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OJHAS Vol. 10, Issue 1:
(Jan-Mar 2011) |
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| Teaching of Critical
Analysis of Drug Advertisements to Medical Students |
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Veena Nayak, Bharti
Chogtu, Shalini Adiga, Bairy KL
Dept. of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India |
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Address for Correspondence |
Department of Pharmacology,
Kasturba Medical College,
Manipal University,
Manipal, Karnataka, India.
E-mail:
bhartimagazine@gmail.com |
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Nayak V, Chogtu B, Adiga S, Bairy KL. Teaching of Critical
Analysis of Drug Advertisements to Medical Students. Online J Health Allied Scs.
2011;10(1):13 |
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Submitted: Feb 26,
2011; Accepted: Mar 31, 2011; Published: April 15, 2011 |
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| Abstract: |
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Background:
Medical practitioners utilize drug promotional materials from pharmaceutical
companies as a major source of information especially in developing
countries. These promotional materials can be highly informative as
long as they are critically appraised but when they are accepted without
question, they lead to irrational prescribing. Aim: To sensitize the
students regarding WHO criteria for medicinal drug promotion and to determine the impact of teaching critical
appraisal of medicinal drug promotion to medical students. Design:
The medical students of second year were given a pre test questionnaire
to identify the violations in generic labeling, pharmacological information,
claims, relevance and references cited in the drug advertisements. Later
they were sensitized about the WHO criteria for medicinal drug promotion
and how to critically appraise a drug advertisement. This was followed
by a post test questionnaire with the same drug advertisement. Result: The
number of students answering the post test correctly was significantly
(p<0.05) more than that of pre test. Conclusion:
Education of medical students regarding critical analysis of drug advertisements
should be a part of the medical curriculum.
Key Words:
Critical appraisal; Drug advertisements; WHO criteria
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Medical practitioners utilize drug promotional
materials from pharmaceutical companies as a major source of information
especially in developing countries.1 It has been documented
that the promotional activities of pharmaceutical industry has an influence
on the prescribing behavior of health care providers1-3
although prescribers deny this.4,5 It has been found that
advertising influences doctors behavior more than what they think,6,7 and the problem lies in that most of the drug advertisements
contain misleading information.8 These promotional materials
can be highly informative as long as they are critically appraised but
when they are accepted without question, they lead to irrational prescribing.
Medical practitioners, however, have no training on the proper way to
utilize these promotional materials. Even in the presence of several
guidelines to evaluate the quality of promotional materials the practice
of irrational prescribing is still rampant. Like doctors, medical students
are also exposed either during their medical course or during internship
to drug promotion. Hence if prescribers rely on the information from
drug advertisements it can result in irrational prescribing. A previous
study reported that physicians failed to recognize inaccurate statements
in drug advertisements.9 This could be due to the fact that
they have not been sensitized to evaluate promotional materials. So,
to prevent irrational prescribing there is a need to educate practitioners
regarding critical analysis of drug advertisements. This can be achieved
by imparting knowledge regarding drug advertisements during the MBBS course and
more so during second year when they are taught pharmacology. Hence
the aim of our study was to sensitize the students regarding WHO
criteria for medicinal drug promotion10
and to determine the impact of teaching critical appraisal of medicinal
drug promotion to medical students.
The study population
included 172 second year (5th semester) medical students
of Kasturba Medical College, Manipal in two sessions of 86 students
each. They were given a pre test questionnaire to identify the violations
in generic labeling, pharmacological information, claims, relevance
and references cited in the drug advertisements. Later a one hour lecture
about WHO criteria for medicinal drug promotion and critical appraisal
of drug advertisements was given to the students. This was followed
by an interactive session where around 5 drug advertisements were projected
one by one and the students had to identify if any violations were present.
This was followed by a post test questionnaire with the same drug advertisement.
The pre and post test questionnaire was obtained from a previous study.11
There was no compulsion for students to take part in the study. Students
consent was taken before their participation in the study. Ethical clearance
was obtained from the institutional ethics committee.
Statistics:
The results were analyzed using Mc Nemar test to compare categorical
variables using SPSS 11.5 version software. The answers were evaluated
using the checklist of WHO ethical criteria for medicinal drug promotion.
A total of
172 students participated in the present study. In the pretest, 45.9%
students correctly answered about generic labeling whereas 88.4% students
answered correctly in the post test; the difference being significant
(p<0.001). Regarding pharmaceutical and clinical information the
right answers in pre test were given by 70.3% and 78% students whereas
68.6% and 84.3% students answered right in the post test. 29.7% students
were able to identify the correctness of claims in pretest whereas
52.9% students answered correctly in post test with a significant difference
compared to the pretest( p<0.001). The relevance of drug advertisement
was correctly identified by 79.1% students in pretest and 83% students
in post test (p<0.05). 65.1% students correctly commented about references
in pretest and after post test 80.2% students were able to comment correctly
(p<0.01). The percentage of students answering correctly in the pre
and post test has been shown in Fig 1.
