Effect of pharmaceutical promotion and incentives offered by pharmaceutical companies on the prescribing pattern of medical students: a cross-sectional study from a developing nation Pakistan.

Background: Pharmaceutical companies continuously pursue healthcare professionals, starting from the medical college level, which can ultimately lead to irrational prescribing of drugs and antibiotics. Therefore, our main aim was to evaluate the opinions and attitudes of medical students toward pharmaceutical promotion. Methods: This study utilized a cross-sectional online survey that applied the snowball sampling technique. Data were collected from three public and three private sector medical colleges in Punjab, Pakistan using snowball sampling. A modified version of a pre-structured questionnaire was used to collect data between October 2020 and January 2021. Medical students from the third year onward were captivated. The tool was made available on Google Forms and students could access it by clicking the link shared. The effect of promotion on prescribing pattern and future prescribing of antibiotics were measured. Descriptive statistics, chi-square, and t-test were used to analyze the data. Results: A total of 1,301 students filled out the survey, but only 1,227 responses were acceptable. The average age was found to be 23.4 ± 1.59 years. Slightly more than half of the respondents were male participants (57.7%), and a significant proportion (84.1%) reported being aware of pharmaceutical promotion. A smaller number (27.7%) felt that physicians who meet medical representatives more frequently tend to prescribe more antibiotics and 46.3% indicated they would be willing to prescribe antibiotics under the promotional influence. Medical students who were male, in senior college years, attended government institutions, and had lower parental income showed significantly higher perception and attitude scores (p < 0.05) which, in turn, may show their inclination to promotional activities. Many students agreed with the view that pharmaceutical promotion (PP) activities may alter prescribing practices and also believed that they contribute to the increased irrational prescribing of drugs and antibiotics. Conclusion: The study revealed that only a small number of students are willing to engage in promotional activities and accept rewards, which influences their choice toward selection of drugs and antibiotics. This study highlighted the necessity of giving proper educational instructions regarding the promotion of drugs to medical students. This study also focused on the educational prerequisites of the students.

Patient Understanding of Oncology Clinical Trial Endpoints in Direct-to-Consumer Television Advertising.

BACKGROUND: This study examined how people interpret overall survival (OS), overall response rate (ORR), and progression-free survival (PFS) endpoints in the context of direct-to-consumer television ads. Although there is little research on this topic, initial evidence suggests that people can misinterpret these endpoints. We hypothesized that understanding of ORR and PFS would be improved by adding a disclosure ("We currently do not know if [Drug] helps patients live longer") to ORR and PFS claims. METHODS: We conducted 2 online studies with US adults examining television ads for fictional prescription drugs indicated to treat lung cancer (N = 385) or multiple myeloma (N = 406). The ads included claims about OS, ORR with and without a disclosure, or PFS with and without a disclosure. In each experiment, we randomized participants to view 1 of 5 versions of a television ad. After viewing the ad twice, participants completed a questionnaire that measured understanding, perceptions, and other outcomes. RESULTS: In both studies, participants correctly differentiated between OS, ORR, and PFS via open-ended responses; however, participants in the PFS conditions (versus ORR conditions) were more likely to make incorrect inferences about OS. Supporting the hypothesis, adding a disclosure made expectations around living longer and quality-of-life improvements more accurate. CONCLUSION: Disclosures could help reduce the extent to which people misinterpret endpoints like ORR and PFS. More research is needed to establish best-practice recommendations for using disclosures to improve patient understanding of drug efficacy without changing their perception of the drug in unintended ways.

Branded Care: The Policy Implications of Pharmaceutical Industry-Funded Nursing Care Related to Specialty Medicines.

An increasing proportion of new drugs approved for market worldwide are now high cost, specialty medicines. Pharmaceutical marketers face the challenge of convincing payers, prescribers, and patients that the cost and complexity of care associated with specialty medicines is worth the trouble, and now offer patient support programs, free of charge, to patients prescribed their drug. We conducted a secondary, qualitative, interpretive analysis of 24 interviews with leaders of patient groups and members of hospital formulary committees in Australia to describe the work of pharmaceutical company-employed or contracted nurses who provide support to patients prescribed specialty medicines, and to prompt discussion around the policy implications of relying on industry-funded nursing care within publicly funded health systems. Participants affirmed the value of specialist, holistic, person-centered nursing care, but perceived gaps within the public health system related to the availability and provision of nursing care for people living with chronic disease. Consequently, participants described the pharmaceutical industry as addressing health system gaps through sponsorship or direct provision of medication-related nursing care, but recognized that care was contingent on commercial interest. Participants highlighted a number of ethical and policy concerns stemming from industry-funded nursing care of people prescribed specialty medicines related to patient safety, continuity of care, inducement to prescribe, and health equity. This analysis suggests that outsourcing necessary medication-related care to pharmaceutical companies has implications for the health system and equitable, sustainable pharmaceutical policy that extend far beyond the care encounter.

Effects of the distribution of product samples to patients and physicians by pharmaceutical companies

Background@#Distribution of product samples is a typical and traditional marketing and promotion strategy used by pharmaceutical companies. However, issues have been raised about their influence on physicians' prescribing behavior and patients' health outcomes. @*Objectives@#This study aimed to determine the effects of the distribution of product samples on physicians' prescribing behavior and adherence to patients' treatment regimens. It also sought to provide policy recommendations on product sample distribution and the administrative order on pharmaceutical promotion. @*Methodology@#The study involved a descriptive design. The study sites were Manila City, Cebu City, and Davao City. Data were collected using focus group discussions, key informant interviews, and surveys among patients and physicians. Content analysis was performed to analyze qualitative data, while descriptive statistics and measures of association were conducted to analyze quantitative data. @*Results@#A total of four FGDs were conducted with one FGD for each stakeholder group, and 846 patients and 286 physicians answered the study questionnaire. About half (48.0%) of the patients received product samples; 75.8% had low medication adherence. Product sample distribution was not significantly associated with patients' adherence (p=0.150). The majority of the physicians (69.2%) received product samples. There was no significant association between product sample distribution and physicians' prescribing behavior (p=0.111). It was found, however, that the distribution of product samples was significantly associated with the other physicians' prescribing behavior (p=0.009). The issues identified included the influence of medical representatives on physicians' prescribing behavior, incapacity of the poor and marginalized population to complete their treatment regimen due to lack of supply of product samples, and mentality of patients that product samples have better quality.@*Conclusion@#This study emphasized that the regulation of product sample distribution was justifiable since this might negatively influence professional behavior affecting rational prescribing and the use of medicines. Furthermore, the distribution of product samples did not directly translate to increased patients' medication adherence. Should the distribution of samples be continuously practiced, the provision of product samples should be strictly followed, and the distribution should be regulated and monitored to prevent the occurrence of violative practices.

Regulation of medicines advertisement in Zimbabwe: an assessment of the impact of pharmaceutical promotion on the prescribing behaviour of healthcare professionals.

BACKGROUND: The pharmaceutical industry plays a key role in drug discovery and is considered useful regards to informing the health care workers health care workers about new medicines. Investigations concerning health care workers to industry interactions are less common. The objective of this study is to determine levels of knowledge, attitude and perception towards regulation of pharmaceutical promotion among healthcare practitioners in Zimbabwe. METHODS: A cross-sectional study was used and 330 healthcare practitioners were enrolled into the study. Data collection was done through combined face-to-face interviews and web-based online survey. The relative importance index score and used as a measure of knowledge, attitude and perception levels towards pharmaceutical promotion. Univariate and bivariate analysis was performed using STATA software package. RESULTS: Our study estimated that 95%, 67%, and 90% of the healthcare practitioners in Zimbabwe have a favourable (i.e. > 65%) relative importance index score of knowledge, attitudes, and perception, respectively, towards regulation of pharmaceutical promotion. Further exploration of the data indicated that the factors that had an association with the knowledge, attitude and perception levels towards regulation of pharmaceutical regulation at 5% level of significance include health care workers' profession, gender, education level, the nature of the working institution and the number of prescriptions involved per week. CONCLUSION: In conclusion, the findings of this study highlighted that in general the health care workers in Zimbabwe have higher levels of knowledge, attitude and perception towards regulation of pharmaceutical promotion, though the attitudes levels weres a  bit lower compared to other domains.

Physician Interpretation of Data of Uncertain Clinical Utility in Oncology Prescription Drug Promotion.

BACKGROUND: Little is known about how physicians interpret data displays that depict preliminary or exploratory clinical data in physician-targeted sales aids for oncology drugs. Using three factorial experiments, we examined whether disclosures of data limitations and clinical uncertainty adequately communicate the limitations and practical utility of this type of data. SUBJECTS, MATERIALS, AND METHODS: The studies used a 2 (disclosure of data limitations: technical, nontechnical) × 2 (disclosure of clinical uncertainty: present, absent) + 1 (control: no disclosure) between-subjects experimental design to examine the impact of disclosures as they relate to presentations of preliminary or exploratory data in promotional communications for oncology products. In each experiment, we randomized oncologists and primary care physicians with oncology experience to view one version of a two-page sales aid. Following this exposure, physicians completed a web-based survey. The design was replicated in three concurrently conducted experiments using sales aids for different fictitious oncology drugs, each featuring one of three common data displays: a forest plot (n = 495), a Kaplan-Meier curve (n = 504), or a bar chart (n = 532). RESULTS: Results provide initial evidence that in some contexts disclosures can improve understanding of the clinical utility of certain information about a drug and the limitations of results presented in a data display. Disclosures can also temper perceptions of how much evidence is presented that supports a conclusion that the drug is an appropriate treatment. In terms of the language used in the disclosure of data limitations, physicians in all three experiments strongly preferred the nontechnical disclosures. CONCLUSION: The findings from the three experiments in this study suggest that disclosures have the potential to increase relevant knowledge, but more research is needed to establish best practice recommendations for using disclosures to convey contextual information relevant for interpreting data displays in promotional communications. IMPLICATIONS FOR PRACTICE: This article reports the results from three large, online experimental studies that address a growing concern that drug companies often share favorable clinical trial results with physicians in promotional materials that lack important context for physicians to interpret the data. This series of studies investigates whether strategic use of two types of disclosures (disclosure of data limitations and a disclosure of clinical uncertainty) improves understanding and reduces misinterpretations among physicians. The results from these studies help identify communication factors that impact how physicians critically appraise preliminary or exploratory clinical trial data to inform policy and regulatory efforts.

Influence of pharmaceutical promotion on prescribers in Jordan.

Background Pharmaceutical promotion efforts should facilitate excellent quality patient care. However, there has been substantial debate about ethical principles related to pharmaceutical promotions. Objectives This study aimed to evaluate (i) attitudes toward pharmaceutical promotion among physicians in the private sector in Jordan, (ii) the impact of pharmaceutical promotion in influencing physicians' prescribing practices, and (iii) the prospect of academic detailing on this issue in Jordan. Setting The private health care sector in Jordan. Methods In this cross-sectional study, a self-administered questionnaire was distributed to a sample of physicians from the private health sector in Jordan during the period from December 2018 to March 2019. Descriptive statistics were conducted to describe physicians' attitudes toward pharmaceutical promotions, factors affecting prescribing practices, and perceptions toward academic detailing. Logistic regression models were performed to investigate predictors of acceptance and skepticism attitudes toward pharmaceutical promotion. Eisenberg model of physician decision-making was applied to evaluate factors influencing physicians' prescribing practice of promoted pharmaceutical products. Main outcome measure Attitudes toward pharmaceutical promotions, exposure to promoted pharmaceutical products, factors affecting physicians' prescribing practice of promoted pharmaceutical products, and their perceptions toward academic detailing and expected challenges. Results A total of 310 physicians completed the survey. The majority of physicians (73%) agreed that pharmaceutical companies provide valuable education on new pharmaceutical products. However, 66% of physicians agreed that lectures that are sponsored by pharmaceutical companies are often biased in favor of their products. Ninety-two percent of physicians agreed that drug samples were the most commonly offered promotional products by pharmaceutical companies. Being educated about the ethical principles related to pharmaceutical promotions among physicians was associated with higher likelihood of being skeptic about pharmaceutical promotional activities. Physicians' years of experience, payers' factors, environmental factors and participation in drug committees were significantly associated with high impact of marketing activities on physicians' prescribing practices (ORs of 1.2, 1.2, 1.49 and 0.43, respectively). The majority of participants in the current study reported positive attitudes toward applying academic detailing services in the future. Conclusions Education seems to play a crucial role in physicians' attitudes toward pharmaceutical promotion. Academic detailing is a promising strategy to counteract unethical marketing practice.

Receipt of Promotional Payments at the Individual and Physician Network Level Associated with Higher Branded Antipsychotic Prescribing Rates.

Pharmaceutical promotion can lead to market size expansion, which is beneficial if previously untreated patients access treatment but deleterious if it leads to overuse, an area of concern for second generation antipsychotics (SGA). We contribute to a growing body of work suggesting that networks of social and professional relationships shape prescribing behavior. We examined 88,439 Medicare Part D prescribing physicians, finding that promotion is associated with SGA market size expansion (elasticity: 0.062) and that network-level promotional activity is associated with network members' branded product prescribing. Research on the effects of promotion should account for its effects in prescribers' networks.

Direct-to-Consumer Broadcast Advertisements for Pharmaceuticals: Off-Label Promotion and Adherence to FDA Guidelines.

BACKGROUND: Direct-to-consumer (DTC) advertisements for prescription drugs in the United States are regulated by the Food and Drug Administration (FDA). Off-label promotion, or the advertisement of a drug for an indication not approved by the FDA, is prohibited. Our objective was to examine the presence of off-label promotion in broadcast DTC ads and to assess their adherence to FDA guidelines mandating fair balance in presentation of risks and benefits and prohibiting misleading advertisement claims. METHODS: All English-language broadcast DTC ads for prescription drugs that aired in the United States from January 2015 to July 2016 were obtained from AdPharm, an online collection of healthcare advertisements. Ad length was measured and adherence to FDA guidelines was assessed for several categories: key regulatory items, indicators of false or misleading ads, and indicators of fair balance in presentation of risks and benefits. RESULTS: Our sample included 97 unique DTC ads, representing 60 unique drugs and 67 unique drug-indication combinations. No ads described drug risks quantitatively, whereas drug efficacy was presented quantitatively in 25 (26%) ads. Thirteen (13%) ads, all for diabetes medications, suggested off-label uses for weight loss and blood pressure reduction. The most commonly advertised drugs were indicated for the treatment of inflammatory conditions (n = 12; 18%), diabetes or diabetic neuropathy (n = 11; 16%), bowel or bladder dysfunction (n = 6; 9%), and infections or allergic reaction (n = 6; 9%). More than three-quarters (n = 51; 76%) advertised drugs to treat chronic conditions. CONCLUSIONS: Few broadcast DTC ads were fully compliant with FDA guidelines. The overall quality of information provided in ads was low, and suggestions of off-label promotion were common for diabetes medications. The impact of current DTC ads and off-label marketing on patient and prescriber decisions merits further scrutiny.

Reconciling a "pleasant exchange" with evidence of information bias: A three-country study on pharmaceutical sales visits in primary care.

OBJECTIVES: To examine and compare the experiences and attitudes of primary care physicians in three different regulatory environments (United States, Canada, and France) towards interactions with pharmaceutical sales representatives, particularly their perspectives on safety information provision and self-reported influences on prescribing. METHODS: We recruited primary care physicians for 12 focus groups in Montreal, Sacramento, Toulouse and Vancouver. A thematic analysis of the interview data followed a five-stage framework analysis approach. RESULTS: Fifty-seven family physicians (19 women, 38 men) participated. Physicians expected a commercial bias and generally considered themselves to be immune from influence. They also appreciated the exchange and the information on new drugs. Across all sites, physicians expressed concern about missing harm information; however, attitudes to increased regulation of sales visits in France and the US were generally negative. A common solution to inadequate harm information was to seek further commercially sourced information. Physicians at all sites also expressed sensitivity to critiques from medical students and residents about promotional interactions. CONCLUSIONS: Physicians have contradictory views on the inadequate harm information received from sales representatives, linked to their lack of awareness of the drugs' safety profiles. Commonly used strategies to mitigate information bias are unlikely to be effective. Alternate information sources to inform prescribing decisions, and changes in the way that physicians and sales representatives interact are needed.

Assessment of a Pharmaceutical Advertisement Analysis Module in a Drug Literature Evaluation Course.

Objective. To evaluate the impact of an educational module on students' self-efficacy when analyzing the content of promotional drug brochures (PDBs) and to assess the students' value of PDBs' as an educational tool. Methods. Third-year bachelor of pharmacy students participated in a one-hour lecture and a two-hour laboratory. Students completed a survey before and after participating in the module. Results. The module elicited a statistically significant change in students' self-efficacy beliefs regarding evaluating promotional drug brochures, while the average perceived value of promotional drug brochures did not change significantly after the module. Conclusion. A brief educational module can increase students' self-efficacy in evaluating the content of PDBs.

