The Counterproductive Effect of Pharmaceutical Marketing in Pakistan: A Qualitative Study

This study explores the effects of pharmaceutical marketing on patients and society in Pakistan. Pharmaceutical marketing is an integral part of the drug industry, which channels product-related information to healthcare professionals. Physicians are the target audience as they prescribe medicine to the users. The pharmaceutical industry mobilizes all resources to influence physicians’ prescriptions in favor of their brands. It is commendable from the organizational perspective, however; it leads to unintended negative consequences for society. The primary reason is the blind pursuit of commercial interest and near-total neglect of ethical behavior in marketing drugs. This study conducted open-ended 20 interviews from primary stakeholders of this issue that includes physicians, pharmaceutical managers, and officials of drug regulatory authority through purposive sampling. The findings show that misleading promotional strategies influencing physicians are responsible for the misuse and abuse of drugs and antibiotics. Pharmaceutical drug incentivization, the personal obligation for physicians, skewed data, and inappropriate promotions were the major categories developed during analysis. The study recommends various steps to minimize these ill effects.

Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands

ObjectivesThis study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours.DesignCross-sectional survey using exploratory factor analysis was conducted to determine litigation attitude and perceived patient pressure factors. Regression analyses were used to regress these factors on to the ordering of extra tests or procedures (defensive assurance behaviour) or the avoidance of high-risk patients or procedures (defensive avoidance behaviour).SettingData were collected from eight Dutch hospitals.ParticipantsRespondents were 160 physicians and 54 residents (response rate 25%) of the hospital departments of (1) anaesthesiology, (2) colon, stomach and liver diseases, (3) gynaecology, (4) internal medicine, (5) neurology and (6) surgery.Primary outcome measuresRespondents’ application of defensive assurance and avoidance behaviours.Results‘Disapproval of justified litigation’ and ‘Concerns about unjustified litigation’ were positively related to both assurance (β=0.21, p<0.01, and β=0.28, p<0.001, respectively) and avoidance (β=0.16, p<0.05, and β=0.18, p<0.05, respectively) behaviours. ‘Self-blame for justified litigation’ was not significantly related to both defensive behaviours. Perceived patient pressures to refer (β=0.18, p<0.05) and to prescribe medicine (β=0.23, p<0.01) had direct positive relationships with assurance behaviour, whereas perceived patient pressure to prescribe medicine was also positively related to avoidance behaviour (β=0.14, p<0.05). No difference was found between physicians and residents in their defensive medical behaviour.ConclusionsPhysicians adopted more defensive medical behaviours if they had stronger thoughts and emotions towards (un)justified litigation. Further, physicians should be aware that perceived patient pressure for care can lead to them adopting defensive behaviours that negatively affects the quality and safety of patient care.