Análise bioética da propaganda e publicidade de medicamentos

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Abstract

Sob a perspectiva da "ética da proteção" e da "bioética de intervenção", a pesquisa analisa a influência das peças publicitárias de medicamentos veiculadas à classe médica na prescrição de medicamentos. Estuda, ainda, a qualidade das informações nas propagandas de medicamentos de venda sob prescrição, antes e depois da Resolução da Diretoria Colegiada da Anvisa - RDC 102/2000, que regulamenta a propaganda de medicamentos no país, bem como discute o papel regulador do Estado na área. Primeiramente, foram entrevistados 50 médicos de Brasília, a fim de examinar como percebem os efeitos da propaganda sobre sua atividade profissional. Em seguida, foram avaliadas 10 peças publicitárias, 5 veiculadas antes e 5 depois da RDC 102/2000. Os resultados permitiram concluir que: a) 98% dos médicos recebem visitas regulares de representantes comerciais; b) 86% recebem brindes; c) 68% crêem na influência direta da propaganda sobre a prescrição; d) 14% disseram prescrever medicamentos em função do recebimento de prêmios; e) 68% acreditam existir inverdades nas informações das peças publicitárias; f) antes da RDC, as informações (contra-indicações, indicações, precauções, cuidados e advertência) nas propagandas representava 28% dos casos; após a RDC, foram encontradas informações em 79% dos casos.

Translated abstract

This study investigates how advertising campaigns for drugs influence drug prescription practices among physicians from a point of view of "protection ethics" and of "intervention bioethics". It also analyzes information quality in advertisements for prescription drugs before and after the ANVISA (National Agency for Sanitary Protection) RDC 102/200 Resolution wich regulates drugs advertising as well as discusses the regulating role of the state in this area. A first approach was to interview 50 physicians in Brasília/DF (25 general physicians and 25 surgeons) in order to examine how they perceive the effects of advertisement on their professional activities. A second approach was to study 10 publicity pieces, five from before and five from after the RDC Resolution. The results showed that: a) 98% of phsicians are visited by sales representatives on a regular basis; b) 86% of physicians receive gifts during these visits; c) 68% beleive that advertising strongly influences prescription practices; d) 14% related prescription practices to the receival of rewards; e) 68% beleive that information contained in advertisements is unreliable; f) before the RDC Resolution, 28% of advertisements had adequate information content (counter-indications, indications precautions, warnings, and adverse reactions); after the RDC Resolution, that number grew to 79%.

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Interactions between physicians and the pharmaceutical industry: what does the literature say?

J Lexchin (1993)

To determine the effect of three types of interaction between physicians and the pharmaceutical industry--company-funded clinical trials, company-sponsored continuing medical education (CME) and information for physicians supplied by pharmaceutical detailers--on orientation and quality of clinical trials, content of CME courses and physicians' prescribing behaviour. MEDLINE and HEALTH searches for English-language articles published from 1978 to 1993, supplemented by material from the author's personal collection. A total of 227 papers from the MEDLINE and HEALTH searches and about 2000 items from the author's library were initially reviewed. The following selection criteria were used: studies conducted in Australia, Canada, New Zealand, Britain and the United States; studies conducted after 1977; quantitative surveys containing details of the survey methods; studies on the orientation and quality of company-funded clinical trials and on the content of CME courses giving explicit criteria used in the evaluation; and reports on the outcome of interactions stating how the outcomes were assessed. Thirty-six studies met these criteria. Information was extracted on five topics: physicians' attitudes toward drug industry interactions, frequency with which physicians participate in the interactions, orientation and quality of company-funded clinical trials, content of company-sponsored CME courses and changes in physicians' prescribing behaviour as a result of an interaction. Although most physicians participate only occasionally in company-sponsored clinical trials, most see detailers and attend company-sponsored CME courses. However, physicians do not have a very high opinion of the information from detailers or of company-sponsored CME events. Many doctors regard pharmaceutical companies as an important source of funding for clinical trials, but they also have concerns about accepting money from this source. Company funding of clinical trials may affect the quality of the trials and the types of research that physicians undertake. Company-sponsored CME courses may have a commercial bias even if conducted under guidelines designed to ensure the independence of the event. All three types of interactions affect physicians' prescribing behaviour and, in the case of obtaining information from detailers, physicians' prescribing practices are less appropriate as a result of the interaction. Physicians are affected by their interactions with the pharmaceutical industry. Further research needs to be done in most cases to determine whether such interactions lead to more or less appropriate prescribing practices. The CMA's guidelines on this topic should be evaluated to see whether they are effective in controlling physician-industry interactions. Further measures may be necessary if the guidelines fail to prevent negative effects on prescribing practices.