This document discusses drug promotion and advertising practices. It notes that drug companies use various marketing tactics like journal advertisements, mailings, company representative visits, gifts, and sponsorships to promote their drugs. It outlines guidelines for medical representatives' interactions with clinicians and cautions that information from representatives can be misleading and increase costs. The document advises critically appraising promotional materials by examining the supporting evidence, wording, appeals, graphics, and claims made. It provides tips for health care practitioners to maintain a skeptical view of drug promotion and make informed prescribing decisions based on evidence, not marketing influence.

1. Drug Promotion and
Critical Appraisal of Drug
Advertisement
Dr. Gyanendra Raj Joshi
PharmD, RPh
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2. Drug Promotion/Advertisement
 Journal advertisements
 Mailings
 Company representative visits
 Gifts ( medical samples , cash , personal gifts , cultural courtesy gifts ,
promotional aids, reminder items , medical utility items )
 Sponsorships ( travel , meals , accommodation, registration fees)
 Direct-to-consumer advertising
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3. Traits of a medical representative
 Must be adequately trained
 Must not give misleading information
 Must not offer inducement to gain interview
 Must not cause inconvenience
 Provision of hospitality
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4. Guidelines for MRs
 Appointment system for meeting clinicians
 Leaving samples of medicines
 Sponsorship of educational meetings
 Frequency of meetings
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5. Meeting with Medical representative
 What’s in it for me?
 Be selective
 By appointment with time limits
 Be in control
 Prepare standard questions
 Beware of bold statements
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6. Information from representatives
 Can be misleading
 Promotes non-rational prescribing
 Decreases generic prescribing
 Increases awareness of new drugs but without the
evidence
 Increases prescribing costs
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7. Oral presentations
 At least one inaccurate fact in 81% of presentations
 On average, at least 11% of statements made in an oral
presentation maybe inaccurate
 All inaccuracies are likely to favour promotion of the
drug
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8. Critical Appraisal
 Supporting Evidence
 Words and phrases
 Appeal to Authority
 Colours, pictures and emotion
 Graphs
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9. Written literature
 Protocols as evidence of clinical benefits
 Publication in non-peer reviewed / obscure journals
 Graphs with misleading axes!
 Surrogate endpoints
 Claims of superior potency
 Data from in-vitro studies, healthy volunteers
 Claims from emerging or scientific opinions
 Price comparisons
 Statistics
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10. What printed material should contain:
 Name of the product
 Active ingredient
 Name and address of manufaturer
 Date of production
 Abbreviated prescribing information
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11. Abbreviated prescribing information
 Approved indications
 Dose
 Method of use
 Contraindications
 Side effects
 Precautions
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12. S
T
Tolerability
E
Effectiveness
P
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Safety
Price

13. Commonly misused shortcuts for
choosing therapies
 Newer is better
 Experts know best
 If there is a mechanism for how a drug works, then it works
 If my peers are prescribing the drug then so should I.
 If the patient improves after the drug is prescribed, then the
therapy must have worked.
 If the manufacturer gives gifts, I should support them in return
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14. Free samples and promotional materials
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15. Countering misleading drug
promotion
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16. Healthy skepticism
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18. Drug companies know how to manipulate
our main motivations
Burnt out Dodo
Caring Bunny
Conservative Sheep
Entrepreneurial Wolf
Branthwaite A, Downing T.
Marketing to doctors – the
human factor. Scrip Magazine
1995 March;32-5
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19. Your ability to cope with potentially
misleading promotion depends on your
understanding of:
 Medicine
 Pharmacology, Epidemiology, Public Health, Evidence Based Medicine,
Drug Evaluation, Pharmacovigilance
 Social sciences
 Psychology, Economics, Sociology, Anthropology, Management,
History, Politics, Communication Studies,
 Humanities
 Logic, Rhetoric,Linguistics, Literature, Art
 Marketing
 Product Management, Advertising Account Planning, Public Relations
 Statistics
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21.  Is it ethically acceptable for
doctors to receive gifts from
drug companies?
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22.  Will you accept visits from
drug company
representatives?
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23.  Will you accept gifts from
drug companies?
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24.  How often is information from
drug companies reliable?
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25.  Will you be vulnerable to
being misled by drug
companies?
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