV e aids no Estado de São Paulo declararam que tiveram alguma relação com empresas farmacêuticas, sendo mais frequentes o recebimento de publicações (54%), de visita de propagandistas (51%) e de objetos de pequeno valor (47%). CONCLUSÃO: Destacam-se duas formas de relacionamento entre a indústria farmacêutica e os médicos que trabalham com HIV-aids: facilitação do acesso dos profissionais à educação continuada e promoção da marca de medicamentos antirretrovirais.

Knowledge, beliefs and attitudes of physicians in low and middle-income countries regarding interacting with pharmaceutical companies: a systematic review

“…Table 1 describes the characteristics of the participants, setting, and type of interaction addressed in each of these studies. The studies were conducted in six different countries: Yemen [ 14 , 15 ], Libya [ 16 ], Turkey, Nigeria [ 17 ], India [ 18 ] and Pakistan [ 19 ], Malaysia [ 20 ], Iraq [ 21 ] and Brazil [ 22 ].…”

“… • Perception of importance of PCR as drug information source: efficient (70 %), reliable and accurate (66 %), influences prescription behavior (72 %), useful and readily used when prescribing (69 %) • Perception of the effect of detailing by a PCR of a promoted drug: increases awareness (82 %), increases preference for prescription (60 %). Rajan 2008 [ 18 ] • Self administered survey questionnaire • General practitioners and specialists from an urban town ( N = 57) • India • Provision of drug information • Sample size calculation: not reported • Sampling frame: not reported • Sampling method: convenience sampling • Response rate: 95 % • Questionnaire based on theoretical model, no validation reported • Perception that product information provided by medical representatives is biased and insufficient: 79 % Scheffer 2014 [ 22 ] • Structured Interview • Physicians in Sao Paolo, Brazil ( N = 300) • October 2007 to May 2009 • Informative materials about ARVs • Visits by sales promoters and sales representatives • Inexpensive objects for the doctor’s office • Invitations to take part in continuing education courses and events Scientific journals sponsored by the laboratories • Sample size calculation: described in detail • Sampling frame: Logistics Control System (SICLOM) of the STD, AIDS and Viral Hepatitis Department of the Ministry of Health in Sao Paolo • Sampling method: stratified random sampling • Response rate: not reported • Validation not reported; pilot testing not reported • Pharmaceutical companies’ actions were considered to have a strong influence (10 %), slight influence (50 %) or no influence (40 %) on physicians’ prescribing of antiretroviral. Siddiqi 2011 [ 19 ] • Self administered questionnaire • General practitioners and consultants ( N = 200) • Various districts of Rawalpindi division, Pakistan • January –June 2010 • Sponsorships • Scientific promotional tools • Personal touch promotional tools Common promotional tools.…”

“…The specialties of physicians included were: both general practitioners and specialists in five studies [ 18 – 20 , 22 ]; specialists only in one study [ 21 ] physicians from private and public hospitals in three studies [ 14 – 16 , 20 ]; and not specified in one study [ 17 ]. The types of interaction assessed were: “visits by PCRs” in three studies [ 14 , 15 , 22 ]; “PCR marketing activity” (promotional tools such as gifts or sponsorships) in four studies [ 16 , 19 , 22 ]; “PCR as source of drug information” in four studies [ 14 , 15 , 17 , 18 , 21 ] and pharmaceutical-sponsored continual medical education (CME) [ 20 ] and invitations to take part in CME courses [ 22 ].…”

“…Table 1 also describes the methodological features of the included studies. There were a number of methodological limitations: only one study reported sample size calculation [ 22 ]; one study used random approach to sampling and another used stratified random sampling [ 22 ] and both described their sampling frame [ 22 ]; and response rates across studies varied between 19.5 and 100 %.…”

Antecedents of Symmetry in Physicians’ Prescription Behavior: Evidence from SEM-based Multivariate Approach

“…The marketing and promotion of a drug starts and ends at the level of physician. With pharmaceutical products, the consumer (patient) is not a direct customer of an organization; rather, the physician is the core customer for the pharmaceutical industry [14,22,107]. It is very interesting that, on one hand, the patient is not the direct consumer; however, on the other hand, the actual customer (physician) has to believe and rely on the information that is provided by the pharmaceutical company.…”