Unwarranted claims of drug efficacy in pharmaceutical sales visits: are drugs approved on the basis of surrogate outcomes promoted appropriately?

AIMS: This study compares physicians' recall of the claims of benefits on cardiovascular disease and diabetes made by pharmaceutical sales representatives for drugs approved on the basis of a surrogate outcome, i.e., an off-label claim, compared with those approved on the basis of a serious morbidity or mortality (clinical) outcome. METHODS: Physicians in primary care practices in Montreal, Vancouver, Sacramento and Toulouse, who saw sales representatives as part of their usual practice and served a non-referral population, were contacted in blocks of 25 from a randomized list of all physicians practising in the relevant metropolitan area. We compared how frequently physicians reported that sales reps made claims of serious morbidity or mortality (clinically meaningful) benefits for drugs approved on the basis of surrogate outcomes vs. drugs approved on the basis of clinical outcomes. RESULTS: There were 448 promotions for 58 unique brand name cardiovascular and diabetes drugs. Claims of clinically meaningful benefit were reported in 156 (45%) of the 347 promotions for surrogate outcome drugs, constituting unwarranted efficacy claims, i.e., off-label promotion. Claims of clinical benefit were reported in 72 of the 101 promotions (71%) for drugs approved on the basis of clinical outcomes, adjusted OR = 0.3 (95% CI 0.2, 0.6), P < 0.001. CONCLUSIONS: Claims of efficacy made in sales visit promotions for drugs approved only on the basis of surrogate outcomes extended beyond the regulator-approved efficacy information for the product in almost half of promotions. Unapproved claims of drug efficacy constitute a form of off-label promotion and merit greater attention from regulators.

German medical students' exposure and attitudes toward pharmaceutical promotion: a cross-sectional survey.

OBJECTIVE: Early contact of medical students with pharmaceutical promotion has been shown in many international studies. We assessed the frequency and places of contact of German medical students to pharmaceutical promotion and examined their attitudes toward pharmaceutical promotional activities. METHODS: This cross-sectional survey was based on a self-developed questionnaire. It was distributed to all clinical students at the University of Goettingen Medical School in 2010. A 4-point rating scale was used to assess the attitudes toward different statements regarding pharmaceutical promotion. RESULTS: The overall response rate was 55% (702/1287). The proportion of students with direct contact to pharmaceutical sales representatives increased from 21% in the first clinical year up to 77% in the final year. 60% were contacted during their elective clerkship. 80% had accepted promotional gifts. 86% stated their prescribing behavior to be unsusceptible to the influence of accepting promotional gifts. However, 35% of the unsusceptible students assumed doctors to be susceptible. Almost all (90%) reported that dealing with pharmaceutical promotion was never addressed during lectures and 65% did not feel well prepared for interactions with the pharmaceutical industry. 19% agreed to prohibit contacts between medical students and the pharmaceutical industry. CONCLUSIONS: German medical students get in contact with pharmaceutical promotion early and frequently. There is limited awareness for associated conflicts of interests. Medical schools need to regulate contacts and incorporate the topic in their curriculum to prepare students for interactions with the pharmaceutical industry.

A survey of pharmaceutical company representative interactions with doctors in Libya.

OBJECTIVES: To examine the frequency of pharmaceutical company representative (PCR) interactions with doctors in Libya and review possible associations between these interactions and the personal and practice setting characteristics of doctors. METHOD: An anonymous survey questionnaire was circulated to 1,000 Libyan doctors in selected public and private practice settings in Tripoli, Benghazi and Sebha. RESULTS: A questionnaire return rate of 61% (608 returned questionnaires) was achieved. Most respondents (94%) reported that they had been visited by PCRs at least 'once' in the last year. Fifty per cent of respondents met with PCRs at least once a month, and 20% at least once a week. The following characteristics were significantly associated with meeting with a representative more than once a week: age, gender (male > female), years of practice, being a specialist (other than an anaesthesiologist) or working in private practice. Ninety-one per cent of doctors reported that they had received at least one kind of relationship gift during the last year. Printed materials (79%), simple gifts (73%) and drug samples (69%) were the most common relationship products given to respondents. Reimbursements or sponsored items were reported by 33% of respondents. Physician specialists were more likely to receive drug samples or sponsored items than residents, general practitioners, anaesthesiologists or surgeons (P<0.01). Participants working in private practice alone or in both sectors were more likely to receive printed materials, simple gifts or free samples from PCRs than doctors working in the public sector (P<0.05). CONCLUSION: Libyan doctors are frequently visited by PCRs. Doctors, working in private practice or specialist practice, are especially targeted by promotional activities. An agreed code of conduct for pharmaceutical promotion in Libya between doctors and PCRs should be created.