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Fig 1: Number of students
answering correctly in the pre and post test
*p<0.05, **p<0.01
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WHO’s ethical criteria for medicinal drug promotion includes the various
details that a drug advertisement should contain. Accordingly a drug
advertisement should contain the name of the active ingredient(s) using
either international non proprietary name(INN) or the approved generic
name of the drug. The generic name should be legible and should not
be too small in comparison to the brand name. In the present study there
was significant increase in the number of students who were able to
identify the generic labeling correctly after the post test. The pharmacological
information includes pharmaceutical and clinical information. The indications,
dosage regimens, contraindications, adverse effects and precautions
should be included in the drug advertisement. There is a tendency for
drug companies not to highlight or lay emphasis on contraindications
and adverse effects.12 Such parameters need critical analysis.
Pharmaceutical information like presence of excipients, shelf life,
legal category is sometimes missed out in drug advertisements12
and keeps the doctors unaware of such important information. In our
study, there was no significant change in pre and post test results
regarding pharmacological information. It suggests that there was not
much change in their perspective towards pharmacological information
after a single intervention. Probably they require more effective exposure
to this concept to change their perception.
Most of the
drug advertisements highlight efficacy claims without stressing on safety
claims.12 The efficacy claims are exaggerated and the safety
ones are underplayed. So a medical practioners should be cautious in
judging the claims made by the company. In our study there was a significant
increase in the number of students who were able to judge the safety
and efficacy claims correctly.
Most of the
drug companies try to make drug advertisements which contain colorful
and attractive pictures without taking into consideration the relevance
regarding the product. They sometimes misguide the busy practitioners
who just glance the drug advertisements. In our study after a single
intervention, a significant number of students were able to judge the
relevance of the pictures in the drug advertisements.
References
are an integral part of drug advertisements because most of the claims
should be substantiated by the references. Most of the advertisements
do not contain references for the claims made.12 In our study
the students were able to identify the importance of references significantly.
Our single intervention was effective in teaching medical students critical
analysis of drug advertisements. If such interventions are made regularly,
students will have a sound knowledge of critiquing a drug advertisement
and this will lay the foundation for rationale prescribing.
A survey done
about educational initiatives taken to teaching drug promotion to medical
students showed that most of the medical schools allotted vey little
or no time to teaching drug promotion.13 Pharmaceuticology
is a study which involves the interaction between doctors with the industry
that manufactures and promotes drugs.14 Incorporation of
this branch into the medical curriculum will enable the doctors in rational
prescribing.
Education of medical students
regarding critical analysis of drug advertisements
has a crucial role to play in preparing future practitioners to respond
to drug promotional activities ethically.
- Bacel B, Bardelay
D,’t Hoew E. Promotion targeting prescribers. Prescrire Int 1995;4:2080-88.
- Wazana A. Phycisians
and the pharmaceutical industry. Is a gift ever just a gift? JAMA 2010;283:373-80.
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MA. Policies to regulate gift to physicians from industry. JAMA
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to physicians in consumers marketing era . JAMA 2000;284:2243.
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influence denied. Aust doctor 2002;15:11.
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skepticism new ad watch: understanding drug promotion. Med J Aus
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- Lexchin J. New directions
in drug approvals. CMAJ 2004 Aug 3;171(3):229-230. Available at
http://www.cmaj.ca/content/171/3/229.long
- Wilkies MS, Doblin
BH, Shapiro MF. Pharmaceutical advertisements in leading medical journals
expert assessment. Ann Intern Med 1992;116:912-919.
- Ziegler MG, Lew
P, Singer PC. The accuracy of drug information from pharmaceutical sales.
JAMA 1995;273:1296-1298.
- World Health Organization.
Ethical criteria for medicinal drug promotion. Geneva: WHO 1988.
- Alvero GY,
Panganiban DL. Teaching critical appraisal of medicinal drug promotions
in a medical school. International conference of improving utilization
of drugs, WHO , July 2008.
- Tandon V, Gupta
B M, Khajuria V. Pharmaceutical drug advertisements in national and
international journals. Indian J Pharmacol 2004;36:313-315.
- Mintez B. Educational
initiatives for medical and pharmacy students about drug promotion.
An international cross sectional survey. Geneva: world Healhty Organization.
(WHO/PSM/PAR/ 2005.2):2005.
- Fleg A. Introduction
to pharmaceuticology. Student BMJ 2007;15:45-88.
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