ABSTRACT
We evaluated the extent of and factors that determine the inappropriate use of antibiotics that are obtained without a physician's prescription. Ninety-eight Greek pharmacists were visited by actress-researchers who played clients requesting antibiotics without a physician's prescription. Pharmacists were randomly challenged in a scenario that involved simulated cases of acute uncomplicated rhinosinusitis with either low fever (38.5 degrees C) or high fever (40 degrees C). Antibiotics were offered by 34 (69%) of 49 pharmacists who were presented with the high-fever scenario and by 42 (86%) of 49 pharmacists who were presented with the low-fever scenario (risk difference, 16.3%; P = .05). Thirty-two (65%) and 35 (71%) pharmacists in the high- and low-fever study arms, respectively, agreed to sell the actress-researchers broad-spectrum antibiotics. Only 28 (57%) and 17 (35%) pharmacists, respectively, recommended that the patient visit a physician (P = .03). Inappropriate recommendations regarding antibiotic use were very common in the studied setting. Antibiotics were more likely to be offered to persons who did not have a prescription when they were less likely to be clinically indicated.
Subject(s)
Anti-Bacterial Agents/supply & distribution , Anti-Bacterial Agents/therapeutic use , Medication Errors , Pharmacists , Rhinitis/drug therapy , Sinusitis/drug therapy , Drug Prescriptions , Female , Fever , Greece , Humans , Patient Simulation , PharmacyABSTRACT
BACKGROUND: Guidelines published in major medical journals are very influential in determining clinical practice. It would be essential to evaluate whether conflicts of interests are disclosed in these publications. We evaluated the reporting of conflicts of interest and the factors that may affect such disclosure in a sample of 191 guidelines on therapeutic and/or preventive measures published in 6 major clinical journals (Annals of Internal Medicine, BMJ, JAMA, Lancet, New England Journal of Medicine, Pediatrics) in 1979, 1984, 1989, 1994 and 1999. RESULTS: Only 7 guidelines (3.7%) mentioned conflicts of interest and all were published in 1999 (17.5% (7/40) of guidelines published in 1999 alone). Reporting of conflicts of interest differed significantly by journal (p=0.026), availability of disclosure policy by the journal (p=0.043), source of funding (p < 0.001) and number of authors (p=0.004). In the entire database of 191 guidelines, a mere 18 authors disclosed a total of 24 potential conflicts of interest and most pertained to minor issues. CONCLUSIONS: Despite some recent improvement, reporting of conflicts of interest in clinical guidelines published in influential journals is largely neglected.
Subject(s)
Clinical Trials as Topic , Conflict of Interest/legislation & jurisprudence , Practice Guidelines as Topic , Preventive Medicine , Research Design/legislation & jurisprudence , Clinical Trials as Topic/legislation & jurisprudence , Clinical Trials as Topic/methods , Clinical Trials as Topic/standards , Disclosure/legislation & jurisprudence , Disclosure/standards , Disclosure/trends , Humans , Periodicals as Topic/legislation & jurisprudence , Periodicals as Topic/standards , Periodicals as Topic/trendsABSTRACT
OBJECTIVE: To describe how pharmaceutical companies cater to the material needs of doctors. DESIGN: Case report of memoirs. SETTING: Facilities that have nothing to do with medicine, somewhere in the Arabian peninsula. PATIENT POPULATION: Random sample of doctors. INTERVENTIONS: Promotion by the pharmaceutical industry. MAIN OUTCOME MEASURES: Short term outcomes were travel, pleasure, amusement, and gifts, and long term outcomes were the market share of specific companies. RESULTS: Short term outcomes were heterogeneous, underlying the diversity of the means employed by the pharmaceutical industry to subvert, divert, and influence medical practice. Overall, 200 doctors were dressed in white gowns, a doctor in preventive medicine quoted Hippocrates in favour of smoking, a senior doctor became a poet, a doctor trying to understand the Methods section of a poster paper wondered whether he should have been sunbathing at the beach instead, and two women doctors were kidnapped by Bedouin warriors. Long term outcomes on the sales of the company drugs are pending but are likely to be most favourable. CONCLUSIONS: Eat, drink, be merry, and boost prescriptions.
Subject(s)
Drug Industry , Interprofessional Relations , Wit and Humor as Topic , Family Practice , Humans , Marketing of Health ServicesABSTRACT
The overall incidence of measles fell markedly in Greece after measles vaccination was introduced (although precise data are not available), but sporadic outbreaks continue to occur. A live monovalent measles vaccine was introduced in Greece in 1965 and r
