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      Promoção e propaganda de medicamentos em ambientes de ensino: elementos para o debate Translated title: Drug promotion and advertising in teaching environments: elements for debate Translated title: Promoción y propaganda de medicamentos en ambientes de enseñanza: elementos para el debate

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          Abstract

          A indústria farmacêutica utiliza a propaganda para a promoção de seus produtos. Os de uso controlado só podem ter a propaganda dirigida a profissionais habilitados a prescrevê-los ou dispensá-los. Este artigo faz uma ampla revisão de artigos científicos que discutem questões éticas e legais acerca da promoção e propaganda de medicamentos em ambientes de ensino médico. Conclui-se que não se justifica a auto-regulamentação da propaganda de medicamentos e que existem evidências suficientes de como o poder da indústria farmacêutica é capaz de influenciar as decisões no âmbito da relação médico-paciente, sendo a promoção e a propaganda um de seus instrumentos. Defende-se sua total proibição em ambientes de ensino, bem como a incorporação da temática na formação dos estudantes. Como a legislação vigente permite a propaganda de medicamentos vendidos sob prescrição apenas a médicos e farmacêuticos, destaca-se que tal propaganda é ilegal quando atinge estudantes de medicina e de farmácia.

          Translated abstract

          The pharmaceutical industry uses advertising to promote its products. Controlled drugs can only be advertised to professionals who are licensed to prescribe or dispense them. This paper makes an extensive review of scientific articles that discuss the ethical and legal implications of drug promotion and advertising in medical teaching environments. It concludes that self-regulation of drug advertising is not justified and that there is sufficient evidence showing how the power of the pharmaceutical industry is capable of influencing decisions made within the physician-patient relationship, in which promotion and advertising are among the tools used. This paper advocates complete prohibition of drug promotion and advertising in teaching environments, and the incorporation of this issue in students' education. Given that the current legislation permits advertising of prescription drugs only to physicians and pharmacists, it is emphasized that such advertising is illegal when it reaches medical and pharmacy students.

          Translated abstract

          La industria farmacêutica utilizada la propaganda para la promoción de sus productos. Los de uso controlado sólo pueden tener la propaganda dirigida a profesionales habilitados a prescribirlos o despacharlos. Este artículo hace una amplia revisión de artículos científicos que discuten cuestiones éticas y legales acerca de la promoción y propaganda de medicamentos en ambientes de enseñanza médica. Se concluyó que no se justifica la auto-reglamentación de la propaganda de medicamentos y que existen evidencias suficientes de como el poder de la industria farmacéutica es capaz de influir en las decisiones en el ámbito de la relación médico-paciente, siendo la promoción y la propaganda uno de sus instrumentos. Se defiende su total prohibición en ambientes de enseñanza, así como la incorporación de la temática en la formación de los estudiantes. Como la legislación vigente permite la propaganda de medicamentos vendidos bajo prescripción solamente a médicos y a farmacéuticos, se resalta que tal propaganda es ilegal cuando alcanza a los estudiantes de medicina y farmacia.

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          Most cited references63

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          Physicians and the pharmaceutical industry: is a gift ever just a gift?

          A Wazana (2000)
          Controversy exists over the fact that physicians have regular contact with the pharmaceutical industry and its sales representatives, who spend a large sum of money each year promoting to them by way of gifts, free meals, travel subsidies, sponsored teachings, and symposia. To identify the extent of and attitudes toward the relationship between physicians and the pharmaceutical industry and its representatives and its impact on the knowledge, attitudes, and behavior of physicians. A MEDLINE search was conducted for English-language articles published from 1994 to present, with review of reference lists from retrieved articles; in addition, an Internet database was searched and 5 key informants were interviewed. A total of 538 studies that provided data on any of the study questions were targeted for retrieval, 29 of which were included in the analysis. Data were extracted by 1 author. Articles using an analytic design were considered to be of higher methodological quality. Physician interactions with pharmaceutical representatives were generally endorsed, began in medical school, and continued at a rate of about 4 times per month. Meetings with pharmaceutical representatives were associated with requests by physicians for adding the drugs to the hospital formulary and changes in prescribing practice. Drug company-sponsored continuing medical education (CME) preferentially highlighted the sponsor's drug(s) compared with other CME programs. Attending sponsored CME events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor's medication. Attending presentations given by pharmaceutical representative speakers was also associated with nonrational prescribing. The present extent of physician-industry interactions appears to affect prescribing and professional behavior and should be further addressed at the level of policy and education.
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            Association of funding and conclusions in randomized drug trials: a reflection of treatment effect or adverse events?

