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July 2007, Volume 57, Issue 7

Student's Corner

Physician-Pharmaceutical Interaction: Training the doctors of tomorrow

Ali Jawaid  ( Final Year Medical Students, Aga Khan University, Karachi. )
Tauseef-ur-Rehman  ( Final Year Medical Students, Aga Khan University, Karachi. )

Madam, Pharmaceutical industry has a huge impacton general and institutional clinical practice in Pakistan.Time and again, it has been reported that Pharmaceutical representatives remain the primary source of information regarding newly launched drugs and treatment of common non-communicable disease for general practitioners (GPs)in Pakistan.1-2It has also been elucidated that a vast majority of general practitioners consider their prescription practice to be influenced by Pharmaceutical representatives/advertisements.1It has been argued that drug promotion by pharmaceuticals serves to educate medical professionals about different pathologic conditions and updates them on latest treatment options. While these benefits certainly cannot be ignored, adoption of an overtly cautious approach remains the best option while relying on Pharmaceutical representatives/ advertisements for knowledge. Alarmingly,it has been observed that Pharmaceutical promotional claims can often be ambiguous, exaggerating, controversialor falsely reassuring.1,3Encounter with Pharmaceutical representatives is very much inevitable for practicing Pakistani doctors.Unfortunately, little legislative and ethical counseling is available for doctors to guide them regarding the controversies surrounding such encounters. We believe that our doctors need to be familiarized with this norm before they enter the clinical practice. This can beachieved by arranging regular simulated sessions of Pharmaceutical Representative Encounter forunder graduate medical students. Such sessions can serveas an effective means of acquainting the future doctors with the scenario of dealing with Pharmaceuticals. This would also generate a critical thinking among medical students about the Pharmaceutical promotional campaigns.Students need to be taught the skill of critical appraisal of pharmaceutical promotional claims/advertisements which can further be polished by practice sessions on actual drug advertisements. Another elementary step could be making the medical students well-versed with the principles of Evidence Based Medicine. Wilkes et al have reported aphenomenal success of simulated Pharmaceutical Representative Encounter sessions for Third Year Medical students in the United States. It was observed that such sessions not only generated healthy discussions among the medical students regarding the ethical considerations of thePhysician-Pharmaceutical interaction but also motivated the students to think about the controversies and uncertainties surrounding the Pharmaceutical representative encounters.4With minor modifications,similar teaching modules could be experimentally incorporated into undergraduate medical curricula in Pakistan. Being fully familiar with the ethical considerations of such interactions and equipped with the skill of critical appraisal of pharmaceutical promotional claims, such doctors would likely be more objective andun-biased in their prescription practices.

References

1.Rohra DK, Gilani AH, Memon IK, Perven G, Khan MT, Zafar H, et al. Criticalevaluation of the claims made by pharmaceutical companies in drugpromotional material in Pakistan. J Pharm Pharm Sci. 2006; 9:50-9.

2.Jafar TH, Jessani S, Jafary FH, Ishaq M, Orakzai R, Orakzai S, et al. Generalpractitioners' approach to hypertension in urban Pakistan: disturbing trends inpractice. Circulation. 2005; 111:1278-83.

3.Burton B. Pfizer Australia is fined for misleading promotion of celecoxib.BMJ. 2005; 330:1230.

4.Wilkes MS, Hoffman JR. An innovative approach to educating medicalstudents about pharmaceutical promotion. Acad Med. 2001; 76:1271-7.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: