WHOHAI Project

1

• WHO-HAI Project
• Curriculum development on drug promotion

Barbara Mintzes Health Action International (HAI
Global, Amsterdam) Therapeutics Initiative, UBC
ISDB Meeting Matagalpa, Dec 1-4
2008 bmintzes_at_chspr.ubc.ca
2
Pakistan 2005 1-2 day relief claim

• Excellent safety, side effect profile similar to
  placebo?
• USA 2004 warning of serious risks
• USA 2007 safety withdrawal

USA 2003 3 day relief claim
3
Peru 2006
Canada 2005

• Same drug, same company, same unethical
  promotional campaign
• Unapproved use
• Illegal direct-to-consumer advertising
• Costly and not very effective

4
Canada
France

5
Survey of identified educators 2005137
medical, 91 pharmacy 228 (46 response rate)
92
31
56
8
20
20
Americas Europe Western Pacific
Eastern Mediterranean Africa South-East Asia
6
Education on drug promotion

• Part of required curriculum 72
• More than one type of course listed 53
• Time allocated to education on promotion

7

• Self-reported degree of success
• Very or somewhat successful 60
• Somewhat unsuccessful 15
• Not at all successful 2
• Those who allocated less time (one half day or
  less) were less likely to judge the education to
  be very or somewhat successful.

8
Survey conclusions

• Volume encouraging compared to published
  literature
• Many innovative educational initiatives
• However, often only one 1-2 hour lecture in a
  class on therapeutics or pharmacology
• Opposition from other faculty, lack of perceived
  importance in institution often mentioned
• Few had been systematically evaluated.
• Whatever rational things we want to inculcate
  in them, that should be done in the student
  period itself. Once they taste big money then
  habits develop and later die hard.

9
Understanding and responding to drug promotion a
practical guide

• Project team
• Richard Laing (WHO), Tim Reed (HAI)
• Editors Barbara Mintzes, Dee Mangin
• Andy Gray (South Africa), Joel Lexchin (Canada),
  Peter Mansfield (Australia), Lilia Ziganshina
  (Russia), Nancy Olivieri (Canada), Suriya
  Suryawati (Indonesia), José Terán (Ecuador) Les
  Toop, Dee Mangin (NZ), Bob Goodman, Jerome
  Hoffman (USA), Arthur Schaffer (Canada)

10
Table of contents

• Promotion of medicines and patient health 
• Techniques that influence the use of medicines 
• Analyzing drug advertisements in medical
  journals 
• Pharmaceutical sales representatives
• Promotion to consumers Responding to patient
  requests for advertised medicines
• Learning How Not To Do the Drug Industry Tango
  an essay on student awareness of ethical
  conflicts of interest ( Nancy Olivieri story)

11
Table of contents - continued

• Regulation of drug promotion Why does regulation
  matter? ( debate self-regulation)
• Using Unbiased Prescribing Information
• Conclusion

12
Next steps pilot test

• Launch of first version May, World Health
  Assembly
• Translation Russian and Spanish
• Pilot testing (protocol Dee Mangin, Les Toop)
• controlled pre- and post (6 months) test of full
  curriculum, 8 sites
• Case-based approach
• Some questions surrogate endpoints, aims,
  variability across sites

13
Is there really such a thing as a free lunch?