Ethical evaluation of pharmaceutical marketing in Pakistan / Evaluación ética del mercado farmacéutico en Pakistán / Avaliação ética do mercado farmacêutico no Paquistão

Our aim in this study is to give a broad overview of the main ethical and legal challenges of pharmaceutical marketing. The purpose of this study was also to investigate unethical pharmaceutical marketing, the effect on physicians of receiving gifts, the influences of perceptions regarding the importance of ethics and social responsibility on ethical intentions of marketing professionals. It also investigates the effect of unethical marketing on ultimate consumer (patient). Questionnaire based survey study was conducted from two main categories: (i) physicians/consultants and (ii) pharmaceutical companies. In Pakistan, there is no mechanism to monitor the drug promotional campaign by pharmaceutical industry despite the fact that there is enough evidence that irrational pharmacotherapy is increasingly encountered even in the developed countries due to unethical practices of pharmaceutical promotion. Medical practitioners and the pharmaceutical industry serve interests that sometimes overlap and sometimes conflict. There is strong evidence that associations between industry and physicians influence the behaviour of the latter in relation to both clinical decision making and ethical promotion of drugs. The basic principles underlying the conduct of physicians with respect to pharmaceutical companies should be openness and transparency.

Nuestro objetivo es dar una amplia visión de los principales desafíos éticos y legales del mercado farmacéutico. El propósito de este estudio fue investigar faltas éticas en el mercado farmacéutico, el efecto de la recepción de regalos por parte de los medicos y la influencia de las percepciones respecto de la importancia de la ética y la responsabilidad social en las intenciones éticas de los profesionales del mercado. También se investigó el efecto de las faltas éticas sobre el consumidor último (el paciente). Se realizó un estudio, mediante una encuesta cuestionario, con dos categorías principales: (i) médicos/consultores y (ii) empresas farmacéuticas. En Pakistán no existe un mecanismo para monitorear la campaña promocional de medicamentos realizada por la industria farmacéutica, a pesar de existir bastante evidencia de que ha aumentado la farmacoterapia irracional, incluso en países en desarrollo, debido a prácticas contrarias a la ética de la promoción farmacéutica. Los médicos practicantes y la industria farmacéutica sirven a intereses que algunas veces se superponen y otras entran en conflicto. Existe fuerte evidencia de que las asociaciones entre la industria y los médicos influyen el comportamiento de los últimos, tanto en relación con la toma de decisiones clínicas como en la promoción contraria a la ética de medicamentos. La apertura y transparencia debieran ser los principios básicos que fundamenten la conducta de los médicos respecto de las empresas farmacéuticas.

Nosso objetivo é dar uma ampla visão dos principais desafios éticos e legais do mercado farmacêutico. O propósito deste estudo foi investigar faltas éticas no mercado farmacêutico, o efeito da recepção de brindes por parte dos médicos e a influência das percepções a respeito da importância da ética e da responsabilidade social nas intenções éticas dos profissionais do mercado. Também se investigou o efeito das faltas éticas sobre o consumidor último (o paciente). Foi realizado um estudo, mediante um questionário, com duas categorias principais: (i) médicos/consultores e (ii) empresas farmacêuticas. No Paquistão não existe um mecanismo para monitorar a campanha promocional de medicamentos realizada pela indústria farmacêutica, apesar de existir bastante evidência de que tem aumentado a farmacoterapia irracional, inclusive em países em desenvolvimento, devido a práticas contrárias à ética da promoção farmacêutica. Os médicos praticantes e a indústria farmacêutica servem a interesses que algumas vezes se superpõem e em outras entram em conflito. Existe forte evidência de que as associações entre a indústria e os médicos influenciam o comportamento destes últimos, tanto em relação à tomada de decisões clínicas quanto na promoção contrária à ética dos medicamentos. A abertura e transparência deveriam ser os princípios básicos que fundamentam a conduta dos médicos a respeito das empresas farmacêuticas.