Perceptions and Attitudes of Medical Sales Representatives (MSRs) and Prescribers Regarding Pharmaceutical Sales Promotion and Prescribing Practices in Pakistan

Abstract

Introduction: Pakistan is the 6 th most populous country in the world and has an enormous potential for an ever increasing drug market. The health care system is highly prone to unethical drug prescribing practices. In addition, there is a huge tendency of pharmaceutical firms to indulge in unethical drug promotional practices by means of inducements and other benefits through their medical sales representatives (MSRs). On the other hand, the prescribers are also reported to be demanding inducements from these companies in return to write higher number of prescription. This study investigated the ground realities of drug promotion and prescribing practices in Pakistan. Materials and Methods: A cross sectional study was conducted for a period of 8 months in which 472 physicians and 609 medical sales representatives of Pakistan selected through prospective sampling were interviewed on a validated, structured questionnaire. The responses of the target groups were then analyzed for association between variables by Chi-square test (p<0.05) and cross tabulation through SPSS, version 20. Results: Majority of practitioners (83.2%) expected both, good communication skills and knowledge from MSRs and at the same time nearly half (53%) of prescribers demanded CME and almost a third proportion (36%) demanded gifts, incentives and inducements from MSRs. Replying to same question, MSRs disagreed with prescribers and believed that around (~70%) of prescribers ask for inducements with a high percentage i.e. (~64%) among them demanding unethical inducements like excessive free samples, gifts, leisure trips and cars. Majority of physicians (92%) have consensus that the multinational pharmaceutical firms have defined promotional practices while the national pharmaceutical companies (~73%) are mainly involved in unethical practices of drug marketing. Conclusion: Majority of national pharmaceuticals as well as prescribers were involved in unethical drug promotion and prescribing respectively. There is a need of curbing the unethical drug promotion and prescribing and formidable policies governing this issue are required to be implemented by the concerned regulatory authorities to avoid unnecessary harm to the patient's life and pocket. Strength and weakness of study: The study explored the drug promotion and prescribing practices for the first time in a developing country however, due to sensitivity of the topic a number of respondents hesitated to participate.

Pharmaceutical promotions and trustworthiness on new drug prescribing among physicians in public general hospitals

“…This concern is doubled when it is reflected in physicians across different parts of the world. [14,15] We suggest the intervention in the way of policy implementation and education on the negative consequences of these relationships between the pharmaceutical industry and physicians at different levels. It must be considered that gifts, medical samples, or industry-funded trips increase the prices of drugs.…”

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

“…Apart from free samples, pharmaceutical companies also use inexpensive gifts as reminders, including prescription pads, pens, paperweights, calendars, mountings, table organizers, wall clocks, diaries, and other gifts [27,68]. These gifts play the vital role of giving a constant reminder of a drug beyond the sales calls to the physician; thus, these reminder gifts play a vital role to enhance the physicians' symmetrical prescription for a certain drug [23,24,69]. Besides these inexpensive gifts, pharmaceutical companies also give some valuable gifts to the physicians for the patients' welfare such as stethoscopes, weighing machines, BP apparatuses, and Blood sugar test machines with strips, water dispensers, drug refrigerators, and other valuable gifts to buy a physicians' time for detailing and for maintaining good relationships.…”

Brand versus generic dispensing trend for ciprofloxacin 500 mg, levofloxacin 500 mg, and moxifloxacin 400 mg (oral dosage forms) among pharmacies of Karachi, Pakistan

“…A number of studies have been conducted in Pakistan, especially in Karachi, that draw attention to the mal prescribing and unethical sales promotion activities of local pharmaceuticals in Pakistan. [ 5 10 ] Apart from this, the surging prices for generic drugs, in this case, highlight the issue of supply shortages. For many drugs, there are only few generic manufacturers that are responsible for the supply of the particular drug.…”

“…In addition, it can lead to competition among pharmaceutical companies and in the absence of vigilance on marketing and sales promotion activities, it can lead to unethical practices. [ 10 ]…”