            Previous studies indicate that industry-sponsored trials tend to draw proindustry conclusions. To explore whether the association between funding and conclusions in randomized drug trials reflects treatment effects or adverse events. Observational study of 370 randomized drug trials included in meta-analyses from Cochrane reviews selected from the Cochrane Library, May 2001. From a random sample of 167 Cochrane reviews, 25 contained eligible meta-analyses (assessed a binary outcome; pooled at least 5 full-paper trials of which at least 1 reported adequate and 1 reported inadequate allocation concealment). The primary binary outcome from each meta-analysis was considered the primary outcome for all trials included in each meta-analysis. The association between funding and conclusions was analyzed by logistic regression with adjustment for treatment effect, adverse events, and additional confounding factors (methodological quality, control intervention, sample size, publication year, and place of publication). Conclusions in trials, classified into whether the experimental drug was recommended as the treatment of choice or not. The experimental drug was recommended as treatment of choice in 16% of trials funded by nonprofit organizations, 30% of trials not reporting funding, 35% of trials funded by both nonprofit and for-profit organizations, and 51% of trials funded by for-profit organizations (P<.001; chi2 test). Logistic regression analyses indicated that funding, treatment effect, and double blinding were the only significant predictors of conclusions. Adjusted analyses showed that trials funded by for-profit organizations were significantly more likely to recommend the experimental drug as treatment of choice (odds ratio, 5.3; 95% confidence interval, 2.0-14.4) compared with trials funded by nonprofit organizations. This association did not appear to reflect treatment effect or adverse events. Conclusions in trials funded by for-profit organizations may be more positive due to biased interpretation of trial results. Readers should carefully evaluate whether conclusions in randomized trials are supported by data.
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              Accuracy of pharmaceutical advertisements in medical journals.

              Because of the effect of the ever-growing evidence-based medicine movement on prescribing behaviour of doctors, the pharmaceutical industry incorporates bibliographical references to clinical trials that endorse their products in their advertisements. We aimed to assess whether the references about efficacy, safety, convenience, or cost of antihypertensive and lipid-lowering drugs included in advertisements supported the promotional claims. We assessed all advertisements for antihypertensive and lipid-lowering drugs published in six Spanish medical journals in 1997 that had at least one bibliographical reference. Two pairs of investigators independently reviewed the advertisements to see whether the studies quoted to endorse the advertising messages supported the corresponding claims. We identified 264 different advertisements for antihypertensive drugs and 23 different advertisements for lipid-lowering drugs. We recorded at least one reference in 31 advertisements in the antihypertensive group and at least one reference in every seven advertisements in the lipid-lowering group, providing a total of 125 promotional claims with references. We could not retrieve 23 (18%) references from monographic works and non-published data on file. 79 (63%) of the 125 references were from journals with a high impact factor; 84 (82%) of the 102 references retrieved were from randomised clinical trials. In 45 claims (44.1%; 95% CI 34.3-54.3) the promotional statement was not supported by the reference, most frequently because the slogan recommended the drug in a patient group other than that assessed in the study. Doctors should be cautious in assessment of advertisements that claim a drug has greater efficacy, safety, or convenience, even though these claims are accompanied by bibliographical references to randomised clinical trials published in reputable medical journals and seem to be evidence-based.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                icse
                Interface - Comunicação, Saúde, Educação
                Interface (Botucatu)
                UNESP (Botucatu )
                1807-5762
                December 2008
                : 12
                : 27
                : 893-905
                Affiliations
                [1 ] Universidade Federal do Rio de Janeiro Brazil
                [2 ] Fundação Oswaldo Cruz
                [3 ] Fiocruz
                Article
                S1414-32832008000400018
                10.1590/S1414-32832008000400018
                c2c2ccbc-0e58-4ed8-af79-b49c0729ce0d

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=1414-3283&lng=en
                Categories
                Education & Educational Research
                Public, Environmental & Occupational Health

                Educational research & Statistics,Public health
                Ethics,Conflict of interests,Medical students,Medical education,Ética,Propaganda,Mercadeo,Conflicto de intereses,Estudiantes de Medicina,Educación médica,Marketing,Advertising,Conflito de interesses,Estudantes de medicina,Educação médica

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